[JOURNAL] HEPATOLOGY
Sun
200 papers
Neural regulation of cancer: from synaptic integration to neuro-immune regulation.
Li X, Li Y, Shi X … +2 more , Wang Y, Ji S
Cell Oncol (Dordr) · 2026 Jul · PMID 42397500 · Publisher ↗
The emerging field of cancer neuroscience has reshaped our understanding of tumor biology, showing that the nervous system is an active participant in the tumor microenvironment. It modulates tumor progression through sy...
The emerging field of cancer neuroscience has reshaped our understanding of tumor biology, showing that the nervous system is an active participant in the tumor microenvironment. It modulates tumor progression through synaptic communication with cancer cells, paracrine signaling via neurotransmitters and neuropeptides, and indirect regulation of the tumor immune microenvironment. Recent discoveries have shown that neurons form synapses with brain tumors and peripheral cancers, driving tumor cell proliferation and invasion. Neurotransmitter and neuropeptide signaling activates pathways in cancer cells to promote malignancy. Furthermore, the nervous system shapes anti-tumor immunity by modulating T cells, natural killer cells, macrophages, and myeloid-derived suppressor cells, creating either an immunostimulatory or, more commonly, an immunosuppressive microenvironment that facilitates immune evasion and treatment resistance. The clinical significance of the neuro-immune-tumor axis is confirmed across multiple cancer types. Consequently, therapeutic strategies targeting neural regulation are emerging, including neurotransmitter receptor blockers, denervation techniques, neuromodulation devices, and approaches to remodel the immune landscape through neural signals. This review synthesizes how nerves regulate tumor progression via synaptic connections, neurotransmitter release, and immune modulation. We also summarize current and emerging therapeutic strategies aimed at disrupting or harnessing neuro-tumor communication. By integrating recent advances, this review aims to establish a framework for understanding neural regulation of cancer and to guide future research and clinical translation in this evolving field.
PTEN negative adenocarcinoma developed in a gastric hamartoma polyp of a Cowden syndrome patient.
Suzuki J, Kato B, Matsushita HO … +7 more , Yoshikawa K, Yorozu H, Edagawa T, Koshiishi H, Tokairin T, Yoshida M, Enomoto K
Clin J Gastroenterol · 2026 Jul · PMID 42397496 · Publisher ↗
Cowden syndrome (CS) is an autosomal dominant genetic cancer predisposition disease caused by mutation of the germline phosphatase and tensin homolog (PTEN) gene. A 60s-year-old man who has been diagnosed as CS at our ho...
Cowden syndrome (CS) is an autosomal dominant genetic cancer predisposition disease caused by mutation of the germline phosphatase and tensin homolog (PTEN) gene. A 60s-year-old man who has been diagnosed as CS at our hospital 10 years ago due to his medical history of Lhermitte-Duclos disease (LDD), thyroid medullary carcinoma and gastrointestinal polyposis. He was regularly followed up by the endoscopic examination of gastrointestinal polyps at our hospital. A recent routine examination revealed a surface irregular and hemorrhagic gastric polyp at the lower body of stomach. As a biopsy report showed a high possibility of carcinoma, an endoscopic mucosal resection (EMR) was performed. Histopathological examination of the EMR specimen revealed well-differentiated tubular adenocarcinoma developed in a hamartoma polyp. Immunohistochemical staining using anti-PTEN antibody showed that PTEN expression was completely deficient in the nuclei of carcinoma cells as well as majority of hamartoma cells, whereas a part of hamartoma cells showed PTEN nuclear expression. Furthermore, we applied the specimen to gene panel analysis and confirmed pGly127Arg (c379G > A) mutation present in PTEN gene. Helicobacter pylori (H. pylori) infection in the biopsied gastric specimen and immunohistochemically high expression of p16 and p53 in cancer cells were detected. In addition to PTEN mutation, these changes may contribute to the gastric carcinogenesis of this patient. Although only few cases of gastric carcinoma in CS patients were reported, our case highlights the importance of regular and careful endoscopic observation of hamartoma polyps to detect early-gastric carcinoma in those with CS.
A special multifiber dietary mixture ameliorates Crohn's-like colitis in an IL-10/ mouse model by promoting treg differentiation through the ETS1/RUNX1/Foxp3 axis.
Liu Y, Jiang W, Wang J … +7 more , Cheng S, Cheng C, Zhang C, Zhang J, Liu C, Zhao J, Wang H
Eur J Nutr · 2026 Jul · PMID 42397430 · Publisher ↗
BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder characterized by immune dysregulation. Regulatory T cells (Tregs) play a pivotal role in maintaining mucosal tolerance, and their dysfunction directly c...
