Search Results (351)

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

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

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

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

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

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

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

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

Background: Rome IV criteria promote a symptom-based (“positive”) diagnosis of pediatric disorders of gut–brain interaction (DGBIs). In clinical practice, however, organic gastrointestinal diseases may mimic DGBIs and lead to diagnostic revision after further evaluation. We aimed to quantify the diagnostic stability of an initial Rome IV-oriented functional diagnosis in a tertiary pediatric outpatient setting and to identify symptom phenotypes associated with a higher likelihood of later organic reclassification. Methods: We performed a single-center retrospective cohort study (2014–14 May 2021) based on outpatient chart review. Eligible patients were children and adolescents aged 0–18 years with an initial Rome IV-oriented functional diagnosis. Diagnostic reassessment was based on follow-up data, available laboratory and instrumental investigations, and/or response to exclusion therapies. Final diagnoses after reassessment were categorized as functional only, organic, or mixed. Groups were compared using Pearson’s chi-square test. Results: The cohort included 220 males (50.0%) and 220 females (50.0%), with a mean age of 8.86 ± 4.65 years. After reassessment, 343/440 (77.95%) remained functional, 73/440 (16.59%) were reclassified as organic, and 24/440 (5.45%) were classified as mixed. Final diagnosis differed by GI tract involvement (p = 0.001) and by symptom cluster (p = 0.001). Upper GI/dyspepsia-spectrum presentations showed the highest organic yield (27.03%), followed by lower abdominal pain/IBS-spectrum presentations (19.61%). Diarrhea and vomiting/cyclic vomiting each showed 16.67% organic diagnoses (mixed: 10.0% and 7.14%, respectively), whereas constipation showed the greatest diagnostic stability (98.89% functional; 1.11% organic). Functional confirmation rates were similar before and during the pandemic (77.71% vs. 78.70%; p = 0.756). Monthly case volume was higher in 2020–2021 (6.29 vs. 4.61 cases/month). Conclusions: In this tertiary cohort, about one in six children initially diagnosed with a functional disorder were later found to have an organic disease, and an additional 5% had mixed organic–functional presentations. Diagnostic revision was associated with presenting phenotype, with the highest organic yield observed in dyspepsia/upper GI presentations and the lowest in constipation. These findings support symptom-stratified evaluation and follow-up alongside Rome IV criteria. Full article

Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disorder that, without treatment, can advance to fibrosis and cirrhosis. Although standard regimens with corticosteroids and thiopurines have significantly improved survival, many patients still experience relapses and drug-related toxicity, highlighting the urgent need for alternative strategies. Recent studies underscore AIH’s multifactorial nature, revealing intricate interactions among genetic susceptibility, environmental triggers, and dysregulated immune responses. Next-generation diagnostics, ranging from novel biomarkers to high-resolution imaging, are enhancing early detection and more precise disease classification. At the same time, multi-omics analyses and artificial-intelligence-based models are refining predictions of disease trajectory and therapeutic response. On the treatment horizon, investigational options such as targeted immunomodulators, B-cell–depleting therapies, and cell-based interventions aim to achieve durable remission while minimizing adverse effects. This review critically appraises these advances and explores how integrating epidemiological insights with cutting-edge research in pathogenesis, diagnostics, and therapy could pave the way for more personalized and effective management of AIH. Full article

