Eur J Gastroenterol Hepatol [JOURNAL]
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200 papers
Antineutrophil cytoplasmic antibody-associated vasculitis with initial gastrointestinal symptoms: case series and literature review.
Tian M, Wang T, Gao L … +5 more , Zhang X, Liu H, Zhou M, Zhou H, Liu Y
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811773 · Publisher ↗
INTRODUCTION: While antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (AAV) is increasingly recognized, cases presenting with initial gastrointestinal symptoms remain underexplored. This study...
INTRODUCTION: While antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis (AAV) is increasingly recognized, cases presenting with initial gastrointestinal symptoms remain underexplored. This study aimed to analyze the clinical characteristics of AAV patients with gastrointestinal onset. METHODS: Seven AAV patients meeting ACR/EULAR criteria, who presented with gastrointestinal symptoms between January 2017 and 2024, were retrospectively identified. A literature review was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, and Wanfang. In total, 23 patients were included in the study. RESULTS: Among the 23 AAV patients with gastrointestinal symptoms, 15 (65.2%) were male, with a median age of 54 years (range: 18-79). Common clinical manifestations included hematochezia (56.5%), weight loss (43.5%), and purpura (34.8%). Eight (34.8%) had superficial gastritis, and seven (30.4%) had colonic ulcers, as identified by gastrointestinal endoscopy. Laboratory findings revealed elevated D-dimer levels and anemia in most patients, with impaired renal function and a median hemoglobin level of 105 g/L. Anti-PR3 immunoglobulin G (IgG) and antimyeloperoxidase IgG antibodies were positive in 83.3 and 80% of cases, respectively. Abdominal computed tomography (CT) revealed wall thickening in 39.1% of patients, and chest CT identified interstitial lung disease in 73.9% of patients. Nine patients (39.1%) were initially misdiagnosed, with five (55.6% of those nine) misdiagnosed as having inflammatory bowel disease. Most patients responded well to glucocorticoid and immunosuppressive therapy, with 39.1% receiving a combination of glucocorticoids and cyclophosphamide. CONCLUSION: Gastrointestinal symptoms in AAV are rare, and misdiagnosis remains a concern. Early detection requires assessing gastrointestinal, pulmonary, and renal involvement.
Stricturing phenotype is associated with an increased risk of postoperative surgical recurrence in isolated small bowel Crohn's disease.
Song T, Chen Y, Zhang C … +7 more , Sun Z, Peng H, Duan M, Gong J, Cao L, Li Y, Zhu W
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811772 · Publisher ↗
BACKGROUND: Isolated small bowel Crohn's disease (ISBCD) is often associated with poorer clinical outcomes. This study aims to summarize the clinical characteristics of patients with ISBCD and to investigate the risk fac...
BACKGROUND: Isolated small bowel Crohn's disease (ISBCD) is often associated with poorer clinical outcomes. This study aims to summarize the clinical characteristics of patients with ISBCD and to investigate the risk factors for surgical recurrence due to disease recurrence. METHODS: A retrospective study was conducted using a prospective database of Crohn's patients. Patients with ISBCD were screened and divided into stricturing and nonstricturing groups according to the Montreal classification behavior definition. The primary endpoint was reoperation due to postoperative recurrence of Crohn's disease. Other endpoints included intraoperative and postoperative outcomes, as well as clinical characteristics. Multivariable Cox regression analysis was used to assess the independent risk factors for surgical recurrence. RESULTS: From January 2017 to June 2024, totally 234 patients (135 in the stricturing group) were included. After propensity score matching, with 79 patients in each group. During the follow-up period (1-90 months), surgical recurrence rates were significantly higher in the stricturing group (11%) compared to the nonstricturing group (4%) (P = 0.04), this was confirmed in Kaplan-Meier curve with log-rank analysis (P = 0.04). No significant differences were observed in postoperative outcomes between the two groups. Variables with P < 0.1 in univariable analysis (stricturing behavior, smoking history, hypoalbuminemia, escalation, or conversion of biologic during follow-up) were incorporated into the multivariable Cox regression analysis, which demonstrated the stricturing behavior [hazard ratio (HR) 4.010; 95% confidence interval (CI) 1.024-15.704; P = 0.04] and the escalation or conversion of biologic agents (HR 6.453; 95% CI 1.906-21.844; P < 0.01) postoperatively were independent risk factors for surgical recurrence. CONCLUSION: The stricturing phenotype is associate with increased risk of operative surgical recurrence in patients with ISBCD. These patients should have a more active prophylactic strategy for the prevention of recurrence after surgery.
Fecal calprotectin-guided treatment escalation strategy enhances disease clearance in ulcerative colitis.