BACKGROUND: Crohn's disease (CD) is a chronic inflammatory disorder characterized by immune dysregulation. Regulatory T cells (Tregs) play a pivotal role in maintaining mucosal tolerance, and their dysfunction directly contributes to CD pathogenesis. METHODS: We used interleukin-10/ mice to evaluate the therapeutic effects of a special multifiber mixture (MF) on colitis. T cell phenotypes, transcriptional profiles, gut microbiota composition, and N-methyl adenosine (m6A) ribonucleic acid (RNA) methylation were analyzed using flow cytometry, RNA sequencing, metagenomics, and methylated RNA immunoprecipitation-quantitative polymerase chain reaction. RESULTS: MF significantly reduced intestinal inflammation, restored epithelial barrier function, and promoted Treg differentiation while suppressing Th1/Th17 polarization. Integrated transcriptomic and proteomic analyses identified ETS1 as a negative regulator of Treg differentiation, modulated by gut microbiota-derived S-adenosylmethionine (SAM) through methyltransferase-like protein 3-mediated m6A methylation. MF feeding reduced SAM levels and m6A enrichment on ETS1 messenger RNA, leading to decreased ETS1 expression. Silencing of ETS1 enhanced Foxp3 expression and expanded the Treg population. RUNX1 was identified as a functional interactor of ETS1, with reciprocal expression patterns validated in both mouse models and colonic tissues from patients with CD. CONCLUSION: MF alleviates colitis by reshaping the gut microbiota and suppressing SAM-dependent m6A methylation, resulting in ETS1 downregulation and the restoration of Treg homeostasis through the ETS1/RUNX1/Foxp3 axis. These findings reveal a mechanistic link between microbiota, epigenetics, and immunity, highlighting MF feeding as a promising nutritional intervention for CD treatment.
Lead Time and Tailored Messaging Promote Early-Onset Colorectal Cancer Prevention and Screening.
Morrow L, Greenwald B
Gastroenterol Nurs · 2026 Jul · PMID 42397354 · Publisher ↗
The American Cancer Society predicts 158,850 new cases of colorectal cancer and 52,230 deaths in 2026. Rates have declined for both men and women since 2011, particularly among those over age 65. This decline is likely d...
The American Cancer Society predicts 158,850 new cases of colorectal cancer and 52,230 deaths in 2026. Rates have declined for both men and women since 2011, particularly among those over age 65. This decline is likely due to reduced smoking and increased uptake of screening. Unfortunately, there has been an increase among those younger than age 55 years since the mid-1990s, likely due to the lifestyle of those born after 1950. Early-onset colorectal cancer is defined as a diagnosis before the age of 50 years. Guidelines now recommend screening for average-risk patients begin at age 45 years (formerly 50 years). High-risk patients should start screening at age 40 years, and possibly earlier. Patients need to learn about this recent change. A high index of suspicion is helpful when any patient presents with complaints of unexplained weight loss, abdominal pain, bloating, change in bowel habits, or rectal bleeding. These patients should be referred, regardless of age, for a diagnostic colonoscopy. Primary care providers can improve their practice's screening rates using evidence-based strategies. The gastroenterology nurse is in a key position to implement lead-time messaging with tailored messages to promote on-time screening and primary prevention through diet and lifestyle.
37-Year-Old Woman With Jaundice.
Zayat MN, Vattikonda A, Pang M
Mayo Clin Proc · 2026 Jul · PMID 42397321 · Publisher ↗
Abstract loading — click title to view on PubMed.
N-acetylcysteine for non-paracetamol-induced acute liver failure in children: A systematic review and meta-analysis.
de Groot ADE, Stoppels DM, Bourgonje AR … +5 more , Hof WFJ, Kneyber MCJ, Touw DJ, Verkade HJ, Mian P
Br J Clin Pharmacol · 2026 Jul · PMID 42397304 · Publisher ↗
AIM: Non-surgical treatment of acute liver failure (ALF) is primarily supportive and depends on the underlying cause. While N-acetylcysteine (NAC) is proven effective in paracetamol-induced ALF, its potential benefits in...