Background: Molecular syndromic stool panels are increasingly used in paediatric diarrheal syndromes; however, interpretation of Clostridioides difficile (C. difficile) detection remains challenging because colonisation is common in younger children. We aimed to assess the frequency of C. difficile detection using a syndromic gastrointestinal panel in a paediatric tertiary-care centre and to describe the subsequent microbiological work-up and CDI-directed treatment. Methods: We conducted a retrospective single-centre study of all BioFire FilmArray Gastrointestinal (GI) panels performed at San Marco Hospital (University Hospital “G. Rodolico-San Marco”, Catania, Italy) from 1 January 2023 to 31 December 2025. Only the first C. difficile-positive result per patient was included; repeat positives within 30 days were excluded. Index-positive episodes were stratified by age (<1 year, 1 to <2 years, and ≥2 years). Data collected included co-detected pathogens, toxin A/B enzyme immunoassay (EIA) results, GeneXpert PCR findings, and CDI-directed therapy. Results: Among the 714 GI panels performed during the study period, 112 (15.7%) were positive for C. difficile. After exclusion of repeat positives, 91 index-positive episodes were analysed. Median age was 1.0 years (IQR 0.75–4.0), and 48/91 cases (52.7%) occurred in children younger than two years. Toxin A/B EIA was positive in 11/82 tested episodes (13.4%), whereas GeneXpert tcdB was positive in 75/84 episodes (89.3%). Co-detection of at least one additional enteric pathogen occurred in 40/91 cases (44.0%). CDI-directed therapy was administered in 9/91 episodes (9.9%), mainly in children aged ≥2 years. Conclusions: Detection of C. difficile by syndromic molecular panels was relatively frequent in our paediatric cohort but rarely associated with toxin positivity or the need for specific treatment. These findings suggest that many positive Nucleic Acid Amplification Test (NAAT) results may represent colonisation rather than true infection, particularly in younger children. Careful clinical interpretation of syndromic panel results is therefore essential to avoid overdiagnosis and unnecessary antimicrobial therapy. Full article

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT). This study aims to report the experience in the surgical treatment of GIST patients, evaluate the prognostic factors and discuss some controversial issues regarding the significance of microscopically margin-negative resection in GIST patients and the importance of tumor rupture during intraoperative surgical manipulation. Methods: Fifty-four GIST patients with primary disease without metastasis were admitted and treated during the past 15 years. Patients initially presenting with metastatic lesions and those who underwent adjuvant systemic therapy prior to surgical treatment were excluded from the study. Results: The median patient follow-up was 84 weeks. The 5-year overall survival was 34.34% and disease-free survival (DFS) was 35.37%. The median DFS was 244 weeks. In multivariate analysis, survival was affected by a high mitotic rate, resection margin status and the tumor rupture occurrence. Tumor size and tumor location did not show an impact. Conclusions: Surgical resection remains the mainstay of GIST treatment. Mitotic rate, resection margin status, and the occurrence of tumor rupture were predicators for DFS in patients presenting with primary disease. Recurrence of disease after resection was predominantly intra-abdominal and involved the original tumor size and the liver. Full article

Background: The optimal bowel preparation regimen for a small bowel capsule endoscopy (SBCE) remains uncertain. The PrepRICE clinical trial showed that the administration of purgatives after the capsule reached the duodenum improved the mucosal visualization and diagnostic yield. However, it was limited to patients with suspected mid-gastrointestinal bleeding who met strict inclusion criteria. This work aims to report real-life results after the implementation of the new protocol and to compare them with those of the PrepRICE trial. Methods: A prospective analysis was performed on all consecutive patients who underwent an SBCE between December of 2024 and December of 2025. The quality of the small bowel visualization (QSBV), gastric transit time (GTT), small bowel transit time (SBTT), adequate visualization rate, and complete examination rate were assessed. The QSBV was evaluated according to the Brotz quantitative scale. Results: A total of 188 patients were included (52.1% male; median age 56 years [IQR 30]). The median Brotz scale scores were 9 (IQR 1), 9 (IQR 1), 8 (IQR 2), and 8 (IQR 1) in the first, second, and third terciles and overall, respectively (compared to 9, 9, 9, 9 in PrepRICE, p < 0.001). No significant differences were found in the complete examination rate (96.8% vs. 99%, p = 0.43), adequate visualization rate (91.3% vs. 92.0%, p = 0.68), GTT and SBTT. Conclusions: The real-life results were good and similar to those of the original study, with a high rate of complete examination and adequate visualization, with slightly weaker QSBV compared to that reported in the periprocedural group in the PrepRICE study yet still superior to the preprocedural groups. Full article