Coelho Rodrigues I, Fernandes SR, Saraiva S … +4 more , Gonçalves AR, Moura Santos P, Valente A, Araújo Correia L
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811771 · Publisher ↗
INTRODUCTION: Disease clearance may represent the ultimate treatment target in ulcerative colitis, but is seldom achieved in clinical practice. A treatment escalation strategy based on fecal calprotectin may potentially...
INTRODUCTION: Disease clearance may represent the ultimate treatment target in ulcerative colitis, but is seldom achieved in clinical practice. A treatment escalation strategy based on fecal calprotectin may potentially improve these results. METHODS: Case cohort study including 108 ulcerative colitis patients with severe endoscopic activity at baseline (Mayo endoscopic subscore = 3) and a follow-up endoscopy with histologic assessment. For each elevated fecal calprotectin (≥250 μg/g) between endoscopic evaluations, we identified any adjustment of medical treatment performed. The ratio of treatment escalation per elevated fecal calprotectin (Te/eFc) was correlated with disease clearance rates at the follow-up endoscopic evaluation. In addition, we compared the rates of negative outcomes (clinical relapse, treatment discontinuation, surgery, and colorectal cancer) in patients with and without disease clearance. RESULTS: Thirty-three (30.5%) patients reached disease clearance over a median follow-up of 21.5 months [interquartile range (IQR): 15-40 months]. Quartile analysis demonstrated that a ratio Te/eFc greater than 50% resulted in higher rates of disease clearance compared with a ratio Te/eFc less than or equal to 50% (51.5 vs. 20.0%; P = 0.001). In multivariate analysis, a ratio Te/eFc greater than 50% was independently associated with disease clearance (odds ratio: 4.47, 95% confidence interval: 1.79-11.15, P = 0.001). Patients with disease clearance presented lower chances of reaching any negative outcome (37.5 vs. 67.1%; P = 0.006). CONCLUSION: A Te/eFc greater than 50% improved the chances of obtaining disease clearance in ulcerative colitis. Disease clearance is associated with better long-term outcomes.
Comparative efficacy of pharmacologic therapies for MASLD in improving fibrosis: systematic review and network meta-analysis.
Han X, Ai X, Sun Y … +3 more , Chen S, Zhao X, You H
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41811770 · Publisher ↗
Fibrosis is a key predictor of the long-term prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). Numerous clinical trials in drug development for MASLD have used fibrosis improvement as an effi...
Fibrosis is a key predictor of the long-term prognosis in metabolic dysfunction-associated steatotic liver disease (MASLD). Numerous clinical trials in drug development for MASLD have used fibrosis improvement as an efficacy endpoint. We aim to compare the efficacy of pharmacologic therapies for MASLD in improving fibrosis using histopathological and noninvasive assessments. A comprehensive search for randomized controlled trials (RCTs) was conducted across multiple databases, focusing on drug therapy in adult patients with MASLD. The primary outcome was more than 1-stage fibrosis improvement. The secondary outcomes included changes in liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE) and magnetic resonance elastography. Each intervention's ranking probability was assessed using the surface under the cumulative ranking curve (SUCRA). Forty-eight RCTs involving 10 119 participants were included. For the primary outcome, pegozafermin, obeticholic acid (OCA), and resmetirom all outperformed placebo in the fibrosis stage F1-3 analysis. OCA was superior to placebo in the 1.5-year analysis. Pegbelfermin (SUCRA: 77.11%) and pegozafermin (SUCRA: 74.91%) at F1-3, and OCA at 1.5 years (SUCRA: 81.64%) were ranked as the most effective treatments. For the secondary outcome, pegozafermin significantly outperformed placebo for decreasing LSM via VCTE in 0.5-year analysis, ranking as the most effective treatment for this outcome (SUCRA: 96.98%). Several new drugs currently in clinical trials have shown potential therapeutic effects for fibrosis improvement in MASLD patients, especially those targeting fibroblast growth factor 21 (FGF21). More definitive efficacy will depend on the results of phase III clinical trials.
Efficacy and safety of split-dose ultra-low-volume polyethylene glycol with ascorbic acid versus sodium picosulfate with magnesium citrate for bowel preparation: a systematic review and meta-analysis.
Abdallfatah A, Hageen AW, Albader D … +9 more , Al-Tamimi A, Alsalumi K, Alzmmam A, Abdullah M, Alreshaid L, Aldhuwayhi S, Almarri N, Fallatah W, Altamimi A
Eur J Gastroenterol Hepatol · 2026 Feb · PMID 41784442 · Publisher ↗
Colonoscopy remains the gold standard for early detection and prevention of colorectal cancer, with adequate bowel cleansing being pivotal for its success. This systematic review aims to evaluate the efficacy and safety...