AIM: Non-surgical treatment of acute liver failure (ALF) is primarily supportive and depends on the underlying cause. While N-acetylcysteine (NAC) is proven effective in paracetamol-induced ALF, its potential benefits in non-paracetamol ALF for paediatric patients remain unclear. This systematic review aimed to evaluate the efficacy of NAC in paediatric patients with non-paracetamol-induced ALF. METHODS: PubMed and Embase were searched for studies published before 20 August 2025. The review was registered on PROSPERO (CRD420251146345). Eligible studies included paediatric patients receiving NAC for non-paracetamol-induced ALF. Primary outcomes were overall survival and transplant-free survival. RESULTS: Statistical analyses were performed with Review Manager version 7.2.0 with a random-effect model, and heterogeneity was assessed with I. Risk of bias 2 and risk of bias in non-randomized studies of interventions were used for bias assessment. The meta-analysis included 310 patients receiving NAC and 242 controls. Overall survival was 77.7% in the NAC group and 73.5% in controls (OR 1.34, 95% CI: 0.90-1.99, p = .15). Transplant-free survival was 60.1% for NAC and 61.6% for controls (OR 0.81, 95% CI 0.26-2.46, p = .71). CONCLUSIONS: Current evidence indicates that NAC does not significantly impact overall survival and transplant-free survival in paediatric patients with non-paracetamol-induced ALF. Given the limited availability of randomized controlled trials, future research should preferably include such study designs, although ethical challenges may limit feasibility. Systematic collection of clinical data remains essential to better assess potential therapeutic effects. Current literature does not support the use of NAC in non-paracetamol-induced ALF in children.
Endoscopic Reintervention Using a Slim Multi-Hole Covered Metal Stent After Endoscopic Ultrasound-Guided Hepaticogastrostomy.
Sugiura R, Nakajima K, Kuwatani M
Dig Endosc · 2026 Jul · PMID 42397294 · Publisher ↗
Abstract loading — click title to view on PubMed.
Resmetirom and semaglutide therapy for patients with MAFLD in the MENA region: expert panel recommendations.
Fouad Y, AlNaamani KM, Alawadi F … +13 more , Al Hassani A, Alkhalidi N, Hotayt B, Abaalkhail F, Rouabhia S, Abdulla M, Altarrah MY, Tahiri M, Sabbah M, Sanai FM, Ormeci N, Esmat G, Eslam M
Expert Rev Endocrinol Metab · 2026 Jul · PMID 42397248 · Publisher ↗
INTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects 25-30% of the global population, with the Middle East and North Africa (MENA) region showing some of the highest prevalence rates, reachi...
INTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects 25-30% of the global population, with the Middle East and North Africa (MENA) region showing some of the highest prevalence rates, reaching up to 40%. MAFLD is a common cause of cirrhosis and hepatocellular carcinoma and is a leading indication for liver transplantation in this region. Hitherto, there have been no specific pharmacotherapies for MAFLD. However, the recent conditional approval of resmetirom and semaglutide by the FDA for the treatment of non-cirrhotic moderate-to-advanced (fibrosis stages 2 or 3) metabolic-associated steatohepatitis (MASH) offers a much-needed therapeutic option for this largely underserved condition. AREAS COVERED: An expert panel from the MENA region conducted a comprehensive literature search via PubMed and Google Scholar, focusing on clinical trials and international guidelines for resmetirom and semaglutide. This review identifies the target treatment population, proposes criteria for cessation of therapy, outlines monitoring protocols, and addresses regional knowledge gaps. EXPERT OPINION: The approval of the first two drugs for MASH is a milestone. Access to and affordability of these therapies will be the crucial determinants of their actual adoption. Future efforts should consider individualized treatment pathways stratified by cost, regulatory status, and healthcare infrastructure, while generating further regional evidence.
Patient Preferences for Virtual Versus In-Person Care in Inflammatory Bowel Disease: A Cross-Sectional Study.
Alghamdi A, Alshahrani S, Almuaili H … +11 more , Alhassoun A, Alothri A, Alfawzan H, Alyousef A, Alhammad B, Alazmi B, Karhan H, Alharbi R, Alhuraibi A, Alotaibi T, Bawazir A
Telemed J E Health · 2026 Jul · PMID 42397174 · Publisher ↗
BACKGROUND: Telemedicine adoption in gastroenterology has accelerated rapidly in recent years. Virtual interventions offer disease activity control comparable to standard in-person care. However, factors determining pati...
