López-Vicente J, Rodríguez-Alcalde D, Hernández Villalba L
… +7 more, Pedregal Pascual P, Adán Merino L, Polo Ortiz F, Bessa Caserras X, Marín Gabriel JC, Varillas Delgado D, endoscopy for high-risk cancer conditions group of the Spanish Gastroenterological Association, Spanish Society of Digestive Endoscopy
BACKGROUND: Serrated polyposis syndrome, the most prevalent colonic polyposis, confers an increased colorectal cancer risk. Guidelines recommend close colonoscopy surveillance, but recent data suggest low neoplasia rates...BACKGROUND: Serrated polyposis syndrome, the most prevalent colonic polyposis, confers an increased colorectal cancer risk. Guidelines recommend close colonoscopy surveillance, but recent data suggest low neoplasia rates, supporting longer colonoscopy intervals. AIMS: Compare advanced neoplasia incidence between two- and three-year surveillance. METHODS: A multicentre, randomized non-inferiority trial was conducted (May 2021-November 2024) in six Spanish hospitals. Patients fulfilling the 2019 WHO criteria for serrated polyposis syndrome, including newly diagnosed individuals and those already under surveillance, with no advanced neoplasia and fewer than five relevant polyps at their previous colonoscopy, were randomized to surveillance at 2 or 3 years. The primary endpoint was advanced neoplasia incidence. RESULTS: A total of 131 patients with serrated polyposis syndrome were included (47.3% women; mean age 66.1). Seventy-two were assigned to 2-year and 59 to 3-year colonoscopy. Among 771 resected lesions, 2.4% were advanced adenomas or advanced serrated polyps; no colorectal cancer was detected. The proportion of patients with advanced neoplasia in the surveillance colonoscopy was 6.9% (2-year) vs 13.6% (3-year), with no statistical difference (p = 0.208) but with a risk difference of + 6.7% (95% CI -4.1 to 17.5%) exceeding the pre-specified non-inferiority margin of + 10%. Time since serrated polyposis syndrome diagnosis ≤ 3 years was associated with advanced neoplasia (OR 4.4; 95% CI 1.56-14.71; p = 0.024). CONCLUSIONS: In patients with serrated polyposis syndrome, extending colonoscopy surveillance to a three-year compared with a two-year interval yielded inconclusive evidence regarding non-inferiority for advanced neoplasia incidence. The early years following serrated polyposis syndrome diagnosis were identified as a risk factor for advanced neoplasia. TRIAL REGISTRATION: Clinical Trial Registry ClinicalTrials.gov (NCT04906343). Date: 5-10-2021.
BACKGROUND: Candida overgrowth in the small intestine can cause non-specific gastrointestinal symptoms mimicking those of other conditions, making diagnosis challenging. AIMS: To describe the characteristics of patients...BACKGROUND: Candida overgrowth in the small intestine can cause non-specific gastrointestinal symptoms mimicking those of other conditions, making diagnosis challenging. AIMS: To describe the characteristics of patients with Candida-related intestinal illness in a large US commercial health insurance claims dataset. METHODS: We used the Merative™ MarketScan® Commercial/Medicare Database to identify patients who received Candida enteritis diagnosis codes. RESULTS: We identified 3,710 patients. Rates were higher among women (20.3/100,000), patients ages 35-44 (19.3/100,000) and in the West (28.1/100,000). Fatigue (44%) and abdominal pain (26%) were common symptoms. Few patients (6%) received an esophagogastroduodenoscopy, the preferred diagnostic method, and 38% received systemic antifungal therapy. CONCLUSIONS: Increased healthcare provider awareness about proper diagnosis and treatment of intestinal Candida overgrowth could be beneficial.
PURPOSE: Alcohol-associated liver disease (ALD) carries significant health care burden as it is the leading indication for hospitalization and liver transplantation among patients with chronic liver disease. Key challeng...PURPOSE: Alcohol-associated liver disease (ALD) carries significant health care burden as it is the leading indication for hospitalization and liver transplantation among patients with chronic liver disease. Key challenge with ALD remains a delay in its diagnosis during the asymptomatic stage warranting the need for improved screening for heavy alcohol use. Further, given the impact of alcohol use in steatotic liver disease, accurate assessment of alcohol use is paramount. The aim of this study is to review the challenges associated with alcohol assessment, importance of subjective assessment, while reviewing available objective tools to assess for alcohol use. METHODS: We searched PubMed for studies evaluating the epidemiology of ALD, self-reporting tools and biomarkers available for assessing alcohol use across general population and chronic liver disease patients. Relevant articles and references were individually reviewed and included. RESULTS: All patients should undergo screening for alcohol use with brief questionnaires. Detailed alcohol assessments should be completed in patients who screen positively on brief questionnaires. Patients undergoing evaluation for steatotic or chronic liver disease warrant a more thorough evaluation with inclusion of objective biomarkers to aid self-reporting questionnaires. Discordant findings between subjective and objective reports should be utilized as an opportunity to engage patients to discuss their alcohol use and review treatment plans to achieve sobriety. CONCLUSION: Accurate alcohol use assessment requires a dual approach in which objective biomarkers are incorporated with self-reporting tools. Early diagnosis of harmful alcohol use accompanied with intervention and referral to treatment can help prevent downstream complications of ALD.