Colonoscopy remains the gold standard for early detection and prevention of colorectal cancer, with adequate bowel cleansing being pivotal for its success. This systematic review aims to evaluate the efficacy and safety of split-dose ultra-low-volume polyethylene glycol (PEG) with ascorbic acid (Asc) versus sodium picosulfate magnesium citrate for bowel preparation. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search across Embase, PubMed, Web of Science, and Scopus from inception to July 2025. Data analysis was conducted using R version 4.2.2 (31 October 2022) and RStudio version 2022.07.2 (2009-2022, RStudio, Inc.) Our literature search yielded six eligible studies involving 3285 patients. Our findings indicate no significant differences in overall and right-sided colon adequate cleansing rates between the two regimens: risk ratio: 1.05, 95% confidence interval (CI): 0.99-1.12, P = 0.1082; and risk ratio: 1.03, 95% CI: 0.99-1.08, P = 0.1755, respectively. However, PEG + Asc demonstrated a significantly lower rate of vomiting compared to sodium picosulfate magnesium citrate (risk ratio: 2.58, 95% CI: 0.94-2.78, P = 0.0008), suggesting better tolerability. Other secondary outcomes, including nausea, abdominal pain, and overall Boston Bowel Preparation Scale scores, did not show significant differences. The quality of the evidence varied across the outcomes. Our results support the comparable efficacy of both bowel preparation agents while highlighting PEG + Asc's potential advantages in tolerability. Our findings suggest that the choice between these two preparations can be tailored to the specific patient, considering their preferences or previous experiences, although some caution is advised in interpreting these findings.
The prevalence of nonmalignant gastrointestinal disease in patients with iron deficiency anemia: a systematic review and meta-analysis.
De Silva R, Thomas JP, Murali N … +5 more , Senathirajah L, Rajendra R, Bialecki S, Chan SSM, Alexandre L
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41784434 · Publisher ↗
OBJECTIVE: Gastrointestinal pathology is a major cause of iron deficiency anemia (IDA). While previous studies have focused on establishing the prevalence of malignant gastrointestinal disease, the prevalence of nonmalig...
OBJECTIVE: Gastrointestinal pathology is a major cause of iron deficiency anemia (IDA). While previous studies have focused on establishing the prevalence of malignant gastrointestinal disease, the prevalence of nonmalignant gastrointestinal disease in patients with IDA has not been analyzed systematically. We performed a systematic review and meta-analysis to determine the prevalence of normal findings, individual nonmalignant findings, and malignancy in patients with IDA. METHODS: We searched Medline, Embase, and Scopus from inception for observational studies that reported the prevalence of individual upper and lower gastrointestinal pathologies among adults (≥18 years) with confirmed IDA who underwent endoscopic investigation. We also sought to establish the prevalence of normal endoscopic findings within the IDA population as well as the prevalence of nonmalignant and malignant gastrointestinal pathology amongst clinically relevant subgroups. Results were synthesized using a random effects meta-analysis. RESULTS: A total of 8563 citations were screened, and 39 articles were included from four continents, comprising 9807 patients with IDA. Overall, the most prevalent upper gastrointestinal finding was Helicobacter pylori gastritis (27.0%), and the most prevalent lower gastrointestinal finding was hemorrhoids (10.0%). The overall prevalence of upper gastrointestinal malignancy was 5.0%, and the prevalence of colorectal cancer was 8.0%. A total of 52.0% of upper gastrointestinal endoscopies and 66.0% of lower gastrointestinal endoscopies did not detect any abnormalities. CONCLUSION: The estimated prevalence of individual malignant and nonmalignant gastrointestinal disease will serve as a guide in the context of clinical decision making before endoscopy in patients with IDA. Further population-based studies are needed, particularly among relevant subgroups.
Cardiovascular risk profiles in patients with primary sclerosing cholangitis.
Sleutjes JAM, van de Pol N, van der Meer AJ … +4 more , de Man RA, van der Woude CJ, Roeters van Lennep JE, de Vries AC
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41784432 · Full text
INTRODUCTION: Chronic inflammation as seen in patients with primary sclerosing cholangitis (PSC) is linked to accelerated development and progression of atherosclerosis. This study aimed to assess atherosclerotic cardiov...