BACKGROUND: Telemedicine adoption in gastroenterology has accelerated rapidly in recent years. Virtual interventions offer disease activity control comparable to standard in-person care. However, factors determining patient satisfaction and personal perceptions of virtual clinics remain poorly explored. This study identifies the clinical, demographic, and socioeconomic predictors of clinic format preference among patients with inflammatory bowel disease. METHODS: We conducted a cross-sectional observational study at King Fahad Medical City in Riyadh, Saudi Arabia. The study included adult patients diagnosed with Crohn's disease or ulcerative colitis. Authors collected demographic parameters, clinical covariates, and patient experience ratings using a structured questionnaire. A multivariable binary logistic regression model was employed to isolate independent predictors of virtual clinic preference. RESULTS: The cohort comprised 1,005 patients. Overall, 55.6% preferred in-person appointments and 44.4% preferred virtual clinics. Prior telehealth exposure served as the strongest predictor for future virtual care (odds ratio [OR] = 4.10; 95% confidence interval [CI]: 2.90, 5.82). Patients utilizing subcutaneous injections (OR = 2.02) or oral medications (OR = 1.81) demonstrated significantly higher odds of selecting virtual care. Conversely, an ulcerative colitis diagnosis predicted a preference for physical visits (OR = 0.63). Prioritizing ease of access (OR = 1.47) and the use of technology (OR = 2.14) underpinned virtual choices. Strict privacy concerns (OR = 0.57) and inadequate physician communication (OR = 0.05) deterred patients from the remote clinic. CONCLUSION: Prior telehealth experience and the use of home-based therapies drive virtual clinic adoption. Disease phenotype, reliance on intravenous treatments, and privacy concerns may necessitate accessible in-person care. Health care systems must abandon uniform digital strategies and implement tailored, hybrid care models to optimize resource allocation.
Detergent-Containing Toothpaste Decreases Esophageal Mucosal Impedance and Alters Salivary Properties in Humans.
Wright BL, Crowell MD, Luo H … +15 more , Masuda MY, Itoh N, Folmes K, Stoa JM, Buras MR, Sherman W, Baheti S, Bowman D, Hill LC, Vela MF, Kita H, Rank MA, Hill DB, Horsley-Silva JL, Doyle AD
Allergy · 2026 Jul · PMID 42397127 · Publisher ↗
BACKGROUND: Eosinophilic esophagitis is associated with epithelial barrier dysfunction. Epidemiologic studies suggest environmental factors promote disease pathogenesis. The common household detergent sodium dodecyl sulf...
BACKGROUND: Eosinophilic esophagitis is associated with epithelial barrier dysfunction. Epidemiologic studies suggest environmental factors promote disease pathogenesis. The common household detergent sodium dodecyl sulfate (SDS) induces epithelial barrier dysfunction and eosinophilic inflammation in mice. We hypothesized that acute SDS exposure would compromise the esophageal mucosal barrier in humans. METHODS: Healthy adults brushed with 2 g of an SDS-containing toothpaste. Esophageal impedance was measured continuously pre-/post-toothbrushing to assess the effect of toothpaste on epithelial barrier function. SDS was measured in saliva using a methylene blue anionic substances assay. Participants completed 1-h esophageal string tests (ESTs) pre-/post-toothbrushing and protein isolates from EST eluates from the proximal and distal esophagus were analyzed by tandem mass tag mass spectrometry. RESULTS: Ten of twelve subjects completed the clinical study. SDS in the initial expectorate measured immediately after toothbrushing varied markedly (median: 321.40 μg/mL; range: 169.90-1243.00 μg/mL) and was detectable in saliva in 80% of subjects (median: 9.55 μg/mL; range: 0-123.40 μg/mL) at 60 min post toothbrushing. Esophageal mucosal impedance decreased within 30 min of toothbrushing (p < 0.01). Toothbrushing increased salivary viscosity and proteins associated with mucosal defense in EST eluates. The tight junction pathway was downregulated while the salivary secretion and complement and coagulation cascades pathways were upregulated in the proximal esophagus. CONCLUSION: In healthy individuals, SDS remained detectable in saliva for a prolonged period after toothbrushing at concentrations previously shown to disrupt esophageal epithelial barrier function in vitro. Toothbrushing with an SDS-containing toothpaste was associated with reduced esophageal mucosal impedance, altered salivary properties, and activated mucosal immune responses.
Navigating the path: Advice to physician-scientists on choosing a clinical specialty.
Swartz T, Cavazos JE, Horwitz M … +10 more , Hu PJ, Sampson B, Scharschmidt T, Zarrinpar A, Mohr N, Mankoff D, Chu J, Rhee KY, Emala CW, Williams CS
Elife · 2026 Jul · PMID 42397115 · Full text
Choosing a clinical specialty is a critical decision for physician-scientist trainees, influencing both clinical practice and research trajectory. This article provides a structured approach to specialty selection, empha...
