BACKGROUND: Biliary adverse events (AEs) have been reported with glucagon-like peptide-1 receptor agonists (GLP-1RAs), but within-class differences remain unclear. METHODS: We conducted a disproportionality analysis of F...BACKGROUND: Biliary adverse events (AEs) have been reported with glucagon-like peptide-1 receptor agonists (GLP-1RAs), but within-class differences remain unclear. METHODS: We conducted a disproportionality analysis of FAERS comparing biliary outcomes (cholelithiasis, cholecystitis, biliary colic, bile duct stone, and cholangitis) across semaglutide, tirzepatide, liraglutide, exenatide, and dulaglutide; semaglutide was used as the reference agent. Proportional reporting ratios (PRR), reporting odds ratios (ROR), 95% confidence intervals, and Fisher exact tests were calculated. Subgroup analyses and sensitivity analyses were performed. RESULTS: After deduplication, 3460 reports were analyzed: semaglutide 1797, tirzepatide 1363, liraglutide 1033, exenatide 999, and dulaglutide 574. Compared with semaglutide, exenatide and tirzepatide showed lower reporting for bile duct stone (PRR 0.39 and 0.58), while exenatide and dulaglutide showed lower reporting for biliary colic (PRR 0.30 and 0.50). Dulaglutide showed higher reporting for cholangitis (PRR 1.65). Exenatide, liraglutide, and tirzepatide showed higher reporting for cholecystitis (PRR 1.12, 1.07, and 1.05) and cholelithiasis (PRR 1.33, 1.21, and 1.15). Subgroup findings were consistent with heterogeneity mainly observed for bile duct stone and biliary colic. Sensitivity analyses was largely concordant, although rarer outcomes lost significance. CONCLUSIONS: Biliary AE reporting varies across GLP-1RAs, highlighting agent-specific differences within class and the need for individualized prescribing and counseling.
Yagi S, Furukawa S, Miyake T
… +14 more, Yoshida O, Tange K, Kitahata S, Ninomiya T, Hanayama M, Suzuki S, Shibata N, Murakami H, Ohashi K, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y
OBJECTIVE: Evidence regarding the association between oral environment and the inflammatory bowel disease (IBD), including ulcerative colitis (UC), exists. However, evidence regarding the association between oral health...OBJECTIVE: Evidence regarding the association between oral environment and the inflammatory bowel disease (IBD), including ulcerative colitis (UC), exists. However, evidence regarding the association between oral health parameters and disease activity of UC is limited. This study aimed to evaluate the association between remaining tooth number and toothbrushing frequency and mucosal healing (MH) in Japanese UC patients. METHOD: The study included 275 patients with UC. Information on lifestyle and oral health parameters was collected via self-administered questionnaires. The definition of MH was based on the Mayo endoscopic subscore (MES) of 0. RESULTS: The prevalence of MH in this cohort was 24.7%. The distribution of remaining teeth was as follows: 13.1% had 20 or fewer teeth, 32.7% had 20-27 teeth, and 54.2% had 28 teeth. Toothbrushing frequency was 23.6% brushed once or less per day, 46.9% brushed twice per day, and 29.5% brushed three or more times per day. No significant difference was observed between remaining teeth and MH. However, toothbrushing frequency is independently positively associated with MH (adjusted odds ratio: 2.87 [95% CI: 1.19-7.29]; p value for trend = 0.021). CONCLUSION: Toothbrushing frequency but not the remaining tooth number might be independently and positively associated with MH in Japanese patients with UC.