Gastroesophageal reflux disease (GERD) is a prevalent comorbidity of chronic respiratory diseases including idiopathic pulmonary fibrosis (IPF), non-IPF interstitial lung disease, asthma, chronic obstructive pulmonary di...Gastroesophageal reflux disease (GERD) is a prevalent comorbidity of chronic respiratory diseases including idiopathic pulmonary fibrosis (IPF), non-IPF interstitial lung disease, asthma, chronic obstructive pulmonary disease (COPD) and refractory chronic cough. Prevalence of symptoms of reflux and/ or refractory respiratory symptoms, along with concerns that refluxed gastric contents into the esophagus may micro-aspirate into the lungs causing injury and potentially accelerate disease progression, have resulted in high usage of empirical anti-reflux treatments. However, empirical treatment of reflux (medical or mechanical) is frequently ineffective without obvious explanation for the lack of respiratory improvement. This review provides novel and updated understanding of the pathophysiological mechanisms that link upper gut dysfunction, reflux (both distal and proximal), lung structure, lung mechanics and breathing patterns, including the potential role of the vagally mediated esophageal-bronchial reflex and the bi-directional nature of these interactions in individual respiratory diseases. We also highlight the need for a consensus between gastrointestinal and respiratory communities and propose a framework for diagnosing and managing GERD in respiratory disease.
INTRODUCTION: We investigated the impact of racial/ethnic disparities in therapy initiation on colorectal cancer (CRC) mortality using Surveillance, Epidemiology, and End Results Program (SEER) database. METHODS: Adults...INTRODUCTION: We investigated the impact of racial/ethnic disparities in therapy initiation on colorectal cancer (CRC) mortality using Surveillance, Epidemiology, and End Results Program (SEER) database. METHODS: Adults aged 18-84 years with CRC were identified. Cox models for 60-month all-cause and cancer-specific mortality were adjusted for demographics, stage, tumor site, income, and rural-urban residence. RESULTS: Therapy initiation was slower for Hispanics (HR 0.85) and non-Hispanic Black (NHB) patients (HR 0.80) compared with non-Hispanic Whites (p < 0.001). Each additional month of delay was associated with a 3% increase in cancer mortality (p < 0.001). Findings were consistent across diagnosis eras, with no significant race-by-era interaction, and adjustment for socioeconomic and geographic factors resulted in minimal attenuation of racial disparities. CONCLUSION: Treatment delays independently contribute to all-cause and cancer-specific mortality, disproportionately affecting NHB and lower-SES patients.
Celiac disease (CD) is a T-cell-immune mediated enteropathy triggered by gluten ingestion in genetically susceptible individuals. The estimated global prevalence is 1% (range 0.7-1.4%), and the clinical manifestation res...Celiac disease (CD) is a T-cell-immune mediated enteropathy triggered by gluten ingestion in genetically susceptible individuals. The estimated global prevalence is 1% (range 0.7-1.4%), and the clinical manifestation results from a complex interplay of genetic, immunologic, and environmental factors. Although it occurs predominantly in predisposed individuals with the genetic haplotypes HLA-DQ2, HLA-DQ8, or DQA1*05 haplotypes, several other predisposing genes have been described. Clinical presentations are variable and include both gastrointestinal and extraintestinal manifestations, contributing to underdiagnosis. Diagnosis is based on a combination of positive serologic tests-such as IgA tissue transglutaminase and IgG deaminated gliadin peptide in IgA-deficient patients, which are used for screening- characteristic histological findings on duodenal biopsy, and symptom resolution following initiation of a gluten-free diet (GFD). Poorly controlled disease may lead to complications, including osteoporosis, malnutrition, vitamin deficiencies, and small bowel lymphoma. A strict gluten-free diet is the only effective treatment, with symptom improvement typically observed within weeks of initiation of therapy. However, adherence is often challenging, socially isolating, and a multidisciplinary approach is essential for optimal management. Several non-dietary therapeutic strategies are currently under investigation. This review summarizes current evidence on epidemiology, pathophysiology, diagnosis, and management of CD, while highlighting emerging therapeutic strategies and approaches to patient care.
BACKGROUND: Incidental pancreatic cystic lesions (PCLs) are increasingly being detected due to the widespread use of high-resolution imaging. Certain PCL subtypes, including intraductal papillary mucinous neoplasms (IPMN...BACKGROUND: Incidental pancreatic cystic lesions (PCLs) are increasingly being detected due to the widespread use of high-resolution imaging. Certain PCL subtypes, including intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN), carry malignant potential and require guideline-directed surveillance strategies. However, real-world adherence to follow-up recommendations in community healthcare settings remains poorly defined. In this context, we aimed to describe surveillance adherence rates for incidentally detected PCLs. METHODS: This was a single-center retrospective study of consecutive adult patients who were found to have an incidental PCL between June 2017 and January 2024. The primary outcome was adherence to follow-up recommendations. Follow-up was defined as completion of repeat imaging based on radiology recommendations. RESULTS: A total of 108 patients were included. The mean age was 74 ± 10 years, 59% were female, and the majority were White (84%) and retired (79%). Branch-duct IPMN was the most common cyst type (42%). Most patients had a single cyst (68%) with a mean size of 19 ± 12 mm. A history of pancreatitis was uncommon (15%), while obesity (BMI ≥ 30) was present in 49% and 56% were never smokers. Cysts were primarily detected in the outpatient setting (64%), most commonly via computed tomography (70%). Overall, 98% of patients completed surveillance imaging, and 87% had gastroenterology follow-up. CONCLUSION: This study shows that the follow-up rate for incidentally discovered PCLs was exceptionally high. Having an established primary care provider and access to subspecialty gastroenterology services appear to be associated with higher follow-up completion.
Perianal fistulizing Crohn's disease (PFCD) is a chronic, aggressive phenotype associated with an elevated risk of malignancy arising within long-standing fistula tracts. Although rare, PFCD-associated cancers carry a po...Perianal fistulizing Crohn's disease (PFCD) is a chronic, aggressive phenotype associated with an elevated risk of malignancy arising within long-standing fistula tracts. Although rare, PFCD-associated cancers carry a poor prognosis and are often diagnosed late due to overlapping symptoms with active inflammatory disease and the absence of established screening guidelines. We present a case of a 71-year-old man with nearly 50 years of untreated PFCD, who developed mucinous adenocarcinoma arising from a chronic perianal fistula. Despite multiple hospitalizations for recurrent abscesses, sepsis, and fistulizing disease, he initially declined definitive surgical and medical therapy, and later was unable to be initiated on advanced Crohn's treatments due to ongoing infections. Progressive enlargement of a complex perianal abscess and new pelvic collections raised concern for malignant transformation, and exam under anesthesia (EUA) with drainage ultimately revealed mucinous adenocarcinoma. His clinical course rapidly deteriorated, preventing oncologic therapy initiation, after which he was transitioned to hospice. This case highlights key diagnostic challenges in PFCD-associated cancer, including the difficulty distinguishing malignancy from active inflammation with imaging and the need for biopsy via EUA for confirmation. Persistent or new perianal symptoms in patients with long-standing PFCD-particularly beyond 10 years-should prompt urgent evaluation. Although formal guidelines are lacking, early involvement of a multidisciplinary team is essential to optimize diagnosis and management. Greater awareness of this rare complication is needed to support earlier recognition and to inform future strategies for screening and treatment.
BACKGROUND: Sphingosine-1-phosphate receptor (S1PR) modulators have emerged as a novel therapeutic class for ulcerative colitis (UC), yet their overall efficacy and safety across clinical trials have not been comprehensi...BACKGROUND: Sphingosine-1-phosphate receptor (S1PR) modulators have emerged as a novel therapeutic class for ulcerative colitis (UC), yet their overall efficacy and safety across clinical trials have not been comprehensively evaluated. This meta-analysis assesses the impact of S1PR modulators on clinical, endoscopic, and histological outcomes in UC. METHODS: A systematic search of PubMed, CENTRAL, Google Scholar, and ClinicalTrials.gov was conducted through November 20, 2025. Randomized controlled trials evaluating S1PR modulators in adults with UC were included. Risk of bias was assessed using the RoB 2 tool, and pooled estimates were calculated using a random-effects model. RESULTS: Eight trials involving 2663 participants were included. Analysis comparing S1PR modulators with placebo included etrasimod, ozanimod, tamuzimod, and KRP203. S1PR modulators significantly improved clinical response during induction (RR 2.47; p < 0.00001) and maintenance (RR 3.30; p = 0.0002). Clinical remission was also significantly increased in both the induction (RR 1.84; p < 0.00001) and maintenance phases (RR 2.20; p = 0.0001). Endoscopic improvement was significantly enhanced during induction (RR 2.32; p < 0.00001) and remained significant in maintenance (RR 1.95; p = 0.03). Histological remission improved significantly in both induction (RR 2.59; p < 0.00001) and maintenance (RR 2.60; p < 0.00001). Mucosal healing was significantly increased in the induction (RR 2.54; p < 0.00001) and maintenance phases (RR 2.21; p < 0.00001). Adverse events were slightly increased with S1PR modulators (RR 1.13; p = 0.002), while serious adverse events (p = 0.73) and discontinuations (p = 0.67) did not differ significantly from placebo. CONCLUSION: S1PR modulators demonstrate robust efficacy during the induction phase across all key clinical and tissue-based outcomes, with more modest or variable effects during maintenance. Their safety profile remains acceptable, supporting their role as a promising therapeutic option for UC.