Choosing a clinical specialty is a critical decision for physician-scientist trainees, influencing both clinical practice and research trajectory. This article provides a structured approach to specialty selection, emphasizing the importance of aligning clinical interests with long-term research goals, evaluating training pathways, and considering lifestyle implications. Physician-scientists, including MD-PhD and other dual-degree graduates, as well as MD graduates with research-intensive training, often pursue specialties with established research pathways. We outline key decision-making factors, including mentorship, clinical exposure, research commitment, and financial sustainability. Additionally, we compare research track and categorical residency pathways, detailing differences in training structure, funding opportunities, and career outcomes. The article explores the evolving role of physician-scientists across career stages, from residency through senior faculty leadership, highlighting strategies to maintain research engagement while balancing clinical responsibilities. By critically evaluating these factors and leveraging mentorship and institutional support, physician-scientists can make informed decisions that align with their aspirations, ensuring a fulfilling and impactful career in both medicine and research.
Preoperative psychological nursing reduces stress and postoperative complications in patients undergoing ERCP: A prospective cohort study.
Lu S, Xu X, Yan H … +4 more , Yu J, Sun W, Teng Y, Xing F
Adv Clin Exp Med · 2026 Jul · PMID 42397099 · Publisher ↗
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) induces substantial psychological distress and physiological stress responses that may adversely affect clinical outcomes. Although psychological nursing...
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) induces substantial psychological distress and physiological stress responses that may adversely affect clinical outcomes. Although psychological nursing interventions have demonstrated efficacy in attenuating perioperative stress across various surgical settings, robust evidence regarding their application in ERCP remains limited. OBJECTIVES: To evaluate the effectiveness of a structured preoperative psychological nursing intervention on psychophysiological stress responses and clinical outcomes in patients undergoing ERCP. MATERIAL AND METHODS: This prospective cohort study enrolled 297 consecutive patients undergoing ERCP at a tertiary care center between June 2022 and June 2025. Participants were allocated to either a control group (n = 148) receiving standard care or an intervention group (n = 149) receiving standard care plus a psychological nursing protocol comprising trust-building communication, procedural education, and relaxation training. The primary outcome was psychological stress measured using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Secondary outcomes included intraoperative hemodynamic parameters, behavioral stress-response grades, and postoperative complication rates. Outcome assessors were blinded to group allocation. RESULTS: Post-intervention, the intervention group demonstrated significantly lower anxiety (SAS: 28.92 ±4.78 vs 41.85 ±8.97; t-test: degrees of freedom (df) = 295; p < 0.001; Cohen's d = 1.79, 95% confidence interval (95% CI): 1.52-2.06) and depression (SDS: 27.89 ±5.14 vs 42.67 ±9.83; t-test: df = 295; p < 0.001; Cohen's d = 1.88, 95% CI: 1.61-2.15) scores compared with controls. Patients receiving the intervention exhibited superior intraoperative hemodynamic stability, including reduced heart rate variability (coefficient of variation: 0.07 ±0.03 vs 0.14 ±0.06; t-test: df = 295; p < 0.001) and fewer severe behavioral stress responses (grade III: 0% vs 7.4%; ÷2 test: df = 2; p < 0.001). The intervention group experienced significantly fewer overall postoperative complications (12.1% vs 27.7%; ÷2 test: df = 1; p = 0.001; risk ratio (RR) = 0.44, 95% CI: 0.26-0.73; number needed to treat (NNT) = 6.4). CONCLUSIONS: Structured preoperative psychological nursing intervention significantly attenuates psychophysiological stress responses and reduces postoperative complications in patients undergoing ERCP. These findings support integration of psychological support protocols into perioperative care pathways, although confirmation through multicenter randomized controlled trials is warranted.
Prevalence of Self-Reported Non-Coeliac Gluten Sensitivity and Its Association With Disorders of Gut-Brain Interaction and Disordered Eating.
Shiha MG, Sanders DS, Burton-Murray H … +3 more , Simren M, Palsson O, Aziz I
United European Gastroenterol J · 2026 Jul · PMID 42396956 · Full text
BACKGROUND: Noncoeliac gluten sensitivity (NCGS) remains a controversial clinical entity at the intersection between disorders of gut-brain interaction (DGBI) and disordered eating. We aimed to determine the prevalence o...