Background: Kartagener syndrome (KS) is a rare subset of primary ciliary dyskinesia characterized by the triad of situs viscerum inversus (SVI), chronic sinusitis, and bronchiectasis. Laparoscopic cholecystectomy (LC) in patients with SVI is technically demanding because of mirror-image anatomy, while evidence supporting the use of indocyanine green (ICG) fluorescence in this setting is scarce. Case Presentation: We report the case of a 25-year-old woman with KS and SVI totalis who underwent elective LC for symptomatic cholelithiasis. The procedure was performed using a mirror American approach with four trocars and near-infrared ICG fluorescence cholangiography. ICG enabled real-time visualization of biliary anatomy and facilitated intraoperative orientation. The procedure was completed laparoscopically without intraoperative or postoperative complications, and the postoperative course was uneventful. Methods: A non-systematic narrative review of the literature was conducted to identify reported cases of LC in patients with SVI, including cases associated with KS. Studies published between 1991 and 2025 were retrieved from PubMed, Web of Science, Scopus, and Embase. Data were descriptively summarized, focusing on surgical technique, trocar placement, and reported use of ICG fluorescence. Results: A total of 143 articles were included. Most cases involved isolated SVI, while KS was reported only in a minority of patients. The mirror American technique and four-trocar configuration were the most frequently adopted approaches. Only three cases, including the present report, described the use of ICG fluorescence during LC in patients with SVI or KS. Conclusions: LC in patients with SVI is feasible but technically demanding. ICG fluorescence may assist intraoperative biliary orientation in complex anatomical settings; however, current evidence is extremely limited and should be considered hypothesis-generating only. Full article

Background/Objectives: Acute severe ulcerative colitis (ASUC) affects up to one quarter of patients with ulcerative colitis and carries a substantial risk of colectomy. Early recognition of the need for escalation beyond intravenous (IV) corticosteroids is essential, yet most indices—such as the Oxford criteria—require reassessment on day 3, delaying rescue therapy. The ASUC score, based on admission albumin, C-reactive protein (CRP), endoscopic severity (Ulcerative Colitis Endoscopic Index of Severity, UCEIS), and pre-admission steroid use, was recently proposed to predict early escalation at admission. This study aimed to externally validate the ASUC score and compare its performance with established indices. Methods: We performed a single-center retrospective validation study including consecutive ASUC admissions (2015–2024). The primary outcome was escalation beyond IV steroids, defined as medical rescue therapy with infliximab or ciclosporin and/or colectomy during the index hospitalization. As a sensitivity analysis providing a more specific estimate of IV corticosteroid non-response, we repeated analyses restricting the outcome to medical rescue therapy alone. The model performance was assessed for discrimination (AUC and bootstrap-corrected 2000 resamples), calibration (intercept, slope, and Brier score), and clinical utility (decision-curve analysis). Comparator indices included Albumin-CRP-Endoscopy score (ACE), Admission Model for Acute Severe Colitis (ADMIT-ASC), Oxford Day 3, Lindgren, and Edinburgh. Predefined subgroup analyses (exploratory and underpowered) evaluated infection and biologic exposure. Results: Ninety-one admissions were included overall. The primary validation was performed in the infection-free cohort (n = 77), and infected cases (n = 14) were analyzed separately. In the infection-free cohort, 17/77 (22.1%) required escalation beyond IV steroids during the index hospitalization (medical rescue therapy and/or colectomy), and 5/91 (5.5%) underwent colectomy within 90 days. The ASUC score showed excellent discrimination (Area under the receiver-operating characteristic curve [AUC] 0.89, 95% Confidence Interval [CI] 0.81–0.95), good calibration (intercept 0.26, slope 1.29), and net clinical benefit across 30–50% thresholds. In the rescue-only sensitivity analysis, discrimination remained high (AUC 0.86, 95% CI 0.77–0.94). At a cut-off of ≥2, sensitivity 94% and specificity 78% outperformed other indices (AUC 0.62–0.83). Exploratory subgroup analyses were imprecise due to small sample sizes; discrimination was lower in the infected-only subgroup (AUC 0.71), and estimates in biologic-experienced patients were unstable because of severe imbalance. Conclusions: The ASUC score accurately identified patients likely to require escalation beyond IV steroids on the day of admission, outperforming or matching established day-3 indices. Its simplicity and reliability support its integration into early ASUC management to expedite rescue therapy and potentially improve outcomes. Full article