INTRODUCTION: Chronic inflammation as seen in patients with primary sclerosing cholangitis (PSC) is linked to accelerated development and progression of atherosclerosis. This study aimed to assess atherosclerotic cardiovascular disease (ASCVD) risk and cardiovascular health (CVH) profiles in patients with PSC. METHODS: This cross-sectional study included PSC patients with and without concomitant inflammatory bowel disease (IBD), assessing cardiovascular risk with anthropometric measurements, serum samples, self-reported questionnaires, and medical chart review. The ideal CVH score was calculated according to the American Heart Association guidelines. Comparisons across groups were analyzed using χ 2 and Mann-Whitney U-test. RESULTS: Ninety-eight patients with PSC were included [72% male; median age 49 years, interquartile range: 34-61 years], with 65% having concomitant IBD. PSC-IBD patients exhibited higher prevalence of obesity (15% vs 0%; P = 0.016), hypertension (35% vs 21%; P = 0.069), diabetes (9% vs 3%; P = 0.525), active smokers (10% vs 3%; P = 0.253) and metabolic syndrome (8% vs 3%; P = 0.363), and lower prevalence of hypercholesterolemia (30% vs 50%; P = 0.020). Nonideal CVH was more common among PSC-IBD (46% vs 22%; P = 0.045). Ten patients had a history of 16 ASCVD events. At time of these events, at 13/16 events patients had one or more traditional ASCVD risk factors of which 77% were modifiable. CONCLUSION: One-third of PSC patients exhibit nonideal CVH, particularly PSC-IBD patients. In this cohort, 10% had prior ASCVD with mostly modifiable risk factors at time of the event. These findings suggest that PSC patients might benefit from proactive ASCVD surveillance and risk management.
Three is not a crowd: improving the study of chronic constipation.
Ferreira AI, Arieira C, Campelo P … +2 more , Xavier S, Cotter J
Eur J Gastroenterol Hepatol · 2026 Aug · PMID 41784429 · Publisher ↗
BACKGROUND: High-definition anorectal manometry (HD-ARM), balloon expulsion test (BET), and magnetic resonance defecography (MR defecography) are important tools in studying constipation. Our aim was to evaluate the prev...
BACKGROUND: High-definition anorectal manometry (HD-ARM), balloon expulsion test (BET), and magnetic resonance defecography (MR defecography) are important tools in studying constipation. Our aim was to evaluate the prevalence of functional defecation disorders and structural anorectal alterations in patients with chronic constipation and compare the findings of HD-ARM and BET with MR defecography. METHODS: Retrospective cohort study including patients with functional constipation or irritable bowel syndrome with constipation (IBS-C), refractory to medical therapy, submitted to HD-ARM, BET, and MR defecography. Patients were divided into three groups: (a) normal anorectal evacuation in HD-ARM and normal BET; (b) abnormal evacuation pattern and abnormal BET; and (c) normal anorectal evacuation pattern and abnormal BET, or abnormal evacuation pattern and normal BET. RESULTS: A total of 64 patients were included, 49 with functional constipation (76.6%) and 15 with IBS-C (23.4%). In MR defecography, 47 patients had structural alterations (73.4%) and 15 had dyssynergia (23.4%). Overall, 19 patients were diagnosed with dyssynergic defecation (29.7%). Comparing the findings of HD-ARM and BET with MR defecography: in group 1 ( n = 20), 15 patients had structural alterations (75.0%); in group 2 ( n = 11), 8 had structural alterations (72.7%); and in group 3 ( n = 33), 22 patients only had structural alterations (66.7%), 6 only had dyssynergic defecation (18.2%), and 2 had both (6.0%). MR defecography allowed the diagnosis of dyssynergic defecation in 8 patients (24.2%). CONCLUSION: One third of patients with functional constipation and IBS-C had dyssynergic defecation and three quarters had relevant structural anorectal alterations. Therefore, it is important to combine MR defecography with HD-ARM and BET in the study of constipation.
Validation of the Urgency Numeric Rating Scale and correlation with endoscopic, histological, and manometric activity in ulcerative colitis.
Guimarães A, Caetano AC, Barbosa I … +9 more , Costa D, Carvalho T, Mendes S, Soares J, Rebelo A, Arroja B, Rodrigues Â, Gonçalves R, Leal T
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41784428 · Publisher ↗
INTRODUCTION AND OBJECTIVES: The Urgency Numeric Rating Scale (U-NRS) assesses the severity of bowel urgency, a common symptom that is often underestimated in ulcerative colitis. This study aimed to translate the U-NRS i...