BACKGROUND: Noncoeliac gluten sensitivity (NCGS) remains a controversial clinical entity at the intersection between disorders of gut-brain interaction (DGBI) and disordered eating. We aimed to determine the prevalence of self-reported NCGS and to characterise its association with DGBI and avoidant/restrictive food intake disorder (ARFID) symptoms in an adult general population. METHODS: We conducted a population-based internet survey with pre-defined demographic quotas across the United States of America and United Kingdom in 2023. Participants completed the Rome IV diagnostic questionnaire, the Nine-Item ARFID screen, and validated instruments for psychological distress, somatisation and quality of life. RESULTS: A total of 4002 participants (50% female; median age 46 years) were included in the analyses. The prevalence of NCGS was 14.2% (95% CI, 13.1-15.3). Participants with self-reported NCGS reported more nongluten food intolerances than those without self-reported NCGS (median 3 vs. 0, p < 0.001). Among individuals with NCGS, 69.4% (95% CI, 65.4-73.1) had concomitant DGBI and/or ARFID symptoms, with nearly one-quarter (24.0%; 95% CI, 20.6-27.8) meeting the criteria for all three conditions. Those with comorbid self-reported NCGS, DGBI and ARFID symptoms had the highest levels of psychological distress, somatic symptom reporting, increased healthcare utilisation and reduced quality of life (all p < 0.001). CONCLUSION: NCGS is reported by approximately one in seven adults in the United States of America and United Kingdom. Individuals with self-reported NCGS frequently meet diagnostic criteria for DGBI and/or ARFID symptoms, and those who experience all three entities represent a distinct high-severity phenotype. Our findings suggest that self-reported NCGS may represent a broader syndrome of food-related symptom attribution rather than gluten-specific pathology.
The Associations Between Acid-Suppressive Drug Intake and Symptom Profiles in Functional Dyspepsia Patients Referred for Open-Access Endoscopy.
Janne S, Florencia C, Hanne M … +2 more , Karen VDH, Jan T
United European Gastroenterol J · 2026 Jul · PMID 42396939 · Full text
BACKGROUND: Functional dyspepsia (FD) is characterised by postprandial fullness, early satiation, epigastric pain, or burning without structural abnormalities on upper endoscopy. Proton pump inhibitors (PPIs) are the pre...
BACKGROUND: Functional dyspepsia (FD) is characterised by postprandial fullness, early satiation, epigastric pain, or burning without structural abnormalities on upper endoscopy. Proton pump inhibitors (PPIs) are the preferred first-line therapy. Given that the diagnosis of FD is largely based on symptom assessment, it remains unclear whether acid-suppression meaningfully influences symptom presentation. OBJECTIVE: This exploratory study aimed to determine the prevalence of acid-suppressive therapy (PPIs or H2 receptor antagonists (H2RAs)) among FD patients and to compare symptom patterns between patients with and without these treatments. METHODS: In this single-centre, cross-sectional observational study, ambulatory patients referred for diagnostic upper endoscopy completed the Waiting Room Questionnaire (WRQ). Endoscopic findings were recorded, and FD was defined using Rome IV. Acid-suppression was defined as self-reported use of PPIs or H2RAs. Symptom frequency was compared between patients on and off therapy. RESULTS: 1158 patients completed the WRQ; 27% fulfiled the criteria for FD. Among FD patients, 60% reported acid-suppressive therapy, similar to patients with endoscopic findings. FD patients receiving acid-suppression reported higher frequencies of early satiation (OR = 1.68, 95% CI 1.08-2.60), nausea (OR = 1.93, 95% CI 1.23-3.01), and epigastric pain (OR = 1.74, 95% CI 1.12-2.69). In subgroup analyses, therapy was associated with more frequent epigastric burning in postprandial distress syndrome (OR = 3.81, 95% CI 1.50-9.67) and higher frequencies of postprandial fullness (OR = 2.90, 95% CI 1.24-6.80) and early satiation (OR = 2.34, 95% CI 1.13-4.85) in the overlap subgroup. CONCLUSIONS: FD is prevalent in open-access endoscopy, and acid-suppressive therapy is frequently used in this population. FD patients receiving acid-suppression reported slightly higher frequencies of several symptoms, highlighting the need to further explore these associations.
Psychosocial Risk Factors and Outcomes Among Men and Women With Alcohol-Associated Liver Disease Undergoing Transplant Evaluation.
Hasan S, Becker O, Jain M … +5 more , Gudur A, Novicoff W, Martin D, Stotts M, Carlini L
Alcohol Clin Exp Res (Hoboken) · 2026 Jul · PMID 42396894 · Full text
BACKGROUND: Women with alcohol-associated liver disease (ALD) have been shown to be listed for transplant less frequently and have more psychiatric comorbidities as compared to men. This study aimed to analyze difference...