BACKGROUND: Nationwide trends in the incidence and prevalence of acute pancreatitis (AP), a leading cause of gastrointestinal hospitalization in the United States (US), remain insufficiently characterized. This study aim...BACKGROUND: Nationwide trends in the incidence and prevalence of acute pancreatitis (AP), a leading cause of gastrointestinal hospitalization in the United States (US), remain insufficiently characterized. This study aims to describe the temporal trends in the incidence and prevalence of AP, as well as by etiology, in the US from 1995 to 2024. METHODS: Adults with AP were identified using TriNetX, a database encompassing over 120 million US individuals, between 1995 and 2024, using ICD-9 and ICD-10-CM codes. Etiologies were identified using ICD-10-CM codes from 2016. Annual age-standardized incidence rates (ASIR) and prevalence rates (ASPR) per 100,000 persons standardized to the 2000 US census population were calculated. Joinpoint regression identified temporal changes in ASIRs and ASPRs, reporting annual percentage changes (APCs) and average APCs (AAPCs), along with 95% confidence intervals (95%CIs). Interrupted time-series analysis assessed the impact of key events on AP trends. RESULTS: Between 1995 and 2024, 558,264 AP cases were identified. ASIR increased from 23.05 per 100,000 in 1999 to 116.69 per 100,000 in 2024 (AAPC 4.81%; 95%CI, 3.95-5.69; p < 0.001), while ASPR rose from 68.52 per 100,000 in 1995 to 615.72 per 100,000 in 2024 (AAPC 6.66%; 95%CI, 6.23-7.08; p < 0.001). Rates were consistently higher in males, although AAPCs were similar across sexes. Incidence of alcohol-induced AP increased significantly since 2016, particularly among females, while drug-induced, gallstone, and idiopathic etiologies remained stable. CONCLUSIONS: The incidence and prevalence of AP in the US rose substantially over three decades. Alcohol-induced AP is the only etiology with a significant increase in incidence regardless of sex.
PURPOSE: Biologic therapies, including tumor necrosis factor (TNF) blockers, vedolizumab (VDZ), and ustekinumab (UST), are generally considered safe during pregnancy in patients with inflammatory bowel disease (IBD), tho...PURPOSE: Biologic therapies, including tumor necrosis factor (TNF) blockers, vedolizumab (VDZ), and ustekinumab (UST), are generally considered safe during pregnancy in patients with inflammatory bowel disease (IBD), though comparative data remain limited. This meta-analysis examines their safety and effectiveness. METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane, and Web of Science was conducted through July 2025. Eligible studies reported maternal or neonatal outcomes in pregnant IBD patients treated with biologics. Studies were pooled using a random-effects model to calculate risk ratios (RRs) with 95% confidence intervals. Heterogeneity was assessed using I. Primary outcomes were preterm birth and disease activity; secondary outcomes included pregnancy and neonatal outcomes. RESULTS: Nine observational studies (n = 6,054) were included. Compared to TNF blockers, VDZ was associated with a higher risk of preterm delivery (RR = 1.35, 95% CI 1.04-1.75, I = 0%) and active disease (RR = 1.55, 95% CI 1.01-2.40, I = 50%). UST was associated with a higher risk of active disease (RR = 1.30, 95% CI 1.06-1.60, I = 0%) and congenital anomalies (RR = 2.08, 95% CI 1.30-3.32, I = 0%) compared to TNF blockers. Compared to UST, VDZ was linked to increased risks of preterm birth (RR = 2.60, 95% CI 1.03-6.57, I = 0%) and low birth weight (RR = 2.38, 95% CI 1.01-5.60, I = 0%). No significant differences were observed for live births, abortions, hospitalizations, or neonatal infections. CONCLUSION: TNF blockers showed a favorable safety and effectiveness profile, VDZ and UST performed broadly similar, and all three biological classes appeared compatible with safe use in pregnancy to maintain effective disease control. Observed differences reflect that VDZ and UST cohorts likely had longer disease duration, prior biologic exposure, and more active disease. The results of this meta-analysis support the continuation of biologic therapy for disease control in pregnant patients with IBD. Treatment decisions should be individualized and tailored to each patient's clinical context.
BACKGROUND: Dolichocolon (DC) is an underrecognized anatomic variant associated with constipation; its association with ulcerative colitis (UC) is unknown. METHODS: We retrospectively reviewed abdominal MRI and CT scans...BACKGROUND: Dolichocolon (DC) is an underrecognized anatomic variant associated with constipation; its association with ulcerative colitis (UC) is unknown. METHODS: We retrospectively reviewed abdominal MRI and CT scans in children with UC, Crohn's disease (CD), and non-inflammatory bowel disease (non-IBD) controls, classifying DC subtypes. RESULTS: A total of 111 cases (66 with UC) were examined. DC was similarly common (p = 0.4436) in patients with constipated (69%) or non-constipated (NC-UC: 57%) UC. In non-constipated (NC) patients, DC prevalence was higher in children with UC than those with CD or controls. Type 1 DC predominated in NC children with proctitis/left-sided UC (E1/E2), while Type 2 DC was enriched in children with extensive/pancolitis (E3/E4). DISCUSSION: DC may be associated with different phenotypes of UC and may influence disease distribution independent of constipation. However, given the cross-sectional design of this study, these associations should be interpreted cautiously and require confirmation in longitudinal studies.
BACKGROUND: Self-expandable metallic stents (SEMSs) are widely used for palliation of malignant esophageal strictures and esophago-respiratory fistulas. As longer survival is achieved with contemporary systemic therapy,...BACKGROUND: Self-expandable metallic stents (SEMSs) are widely used for palliation of malignant esophageal strictures and esophago-respiratory fistulas. As longer survival is achieved with contemporary systemic therapy, late complications, particularly stent obstruction, are increasingly reported. AIMS: We evaluated the outcomes and late complications of stent placement, focusing on obstruction. METHODS: This single-center, retrospective cohort study included patients who underwent SEMS placement for malignant esophageal strictures or fistulas between February 2009 and February 2024. Dysphagia severity and oral intake were assessed using dysphagia scores, and adverse events were recorded. Patients with or without obstruction were compared. RESULTS: Among the 103 included patients (median age: 74 years, 76% male), 67% had primary esophageal cancer. The technical success rate was 99%, and one patient died from intraoperative perforation. The median dysphagia score improved from 3 to 1 after placement, and 94% of patients could swallow liquids. Overall, adverse events occurred in 24% of cases; early (≤ 30 days) events included perforation, migration, obstruction, pain, bronchial obstruction, and aspiration pneumonia, with two hospital deaths possibly procedure-related. Late (> 30 days) events included obstruction in 11 patients (11%) and migration in 2 patients (2%). Twelve cases of obstruction occurred (11 late, 1 early), 7 of which were caused by epithelial hyperplasia (58%), the most common cause. The median survival time was 85 days and was longer in obstruction cases. CONCLUSIONS: Stent placement is effective and considered safe. As systemic therapy evolves and some patients survive longer, epithelial hyperplasia-related late obstruction has become clinically relevant.
BACKGROUND: Artificial intelligence (AI) is transforming inflammatory bowel disease (IBD) care, but concerns over data quality, privacy, and provider familiarity remain. AIMS: To examine international health care provide...BACKGROUND: Artificial intelligence (AI) is transforming inflammatory bowel disease (IBD) care, but concerns over data quality, privacy, and provider familiarity remain. AIMS: To examine international health care providers' (HCPs) perceptions, clinical use of, and barriers to applying AI in IBD care. METHODS: An anonymous 17-item survey was developed and pretested by an international team. The survey was fielded internationally from January to May 2025 via social media, international IBD newsletters and email listservs. RESULTS: Of 323 IBD professionals from North America (35.3%), Europe (26.0%), Asia-Pacific (19.2%), 207 (64.1%) viewed AI as very or extremely promising. AI-assisted endoscopy was reportedly adopted by 131 (40.6%) of respondents, but only 69 (21.4%) reported applying AI in IBD care or research. Males supported AI in IBD endoscopic scoring (89.9% vs. 79.1%, p = 0.009) and radiomics more than females (86.6% vs. 75.2%, p = 0.022), while females endorsed AI for patient education more than males (81.5% vs. 70.6%, p = 0.026). 145 (44.9%) respondents were concerned about AI usage in IBD care. Females were less concerned about cost (18.5% vs. 30.1%, p = 0.019) and more concerned about oversight (28.7% vs. 14.7%, p = 0.003). Concerns regarding AI usage decreased with age (OR 0.021 for age > 55 compared to age 25-34 years old; 95% CI 0.13-0.84). Exposure to IBD-focused AI-based tools was associated with more favorable perceptions of AI use in IBD care (OR 2.63, 95% CI 1.25-5.53). CONCLUSION: Based upon survey results, HCPs had concerns over insufficient education, regulatory ambiguity, and perplexing implementation strategies for AI. Proven clinical benefit (74.9%) and adequate AI training (72.1%) are the top solutions for enabling the appropriate adoption of AI tools in IBD.
BACKGROUND: Sarcopenia after liver transplantation is poorly characterized in recipients with metabolic dysfunction-associated steatotic liver disease (MASLD) and severe obesity. We evaluated longitudinal changes in psoa...BACKGROUND: Sarcopenia after liver transplantation is poorly characterized in recipients with metabolic dysfunction-associated steatotic liver disease (MASLD) and severe obesity. We evaluated longitudinal changes in psoas muscle index (PMI) after transplantation and examined whether PMI trajectory was associated with post-transplant survival. METHODS: We performed a retrospective single-center study of adults with MASLD and body mass index ≥ 35 kg/m who underwent orthotopic liver transplantation between January 2015 and June 2023. PMI was measured on computed tomography at the L3 level before transplantation and at 6 months, 1 year, 3 years, and 5 years when available. Longitudinal change was assessed using linear mixed-effects models adjusted for survival status. Survival analyses included Kaplan-Meier estimation and univariate logistic regression. RESULTS: Seventy-three recipients were included; mean age was 59.3 years, 50.7% were women, median body mass index was 38.1 kg/m2, and mean Model for End-Stage Liver Disease score was 23.6. PMI declined significantly from baseline to 6 months (β = - 0.60, 95% confidence interval [CI] - 0.98 to - 0.22; p = 0.002) and 1 year (β = - 0.46, 95% CI - 0.83 to - 0.09; p = 0.015), with persistent reduction at 3 years. Survivors showed modest early decline followed by relative stabilization, whereas non-survivors demonstrated steeper decline. However, pre-transplant PMI, 6-month PMI, and early PMI change were not significantly associated with mortality. CONCLUSIONS: In liver transplant recipients with MASLD and severe obesity, muscle loss worsens during the first post-transplant year and may persist thereafter. These findings raise questions regarding optimal timing of nutritional and physical rehabilitation and justify larger studies to determine the prognostic significance of post-transplant muscle trajectories.
BACKGROUND AND AIMS: Endoscopic retrograde cholangiopantography (ERCP) is widely utilized but carries a risk of post-ERCP pancreatitis (PEP), a major source of morbidity, mortality, and healthcare costs. Although known r...BACKGROUND AND AIMS: Endoscopic retrograde cholangiopantography (ERCP) is widely utilized but carries a risk of post-ERCP pancreatitis (PEP), a major source of morbidity, mortality, and healthcare costs. Although known risk factors exist, the impact of cystic fibrosis (CF) and cystic fibrosis transmembrane conductance regulator (CFTR)-related biology remains incompletely understood. CF affects ~ 30,000 individuals in the U.S. and often involves hepatobiliary disease requiring ERCP. To this end, we aim to determine whether CF heterozygosity carries an elevated risk of PEP following ERCP. METHODS: An analysis was conducted using patient data obtained from the Epic Cosmos cohort, a large-scale population health research platform developed by Epic Systems Corporation. Cosmos aggregates approximately 300 million patient records from participating centers. We included patients undergoing their first ERCP and who required at least one year of prior clinical observation. CF carrier status and CF diagnosis were ascertained using diagnostic codes. PEP was defined as a diagnosis of non-gallstone pancreatitis within 14 days post-ERCP. Multivariable logistic regression and entropy balancing were used for adjustment. RESULTS: A retrospective analysis of 364,707 patients undergoing 593,660 ERCPs. Of these, 1,074 ERCPs were compared to controls. CF carrier patients were more likely to be female (65.9% vs. 53.9%), older, have prior ERCP (54.0% vs. 39.1%), receive rectal indomethacin (21.1% vs. 14.4%), but less likely to have cholangitis (9.9% vs. 19.6%). The unadjusted PEP rate was significantly higher in CF carriers (40.4% vs. 11.3%, OR = 5.33, p < 0.001). After adjustment, CF carrier status was associated with increased PEP risk (logistic regression: adjusted OR = 2.34, 95% CI: 2.03-2.69; entropy balancing: adjusted OR = 2.13, 95% CI: 1.83-2.48). CONCLUSION: CF heterozygosity status is independently associated with a substantially increased risk of post-ERCP pancreatitis, suggesting that CFTR dysfunction may heighten pancreatic vulnerability during ERCP. Clinically, CF carriers may represent an underrecognized high-risk group who could benefit from more intensive pre-procedural risk assessment and optimized prophylactic strategies.
PURPOSE: Chronic colitis is a major risk factor for colitis-associated colorectal cancer (CAC), but the mechanisms linking recurrent inflammation to crypt-level dysplasia remain incompletely defined. This review examines...PURPOSE: Chronic colitis is a major risk factor for colitis-associated colorectal cancer (CAC), but the mechanisms linking recurrent inflammation to crypt-level dysplasia remain incompletely defined. This review examines whether spatially heterogeneous nitric oxide (NO) and reactive nitrogen species (RNS) exposure within the intestinal stem cell (ISC) niche may connect inflammation, DNA damage, stemness, and clonal evolution in CAC. METHODS: This narrative, mechanistic review synthesized peer-reviewed English-language studies identified through PubMed/MEDLINE, Web of Science, and Google Scholar through 1 May 2026. Included literature addressed NO/NOS biology, ISC and crypt niche regulation, colitis-associated carcinogenesis, nitrosative DNA damage, cancer stem-like traits, and epithelial, stromal, immune, vascular, lymphatic, microbial, neural, and glial NO sources. RESULTS: Constitutive NOS-derived NO supports mucosal perfusion, barrier integrity, and homeostasis, whereas colitis-associated NOS upregulation can generate high-flux NO, peroxynitrite, epithelial injury, and mutagenic nitrosative stress. The reviewed evidence supports a spatial NO/RNS-field model in which recurrent crypt-level nitrosative microdomains influence DNA damage, repair stress, Wnt/stemness signaling, immune selection, microbiome-redox interactions, and cancer stem-like programs. However, direct causal evidence in human colitic ISCs remains limited. CONCLUSION: Chronic colitis may create recurring NO/RNS-rich crypt microenvironments that favor survival and expansion of damaged or NO-tolerant stem/progenitor clones. This model may guide crypt-resolved biomarker development and locally restricted prevention strategies, but prospective validation is required.
OBJECTIVE: Endoscopic resection has become an accepted approach for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), but there are technical challenges, especially during ESD for SNADETs....OBJECTIVE: Endoscopic resection has become an accepted approach for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), but there are technical challenges, especially during ESD for SNADETs. The aim of this study is to evaluate the efficacy and safety of an innovative traction technique for ESD in the treatment of SNADETs. METHODS: We sought to evaluate the clinical value of detachable clip combined with rubber band-assisted ESD (DCRB-ESD) in the treatment of SNADETs in a large tertiary center. The patients who underwent DCRB-ESD or conventional endoscopic submucosal dissection (C-ESD) between July 2010 and December 2025 were enrolled in this study. Propensity score matching was applied to match patients with similar baseline characteristics. The clinical characteristics of patients and lesions, submucosal fibrosis, procedural time, therapeutic outcomes, adverse events, and follow-up data were analyzed. RESULTS: One hundred and forty-nine patients were included in this study. Of these patients, 54 patients were matched in each group via propensity score matching. The en bloc resection rate and R0 resection rate of SNADETs in the DCRB-ESD group were superior to those in the C-ESD group [100 vs. 94.4%, P = 0.24; 96.3 vs. 85.2%, P < 0.05]. The procedure time was significantly shorter in the DCRB-ESD group than in the C-ESD group [48.5(28.9-81.2) vs. 57.1(40.1-119.8) min, P < 0.05]. Although there were no statistical differences in postoperative complications (1.9 vs. 5.6%, P = 0.62), the rate of intraoperative complications in the DCRB-ESD group was significantly lower than that in the C-ESD group (7.4 vs. 22.2%, P < 0.05). CONCLUSION: DCRB-ESD is a safe and effective method for treating superficial duodenal epithelial tumors. It can shorten procedural time, reduce technical difficulty, and may facilitate the management of larger lesions or those with submucosal fibrosis.