INTRODUCTION AND OBJECTIVES: The Urgency Numeric Rating Scale (U-NRS) assesses the severity of bowel urgency, a common symptom that is often underestimated in ulcerative colitis. This study aimed to translate the U-NRS into Portuguese and to provide validation in clinical practice, as well as to assess the prevalence of bowel urgency in a cohort of ulcerative colitis patients and, in those in clinical remission, to evaluate its relationship with endoscopic and histological activity and manometric changes. METHODS: After translation of the U-NRS into Portuguese, patients with ulcerative colitis seen at the outpatient clinic were asked to complete the scale at T0, after 2 weeks (T1) and after 3 months (T2). Patient-reported outcome-2 ulcerative colitis (PRO-2-UC), EQ-5D, EQ-Visual Analogue Scale (EQ-VAS), inflammatory bowel disease disk (IBD-Disk), and the Global Perceived Effect Scale were also completed. Acceptability, reliability, construct validity, responsiveness, and interpretability were assessed. A subgroup of patients in clinical remission with bowel urgency underwent sigmoidoscopy with rectal biopsies and anorectal manometry and were compared with a control group (in clinical remission without bowel urgency). RESULTS: In total, 126 patients were included, of whom 49.21% ( n = 62) had bowel urgency. Test-retest reliability was excellent (intraclass correlation coefficient: 0.768). The U-NRS correlated significantly with the PRO-2-UC, IBD-Disk, EQ-VAS, and EQ-5D ( P < 0.001), demonstrating construct validity. The U-NRS values correlated with the first constant sensation volume on anorectal manometry ( rs = -0.374, P = 0.038). CONCLUSION: The U-NRS scale is an easy and quick tool for assessing bowel urgency and can be incorporated into clinical practice.
Agile 3+ and Agile 4 scores are accurate to detect advanced metabolic dysfunction-associated steatotic liver disease.
Manica M, Ferreira LF, Villela-Nogueira CA … +6 more , Parise ER, Leite NC, Cardoso ACF, de Azevedo ALF, Ruffeil NLS, Tovo CV
Eur J Gastroenterol Hepatol · 2026 Apr · PMID 41784427 · Full text
BACKGROUND: The prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) is related to the presence of liver fibrosis (LF). The Agile 3+ and Agile 4 scores are proposed as noninvasive methods to iden...
BACKGROUND: The prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) is related to the presence of liver fibrosis (LF). The Agile 3+ and Agile 4 scores are proposed as noninvasive methods to identify advanced LF and cirrhosis, respectively, associating vibration-controlled transient elastography (VCTE) with clinical and laboratorial data. AIM: To evaluate the performance of Agile scores in the assessment of LF in MASLD patients. METHODS: This is a cross-sectional multicentric study conducted at three gastroenterology/hepatology outpatient units from Brazil, including individuals with biopsy-proven MASLD. To calculate the Agile 3+ and Agile 4 scores for the evaluation of advanced fibrosis (F≥3) and cirrhosis (F4), respectively, the formula proposed by Sanyal et al . was applied. RESULTS: A total of 220 patients were included, mostly women ( n = 146; 66%) and with diabetes ( n = 136; 61.5%). The prevalence of advanced fibrosis and cirrhosis was 21.82% ( n = 48) and 9.55% ( n = 21), respectively. There was a strong correlation between Agile 3+ ( r = 0.751) and VCTE ( r = 0.729) with the LF stage evaluated by liver biopsy, while the correlation of Agile 4 was moderate ( r = 0.535). However, the Agile 3+ and Agile 4 scores have shown high sensitivity and specificity (higher than 80% in all cases) when compared to liver biopsy. Also, there was significance in the area under the ROC curve, which was inferior than 0.5 for all cases. CONCLUSION: A good correlation was confirmed between the Agile scores and VCTE with the stages of fibrosis in MASLD individuals, classifying correctly the presence of LF and cirrhosis better than VCTE solo, with a smaller indeterminate zone.
Impact of biosimilars on the costs of advanced therapies for inflammatory bowel diseases: a population-based study in Italy.
Tursi A, Elisei W, Terlizzi AP … +8 more , Antonino N, Casamassima C, Rizzi FV, Di Pierro F, Di Brino E, De Chiara C, Covino M, Papa A
Eur J Gastroenterol Hepatol · 2026 Aug · PMID 41784426 · Publisher ↗
OBJECTIVE: The use of advanced therapies (biologics and small molecules) for treating inflammatory bowel diseases (IBD) has increased in recent years. We aimed to evaluate the incidence and prevalence of IBD in an Italia...
OBJECTIVE: The use of advanced therapies (biologics and small molecules) for treating inflammatory bowel diseases (IBD) has increased in recent years. We aimed to evaluate the incidence and prevalence of IBD in an Italian province (Barletta-Andria-Trani), the rate of IBD patients treated with advanced therapies, and their costs. METHODS: Case searching used predefined read codes to systematically search computer diagnostic and prescription records from 1 January 2018 to 31 December 2023. All the cases of ulcerative colitis and Crohn's disease were extracted from the electronic database of the Local Health Agency 'Barletta-Andria-Trani'. The same database was queried to assess the rate of IBD patients treated with advanced therapies. RESULTS: During the observational period, the prevalence of Crohn's disease and ulcerative colitis increased significantly from 146.6/100 000 to 203.6/100 000 [95% confidence interval (CI): 0.09-0.11] and from 303.2/100 000 to 408.3/100 000 (95% CI: 0.05-0.06), respectively. The incidence of Crohn's disease and ulcerative colitis showed no statistically significant increase: from 8.3/100 000 to 10.5/100 000 (95% CI: -0.6 to 1.44) and from 13.7/100 000 to 17.6/100 000 (95% CI: -0.12 to 1.6), respectively. The rate of IBD patients treated with advanced therapies increased from 11.9 to 19.3%. Opposite, the costs for advanced therapies decreased from € 1 481 558.19 to 1 171 132.50 (-20.95%). CONCLUSION: This population-based study found increased advanced therapies use partially because of the higher IBD prevalence observed during the study period, but with decreasing costs, mainly attributable to the significant use of anti-tumor necrosis factor αlpha biosimilars.
Tissue penetration of anti-tumour necrosis factor therapy in perianal fistulising Crohn's disease: a proof-of-concept study.
Anandabaskaran S, Liu Z, Hanna L … +6 more , Lung P, Alexander JL, Powell N, Connor SJ, Tozer P, Hart A
Eur J Gastroenterol Hepatol · 2026 Aug · PMID 41784425 · Full text
BACKGROUND: Perianal fistulising Crohn's disease (pfCD) remains a therapeutic challenge, with a limited sustained response to biological therapy. Although higher serum anti-tumour necrosis factor (TNF) levels are associa...
BACKGROUND: Perianal fistulising Crohn's disease (pfCD) remains a therapeutic challenge, with a limited sustained response to biological therapy. Although higher serum anti-tumour necrosis factor (TNF) levels are associated with improved fistula healing, tissue pharmacokinetics in pfCD are poorly understood. This proof-of-concept study aimed to establish the feasibility of quantifying anti-TNF concentrations within fistula tissue and evaluate their relationship with serum levels and treatment outcomes. METHODS: Paired blood and fistula tract biopsies were obtained from 14 patients (infliximab, seven; adalimumab, seven) with active pfCD on established anti-TNF therapy (>14 weeks post-induction). The serum was processed by centrifugation within 8 h and stored at -80°C. Fistula tract biopsies were snap-frozen, homogenised, and extracted using an ELISA buffer proportional to tissue weight. Anti-TNF levels in the serum and tissue supernatants were quantified using standard and high-sensitivity ELISA assays, respectively. RESULTS: All patients had detectable anti-TNF concentrations in both serum and fistula tissues. Tissue and serum levels showed a moderate positive correlation ( r = 0.45, P = 0.09), with a stronger and statistically significant association in the infliximab subgroup ( r = 0.81, P = 0.01). Higher fistula-to-serum ratios, reflecting enhanced tissue penetration, tended towards improved clinical and radiological outcomes and lower perianal disease activity index scores, although the difference was not statistically significant. CONCLUSION: Anti-TNF levels in perianal fistula tissue are measurable and correlated with serum concentrations, supporting a mechanistic link between systemic exposure and local drug penetration. These findings highlight the feasibility of tissue-level pharmacokinetic assessments and warrant validation in larger prospective cohorts.
Coexistence of hepatopulmonary syndrome and portopulmonary hypertension before a liver transplantation: a case report and review of the literature.
Tazibt D, Vacelet V, Vendeville S … +2 more , Seronde MF, Thévenot T
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41784424 · Publisher ↗
Liver transplantation remains the treatment of choice for hepatopulmonary syndrome (HPS) with severe hypoxemia, but portopulmonary hypertension (PoPH) has traditionally been viewed as a contraindication to liver transpla...
Liver transplantation remains the treatment of choice for hepatopulmonary syndrome (HPS) with severe hypoxemia, but portopulmonary hypertension (PoPH) has traditionally been viewed as a contraindication to liver transplantation owing to its frequent posttransplant deterioration. We describe here the sequential presence of both pulmonary vascular disorders in a cirrhotic patient in the pretransplant period. Liver transplantation was made possible following effective management of pulmonary hypertension, with favorable outcome 3 years post-liver transplantation. Finally, our case report and literature review suggest that the coexistence of HPS and PoPH in patients with advanced liver disease could be more common than previously recognized.
Metabolic dysfunction-associated fatty liver disease is an independent risk factor for advanced colorectal adenoma or cancer.
Bae JK, Park JJ, Kim SU … +1 more , Youn YH
Eur J Gastroenterol Hepatol · 2026 May · PMID 41784423 · Publisher ↗
BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We investigated whether MAFLD or its respectiv...
BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We investigated whether MAFLD or its respective subtypes were associated with the risk of advanced colorectal neoplasia (ACN), including age-specific associations. METHODS: This single-centre retrospective study included 21 642 participants who underwent medical health check-ups. Participants were categorised by fatty liver disease presence (NAFLD or MAFLD). Patients with MAFLD were categorised into three subtypes: overweight-MAFLD, lean-MAFLD, and diabetes-MAFLD. The fibrosis-4 index assessed hepatic fibrotic burden. RESULTS: Both NAFLD and MAFLD were significantly associated with nonadvanced colorectal neoplasia risk [odds ratio (OR) = 1.19 and 1.34, respectively; P < 0.05]. In contrast, NAFLD was not significantly associated with ACN risk. Multivariate analysis showed that MAFLD was independently associated with increased ACN risk (OR = 1.20, P < 0.05). Among MAFLD subtypes, diabetes-MAFLD alone was independently associated with increased ACN risk (OR = 1.56, P < 0.05). This MAFLD-ACN association was significant only in patients aged less than or equal to 50 years (OR = 2.54 for 30-39 years and OR = 1.43 for 40-49 years, all P < 0.05). High hepatic fibrotic burden (fibrosis-4 greater than or equal to 1.3) was associated with higher ACN risk in MAFLD patients (OR = 1.31, P < 0.05). CONCLUSION: MAFLD was independently associated with an increased risk of ACN; however, this association differed according to age and MAFLD subtype. Patients with MAFLD, especially those with high fibrotic burden, underlying diabetes, or aged less than or equal to 50 years, may benefit from appropriate colorectal cancer screening.
Glucagon-like peptide-1 receptor agonist reduces risk of alcohol-associated cirrhosis in type 2 diabetes and alcohol use disorder patients.
Hwang SY, Hsieh P, Díaz LA … +5 more , Goodman RP, Schaefer EA, Wong RJ, Luther J, Zhang W
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41784422 · Publisher ↗
OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can reduce alcohol consumption and craving; however, it is unclear whether GLP-1 RAs can prevent the development of alcohol-associated cirrhosis. We analyz...
OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can reduce alcohol consumption and craving; however, it is unclear whether GLP-1 RAs can prevent the development of alcohol-associated cirrhosis. We analyzed the incidence of cirrhosis and hepatic decompensation in individuals with type 2 diabetes and alcohol use disorder (AUD) who received GLP-1 RAs compared with other antidiabetic medications. METHODS: Using the TriNetX database, we identified adult patients with AUD and type 2 diabetes between 2010 and 2022 and compared outcomes among patients who received either a GLP-1 RA or other antidiabetic medications. Primary outcomes were alcohol-associated cirrhosis and its complications, and a propensity score model was built adjusting for demographics, comorbidities, AUD treatment, BMI, hemoglobin A1c, and alanine aminotransferase. RESULTS: After matching, sample sizes ranged from 2543 patients each in the GLP-1 RA versus thiazolidinedione group to 6776 patients each in the GLP-1 RA versus sulfonylurea group. The hazard ratio of GLP-1 RA versus dipeptidyl peptidase 4 inhibitor on any cirrhosis or decompensation event was 0.684 [95% confidence interval (CI): 0.615-0.762], while the hazard ratio of GLP-1 RA versus metformin was 0.87 (95% CI: 0.752-1.006). In patients with obesity, GLP-1 RA exhibited a lower risk of any cirrhosis or decompensation event than insulin group (hazard ratio: 0.327, 95% CI: 0.263-0.406) and sodium-glucose co-transporter 2 inhibitor group (hazard ratio: 0.81, 95% CI: 0.674-0.973), whereas in nonobese patients, GLP-1 RA showed a lower risk of any cirrhosis or decompensation event compared with the insulin group (hazard ratio: 0.222, 95% CI: 0.133-0.373) and dipeptidyl peptidase 4 inhibitor group (hazard ratio: 0.732, 95% CI: 0.574-0.933). CONCLUSION: GLP-1 RAs were associated with lower odds of the development of advanced alcohol-associated liver disease, including cirrhosis or hepatic decompensation.
EndoFLIP® in real-world esophagology: a versatile tool for diagnosing and managing dysphagia across diverse clinical scenarios.
Gonçalves R, Peixoto A, Santos AL … +1 more , Macedo G
Eur J Gastroenterol Hepatol · 2026 Jul · PMID 41784421 · Publisher ↗
BACKGROUND: High-resolution manometry (HRM) is the gold standard for evaluating esophageal motility but may be inconclusive, poorly tolerated, or unavailable. The Endoluminal Functional Lumen Imaging Probe (EndoFLIP) pro...
BACKGROUND: High-resolution manometry (HRM) is the gold standard for evaluating esophageal motility but may be inconclusive, poorly tolerated, or unavailable. The Endoluminal Functional Lumen Imaging Probe (EndoFLIP) provides real-time assessment of esophageal distensibility and contractility and is emerging as a complementary diagnostic modality. AIM: To evaluate the impact of routine EndoFLIP use across diverse esophageal pathologies, particularly when HRM is inconclusive or unavailable and to contextualize findings within current evidence. METHODS: We retrospectively analyzed 106 adults with dysphagia who underwent endoscopy with EndoFLIP (16-cm catheter). Indications included inconclusive/unavailable HRM ( n = 27), suspected esophagogastric junction outflow obstruction (EGJOO, n = 14), eosinophilic esophagitis (EoE, n = 29), achalasia ( n = 13), and postsurgical dysphagia ( n = 23). Distensibility index, cross-sectional area, and maximal diameter were correlated with endoscopic, histologic, and clinical data. RESULTS: EndoFLIP clarified diagnoses in 92.6% of inconclusive HRM cases and prompted management changes in 81.1% overall. Only 2/14 EGJOO patients showed reduced esophagogastric junction distensibility, avoiding unnecessary interventions in the remainder. In EoE, 86.2% exhibited reduced distensibility, leading to dilation ( n = 6) or escalation to biologic therapy ( n = 3). In achalasia, EndoFLIP-guided referral for peroral endoscopic myotomy or Heller myotomy enabled posttreatment assessment. In postsurgical dysphagia, reduced distensibility was detected in 45% of cases, prompting intra-procedure intervention in 44%. CONCLUSION: EndoFLIP provides objective, real-time evaluation of esophageal mechanics, enhancing diagnostic accuracy and facilitating targeted therapy in complex or indeterminate cases. These findings, consistent with contemporary literature, support its integration into routine esophageal assessment.
SAFE vs. FIB-4: diagnostic accuracy for clinically significant fibrosis in U.S. adults with cardiometabolic risk factors - a NHANES 2017-2020 analysis.
Aydin A, Aydin Y, Borz-Baba CI
Eur J Gastroenterol Hepatol · 2026 Jun · PMID 41784418 · Publisher ↗
BACKGROUND: Steatotic liver disease (SLD), largely driven by cardiometabolic dysfunction, affects nearly one-third of the global population and may progress to advanced fibrosis. Although liver biopsy remains the gold st...
BACKGROUND: Steatotic liver disease (SLD), largely driven by cardiometabolic dysfunction, affects nearly one-third of the global population and may progress to advanced fibrosis. Although liver biopsy remains the gold standard for fibrosis assessment, noninvasive tools such as the Fibrosis-4 (FIB-4) and the recently developed steatosis-associated fibrosis estimator (SAFE) score are used risk stratification. We compared the diagnostic accuracy of FIB-4 and SAFE for detecting clinically significant fibrosis in adults with cardiometabolic risk factors. METHODS: We conducted a cross-sectional analysis of 2196 adults aged 18-80 years from the National Health and Nutrition Examination Survey (2017-2020) with valid liver stiffness measurements (LSM) by FibroScan. Individuals with known chronic liver disease, excessive alcohol use, or missing data were excluded. Clinically significant fibrosis was defined as LSM ≥ 8.0 kPa. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, and area under the receiver operating characteristic curve (AUC). RESULTS: SAFE demonstrated superior discrimination compared with FIB-4 (AUC 0.719 vs. 0.578; P < 0.001). As a rule-out test, SAFE showed higher sensitivity (78% vs. 41%) and negative predictive value (95% vs. 91%). FIB-4 missed 58.6% of patients with significant fibrosis, whereas SAFE missed 22%. SAFE consistently outperformed FIB-4 across age, sex, MASLD status, and glycemic control subgroups. CONCLUSION: These findings support the use of SAFE over FIB-4 as a noninvasive screening tool for significant fibrosis in patients with cardiometabolic risk factors.
Endoscopic retrograde cholangiopancreatography discharge tool combined with rapid trypsinogen-2 test to predict same-day discharge: a prospective cohort study.
Memon GM
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41757618 · Publisher ↗
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Nonobese nonalcoholic fatty liver disease is not a low-risk phenotype: cardiometabolic, fibrosis, and thyroid-related implications across body mass index categories.
Zhang J, Yang B
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41757617 · Publisher ↗
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Uncontrolled socioeconomic status: a potential challenge to conclusions on sex-based disparities in hepatocellular carcinoma recurrence.
Chen S, Chen Y, Xu Y … +1 more , Song B
Eur J Gastroenterol Hepatol · 2026 Mar · PMID 41757616 · Publisher ↗
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