BACKGROUND: Women with alcohol-associated liver disease (ALD) have been shown to be listed for transplant less frequently and have more psychiatric comorbidities as compared to men. This study aimed to analyze differences in psychosocial risk factors between men and women with ALD using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), a pre-transplantation tool that assesses a candidate's psychosocial risk factors. The secondary aim was to determine if SIPAT scores are associated with transplant-related outcomes. METHODS: A single-center, retrospective cohort study was conducted. All outpatients with ALD who were evaluated for liver transplant between 2015 and 2021 and who had at least one completed SIPAT evaluation were included. Fisher's exact and Mann-Whitney U tests were used to compare baseline characteristics and SIPAT scores. Multivariable logistic regression was used to analyze transplant outcomes. Survival differences were assessed using survival analysis, with comparisons evaluated using the log-rank test. RESULTS: Total SIPAT scores were similar between men and women, but women were found to have significantly higher psychopathology domain scores, related to higher rates of depression and anxiety. Higher psychopathology domain scores and presence of anxiety were associated with lower odds of death among women only. There were no differences in waitlisting, transplantation, or death between men and women with ALD. CONCLUSIONS: This study highlights gender differences in psychosocial risk factors among patients with ALD undergoing transplant evaluation. The mechanism by which anxiety is associated with lower odds of death among women is unclear, and it remains to be seen whether this finding would be reproduced in a larger, prospective study or would generalize to women with other etiologies of cirrhosis. Overall, these findings underscore the importance of incorporating gender-sensitive, nuanced psychosocial assessment in the liver transplant evaluation process.
M2 macrophage activation in recurrent acute pancreatitis: an explorative analysis of a randomized controlled trial.
Hagn-Meincke R, Cook ME, Frøkjær JB … +13 more , Davidsen L, Knoph CS, Novovic S, Hadi A, Jørgensen MT, Mortensen MB, Schaffalitzky O, Nielsen LBJ, Berner-Hansen M, Deleuran BW, Møller HJ, Drewes AM, Olesen SS
Scand J Gastroenterol · 2026 Jul · PMID 42396887 · Publisher ↗
OBJECTIVES: M2 macrophage activation contributes to pancreatitis pathophysiology and may drive progression from recurrent acute pancreatitis (RAP) to chronic disease. Evidence is mainly preclinical or cross-sectional, hi...
OBJECTIVES: M2 macrophage activation contributes to pancreatitis pathophysiology and may drive progression from recurrent acute pancreatitis (RAP) to chronic disease. Evidence is mainly preclinical or cross-sectional, highlighting a need for prospective studies. METHODS: This was an exploratory analysis of a multicenter, randomized, placebo-controlled trial, which included patients with RAP randomized to naldemedine (tablet 0.2 mg daily), a peripherally acting µ-opioid receptor agonist hypothesized to reduce RAP frequency, or placebo for 12 months. Biomarkers of M2 macrophage activation (plasma levels of sCD163 and sCD206) were measured at baseline and trial end. Linear mixed-effects models assessed biomarker changes within and between treatment groups. Spearman correlation assessed associations between biomarker changes and disease activity, defined by RAP attacks and pain flares. RESULTS: Fifty-six patients with paired plasma samples were included (32 naldemedine, 24 placebo) in this exploratory analysis. Despite a numerical reduction in RAP frequency with naldemedine (hazard ratio 0.49; 95% confidence interval: 0.23 to 1.08; = 0.076), no differences in mean change of sCD163 (-0.07 mg/L, = 0.652) or sCD206 (0.01 mg/L, = 0.299) were observed compared to placebo. Change in plasma levels of sCD163 correlated with the frequency of RAP attacks (rho = 0.348, = 0.009) and pain flares (rho = 0.318, = 0.017). No associations between disease activity and plasma levels of sCD206 were observed. CONCLUSIONS: Naldemedine did not significantly affect M2 macrophage activation, suggesting limited immunomodulatory effects. However, changes in sCD163 plasma levels correlated with clinical disease activity, highlighting macrophage activation in RAP.
Response to the Letter Regarding "Efficacy and Safety of Hypofractionated Radiation Therapy Combined With Immunotherapy for Hepatocellular Carcinoma With Vp4 Portal Vein Tumor Thrombosis".
Tameda M, Nakagawa H
Hepatol Res · 2026 Jul · PMID 42396862 · Publisher ↗
Abstract loading — click title to view on PubMed.
Endoscopic Management of Choledocholithiasis in the Elderly: Balancing Safety and Effectiveness in the Aging Era.
Hakuta R, Nakabayashi R, Otsuka N … +3 more , Ishigaki N, Takayama Y, Nakai Y
Dig Endosc · 2026 Jul · PMID 42396615 · Publisher ↗
Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as a first-line treatment for bile duct stones in multiple guidelines. Although ERCP is an established and effective procedure, it is associated with e...
Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as a first-line treatment for bile duct stones in multiple guidelines. Although ERCP is an established and effective procedure, it is associated with early adverse events, particularly in elderly patients. Older individuals frequently have multiple comorbidities, are often treated with antithrombotic agents, and may have underlying oropharyngeal dysphagia, all of which increase the risk of complications such as bleeding, hypotension, and aspiration pneumonia. In addition, bile duct stones in elderly patients tend to be larger and more numerous, and the high prevalence of periampullary diverticula may limit the extent of endoscopic sphincterotomy, thereby prolonging procedure time and increasing procedural complexity. Recent evidence has also demonstrated an association between frailty and post-ERCP mortality. While definitive stent placement without stone extraction could be a treatment option, it should only be considered in very elderly patients with significant frailty and limited life expectancy since endoscopic stone removal reduces long-term biliary events and subsequent mortality. In patients with concomitant cholangitis, urgent biliary drainage reduces mortality regardless of severity. However, because elderly patients are at increased risk of periprocedural hypotension and aspiration pneumonia, urgent ERCP should be performed with careful monitoring and meticulous supportive management. In summary, treatment decisions should not be based solely on chronological age but should incorporate a comprehensive assessment of overall physical condition, including frailty.
Limited benefit of liver transplantation in a boy with biallelic severe deficiency of hydroxymethylbilane synthase and review of prior reported cases.
Araque M, Ma CD, Jordan A … +3 more , Faust D, McGuire L, Bonkovsky HL
Mol Genet Metab Rep · 2026 Sep · PMID 42396593 · Full text
INTRODUCTION: A male infant presented at three months of age with generalized ataxia, hypotonia, aspiration of liquids and recurrent generalized seizures. He was treated with levetiracetam and phenobarbital. Methods: Ext...
INTRODUCTION: A male infant presented at three months of age with generalized ataxia, hypotonia, aspiration of liquids and recurrent generalized seizures. He was treated with levetiracetam and phenobarbital. Methods: Extensive testing, including whole genome sequencing was done. RESULTS: He had two known pathogenic variants in the gene: p.R167Q [maternal] and p.T35M [paternal]. Plasma and urine exhibited high concentrations of 5-aminolevulinic acid, porphobilinogen, and uroporphyrin 1. Activity of hydroxymethylbilane synthase in red blood cells of the child was markedly reduced [18 nmol uroporphyrin/ g hemoglobin /h; reference range: 60-335]; it was ∼50% of normal in parents. The findings supported the diagnosis of biallelic severe HMBS deficiency with severe disease phenotype. A 5-day course of intravenous heme led to no observable clinical improvement. Orthotopic liver transplantation at the age of 15 months led to only mild transient improvement. Developmental delays and seizures persisted. MRI scans of the brain showed progressive white matter volume loss, cystic changes, and multifocal supratentorial signal abnormalities. He died at 88 months of age. Findings at autopsy of the brain showed patchy gliosis and leukodystrophy. We also review 11 previously reported cases. CONCLUSION: No effective disease-modifying therapy currently exists for biallelic HMBS deficiency. Substantial neurological injury is present by the time of diagnosis and seems irreversible.
Publication time valid prediction of citation risk outcomes in a bounded clinical specialty literature corpus.
Chung S, Kahi C, Singh S
Res Sq · 2026 Jun · PMID 42396484 · Full text
Citation-prediction studies often estimate citation counts using information unavailable at publication. We evaluated whether citation-risk outcomes can be predicted using only publication-time information: metadata, ref...
Citation-prediction studies often estimate citation counts using information unavailable at publication. We evaluated whether citation-risk outcomes can be predicted using only publication-time information: metadata, references, author history, and text available on or before publication. We assembled 9,424 original-research articles published from 2017 to 2022 across seven clinical gastroenterology journals using OpenAlex and PubMed. The primary reference-observed cohort included 8,409 articles with a parsed reference list. The primary outcome was ≤ 3 citations within 2 years; secondary outcomes were 0 citations within 3 years, ≤ 3 citations within 3 years, and > 20 citations within 2 years. Models compared a nonsemantic citation/reference/context baseline, author-history variables, whole-document title/abstract embeddings, role-segmented source-text embeddings, and reference-context distributional features. Evaluation used two held-out publication-year folds with PR-AUC, or area under the precision-recall curve, F1, and precision among the top-ranked 10% of predictions. For the primary outcome, the nonsemantic baseline achieved PR-AUC 0.818, F1 0.722, and precision@10% 0.935. Adding whole-document embeddings improved performance to 0.828, 0.735, and 0.962, respectively. Structure-aware features did not improve the primary outcome but provided endpoint-specific gains for secondary outcomes. Author-history features showed standalone signal but did not improve the baseline. Pooled performance exceeded journal-local performance, indicating that citation-risk signal operated at the corpus level. These findings support publication-time-valid citation-risk modeling as a reproducible framework for studying evidence visibility within bounded literatures and motivate replication across other journal sets, specialties, and publication eras.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe