BACKGROUND: Dupilumab is increasingly used for the treatment of eosinophilic esophagitis (EoE), yet its infectious safety profile in real-world clinical practice remains incompletely defined. Given the immunomodulatory e...BACKGROUND: Dupilumab is increasingly used for the treatment of eosinophilic esophagitis (EoE), yet its infectious safety profile in real-world clinical practice remains incompletely defined. Given the immunomodulatory effects of IL-4/IL-13 pathway inhibition, understanding infection risk relative to conventional therapies, such as proton pump inhibitors (PPIs) and swallowed TCS, is clinically important. METHODS: Using the TriNetX Research USA network, we conducted three retrospective propensity-matched cohort analyses among adults with EoE initiating (1) dupilumab vs. PPIs, (2) dupilumab vs. topical steroids, (3) dupilumab vs. combined PPI/topical steroid therapy, and (4) dupilumab vs. no treatment. Patients receiving other systemic immunosuppressive biologics were excluded. One-to-one matching was adjusted for demographics and comorbidities associated with infection risk. Infectious outcomes ≥ 30 days post-index were noted. Relative risks and Kaplan-Meier analyses were performed. RESULTS: After propensity matching, cohorts included 3053 pairs (dupilumab v. PPI), 2143 pairs (dupilumab v. topical steroids), 3973 pairs (dupilumab v. combined therapy), and 2329 pairs (dupilumab vs. no treatment). Infection rates were similar between dupilumab and PPIs or topical steroids alone across all outcomes. Compared with combined PPI/topical steroid therapy, dupilumab was associated with lower rates of COVID-19 (10.3 vs. 12.6%; RR 0.82, p = 0.001), pneumonia (1.9 vs 2.7%; RR 0.69, p = 0.011), and influenza (1.6 vs 2.3%; RR 0.71, p = 0.034). Herpes zoster, cellulitis, or urinary tract infection had similar rates. CONCLUSIONS: In large real-world matched cohorts, dupilumab was not associated with increased infectious risk compared with standard EoE therapies. These findings provide reassurance regarding the infectious safety of dupilumab in routine clinical practice.
BACKGROUND: Open surgical necrosectomy remains an important intervention for selected patients with infected pancreatic necrosis, yet data on post-recovery health-related quality of life (HRQoL) are limited. We aimed to...BACKGROUND: Open surgical necrosectomy remains an important intervention for selected patients with infected pancreatic necrosis, yet data on post-recovery health-related quality of life (HRQoL) are limited. We aimed to describe HRQoL outcomes following open necrosectomy. METHODS: In this single-center observational study, consecutive patients who underwent open surgical necrosectomy for infected pancreatic necrosis were assessed for HRQoL at a single post-recovery time point using the Short Form 36 (SF-36) questionnaire. Domain and composite scores were analyzed descriptively and compared across age groups, disease severity (revised Atlanta classification), culture positivity, and the presence of bowel communication. RESULTS: Eighty-two patients were included (mean age 34.7 ± 11.5 years; 87.8% male). Mean SF-36 domain scores clustered in the low-to-mid 80 s, indicating broadly preserved HRQoL. Highest mean scores were observed in Mental Health (86.5 ± 18.0) and Social Functioning (86.1 ± 19.9), while Role-Physical showed the greatest variability (76.5 ± 39.4). Composite Physical and Mental Health scores were consistent across age categories. Domain-specific differences were seen across severity categories without a clear severity-dependent trend. Patients with positive cultures and those with bowel communication tended to have higher scores across most domains. CONCLUSIONS: Survivors of open surgical necrosectomy can achieve favorable post-recovery HRQoL across multiple domains, supporting inclusion of patient-reported outcomes in pancreatitis research and survivorship-focused postoperative care.
AIM: To develop effective prevention measures, a deep understanding of the evolution patterns and trends of pancreatitis burden is essential. Our study aims to quantify the burden related to pancreatitis in 204 countries...AIM: To develop effective prevention measures, a deep understanding of the evolution patterns and trends of pancreatitis burden is essential. Our study aims to quantify the burden related to pancreatitis in 204 countries and regions from 1990 to 2021. METHODS: Data related to pancreatitis were derived from the Global Burden of Disease Study in 2021. The burden of pancreatitis was assessed using incidence, disability-adjusted life years (DALYs), deaths and their corresponding age-standardized rates (ASRs), stratified by age, sex, Sociodemographic Index (SDI) and Human Development Index (HDI). The estimated annual percentage change was used to quantify the variation in ASRs. The analysis covered the period from 1990 to 2021. RESULTS: In 2021, there were 2,741,736 new cases of pancreatitis (95% UI 2,413,878-3,133,076), leading to 122,416 deaths (95% UI 109,848-141,362), accounting for 0.22% of global deaths, causing a loss of 4,101,154 DALYs (95% UI 3,647,631-4,684,283). The burden of pancreatitis in 2021 and its trends from 1990 to 2021 showed substantial differences based on sex, SDI quintiles and geographical regions. CONCLUSION: Based on our results, the burden of pancreatitis is high and increasing among males and the elderly. Countries with high levels of SDI bear a greater disease burden. Forecast analysis predicts that by 2050, the number of deaths and DALYs related to pancreatitis will continue to rise. Understanding the disease burden and future burden trends associated with pancreatitis is crucial for implementing effective interventions to alleviate the global burden.
BACKGROUND: Hypermobile Ehlers-Danlos Syndrome (hEDS) is a connective tissue disorder that is often diagnosed after diagnostic delays due to reliance on heightened clinical suspicion. Hypermobility spectrum disorders (HS...BACKGROUND: Hypermobile Ehlers-Danlos Syndrome (hEDS) is a connective tissue disorder that is often diagnosed after diagnostic delays due to reliance on heightened clinical suspicion. Hypermobility spectrum disorders (HSD) bridge the gap between asymptomatic joint hypermobility and hEDS. Due to overlapping features and evolving diagnostic criteria, these entities are often discussed collectively as hEDS/HSD. Patients commonly present with gastrointestinal (GI) symptoms, prompting referral for specialized care. OBJECTIVES: This review summarizes the diagnostic criteria, epidemiology, and GI manifestations of hEDS/HSD to aid gastroenterologists in recognizing common presentations and facilitating earlier diagnosis and appropriate management. METHODS: We conducted a narrative review of the GI manifestations of hEDS/HSD, including associations with disorders of gut-brain interaction (DGBIs), organic GI disease, structural abnormalities, motility disorders, postural orthostatic tachycardia syndrome (POTS), and mast cell activation syndrome (MCAS). RESULTS: The strongest GI association in hEDS/HSD is with DGBIs. Evidence suggests possible associations with organic conditions, such as celiac disease and eosinophilic esophagitis, as well as structural GI abnormalities and dysmotility. In addition, hEDS/HSD is closely linked with POTS and MCAS, which may share pathophysiologic mechanisms and have synergistic effects on symptoms. CONCLUSION: Gastroenterologists should maintain a high index of suspicion for hEDS/HSD, which can be readily screened for using the Beighton score. Earlier diagnosis may be therapeutic by reducing uncertainty related to multisystem symptoms. A multidisciplinary approach incorporating mental health, nutrition, and pain management may be required to optimize patient outcomes.
BACKGROUND: The increasing global burden of ulcerative colitis (UC) is showing a high incidence in developed countries and a swift rise in developing countries. n-3 polyunsaturated fatty acids (PUFAs), particularly eicos...BACKGROUND: The increasing global burden of ulcerative colitis (UC) is showing a high incidence in developed countries and a swift rise in developing countries. n-3 polyunsaturated fatty acids (PUFAs), particularly eicosatetraenoic acid (EPA) and docosahexaenoic acid (DHA), have demonstrated anti-inflammatory effects. However, their exact mechanisms in intestinal barrier repair for UC remain incompletely elucidated. METHODS: Acute UC was induced using 2% dextran sulfate sodium (DSS) and the therapeutic effects of mesalazine, EPA, DHA, and EPA + DHA were evaluated. The mucus barrier was assessed histologically. RT-qPCR and Western blot were used to quantify the expression of Mucin2, mechanical barrier proteins (Claudin-1/Occludin), and key signaling pathways (PI3K/Akt, TNF-α/NF-κB, GPR120/PKA/CREB). Gut microbiome composition was analyzed via 16S rRNA sequencing. RESULTS: EPA + DHA intervention demonstrated optimal efficacy in alleviating colitis, through establishing an anti-inflammatory colonic lipid microenvironment by elevating the EPA/AA and DHA/AA ratios. Inhibiting PI3K/Akt/NHE3, downregulating TNF-α/NF-κB/DRA, activating GPR120/PKA/CREB/AQP) improved the mucosal barrier and restored tight junction to enhance the mechanical barrier. Furthermore, EPA + DHA significantly increased the abundance of beneficial microbiome like Lachnospiraceae and Ruminococcaceae. CONCLUSION: EPA + DHA effectively alleviates acute UC in mice by fortifying the colonic mucus-mechanical dual barrier and regulating gut microbiome homeostasis, providing a novel potential strategy for UC adjunctive treatment.
PURPOSE: Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. We aim to provide a comprehensive review of basic nutrition related concepts in chronic liver disease,...PURPOSE: Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. We aim to provide a comprehensive review of basic nutrition related concepts in chronic liver disease, review the implications of nutritional abnormalities and discuss current management recommendations. RESULTS: Malnutrition is an overarching concept related to an imbalance of nutrients. Frailty is related to reduction in physical strength & function and is identified via hand grip strength, the liver frailty index and the six minute walk test. Sarcopenia is progressive reduction in skeletal muscle. Sarcopenia and VSO can be identified with the use of cross-sectional imaging and are associated with increased mortality and adverse health related outcomes in the pre- and posttransplantation settings. Glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide can prevent progression of disease in metabolic dysfunctionassociated steatotic liver disease, promote weight loss in chronic liver disease patients with obesity and VSO and are associated with decreased mortality in the pre & post liver transplant settings. Bariatric and endobariatric interventions are being used to manage chronic liver disease patients with obesity and VSO in pre & post-transplant. CONCLUSION: Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. GLP-1 RAs are effective in the pre & post liver transplant settings; however, careful monitoring for the development of worsened or new sarcopenia is warranted. Further investigation into the role of surgical and endoscopic bariatric interventions in the pre & post liver transplant settings is warranted.
PURPOSE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the second leading indication for liver transplant in the United States, but the prevalence is unevenly distributed across ethnic groups with 2...PURPOSE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the second leading indication for liver transplant in the United States, but the prevalence is unevenly distributed across ethnic groups with 22.3% of Hispanic patients affected. This study aimed to assess racial and ethnic diversity among MASLD clinical trials. METHODS: We performed a meta-analysis of 91 randomized controlled trials (RCTs) of MASLD therapies in the US and Canada, and multinational RCTS involving the US from 2005 to 2024. RESULTS: 78 studies (85.7%) reported racial data and only 56 (61.5%) included ethnicity data. Meta-analysis revealed a pooled prevalence of 78.8% (95% CI 72.9 - 84.6, I = 97.0%) in White patients, 6.2% (95% CI 4.1 - 8.3, I = 94.1%) in Asian patients, 2.5% (95% CI 1.6 - 3.5, I = 70.2%) in Black patients, and 31.7% (95% CI 26.8-36.6, I = 96.2%) in Hispanic patients. This prevalence was higher than the reported national Hispanic prevalence, and Hispanic enrollment also increased over time from 20.3% (2009 - 2014), 30.8% (2015-2019), to 40.0% (2020-2024). CONCLUSION: Our results show that compared to previous efforts, clinical trials are increasingly including Hispanic patients, yet they still need to increase inclusion of ethnicity data. Since MASLD disproportionately affects Hispanic patients, it is imperative that clinical trials make a targeted effort to diversify patient recruitment.
Despite the significant gastrointestinal (GI) disease burden in rural America, prior research has highlighted persistent disparities in access to care for GI diseases for patients in non-metropolitan regions. In the stud...Despite the significant gastrointestinal (GI) disease burden in rural America, prior research has highlighted persistent disparities in access to care for GI diseases for patients in non-metropolitan regions. In the study by Cwalina et al. [5], the authors analyze gastroenterologist data from the Physician Compare Database collected from 2014 to 2025, finding that while the absolute number of rural gastroenterologists increased, the proportion practicing rurally remained stable at approximately 7.7%. Late career stage and the Midwest region were associated with increased odds of rural practice, whereas female sex, hepatology subspecialization, academic affiliation, and both small and large practice sizes were associated with decreased odds. These findings reveal a workforce that has grown numerically, but has not kept sufficient pace with the access needs of rural patients, thereby highlighting two intersecting vulnerabilities: an aging rural GI workforce and a rising proportion of women in gastroenterology who face structural barriers to rural practice. This commentary contextualizes these findings, calling for proactive, patient-centered strategies to sustain rural gastroenterology care.
BACKGROUND: Due to the lack of unified diagnostic standards and low clinical awareness, autoimmune gastritis (AIG) remains underdiagnosed globally. This study aimed to employ the Plan-Do-Check-Act (PDCA) cycle to enhance...BACKGROUND: Due to the lack of unified diagnostic standards and low clinical awareness, autoimmune gastritis (AIG) remains underdiagnosed globally. This study aimed to employ the Plan-Do-Check-Act (PDCA) cycle to enhance the diagnostic rate of AIG. METHODS: This single-center, prospective, observational study enrolled 20 endoscopists from two hospital campuses (10 each in the intervention and control groups). The intervention group underwent PDCA cycle management, including standardized training and dynamic data monitoring, while the control group received no intervention. Diagnostic rates were compared before and after the intervention. RESULTS: A total of 9,763 patients underwent gastroscopy by 20 endoscopists, among whom 67 were diagnosed with AIG. Application of the PDCA cycle further standardized the diagnostic process of AIG in the Department of Gastroenterology at the First Affiliated Hospital of Ningbo University. The diagnostic rate of AIG in the PDCA group reached 0.987%, while that in the control group was 0.423% (P < 0.001), exceeding the target of 0.9% and higher than previously reported baseline rates in Asia. Moreover, the diagnostic rates at all stages of the PDCA cycle in the PDCA group were higher than those in the control group. CONCLUSION: Implementation of the PDCA cycle was associated with a higher diagnostic rate of AIG in this quality-improvement setting, supporting its potential value in improving case detection and standardizing the diagnostic workflow. Trial registration Clinical Trials.gov,NCT06557252. Registered on 13/8/2024. https://register. CLINICALTRIALS: gov/prs/beta/studies/S000ESP900000038/recordSummary . Registered 6 July 2021.
Djinbachian R, Jacques J, Michal V
… +24 more, Alfarone L, Bechara R, Burgess NG, Figueiredo M, Fujiyoshi Y, Heroin L, Kaminski MF, Lam E, Leclercq P, Lienhart-Chambon I, Lupu A, Menard C, Mosko J, Mottacki N, Pohl H, Rex DK, Rodriguez De Santiago E, Saito Y, Sethi A, Sferazza S, Shahidi N, von Renteln D, Yang D, Pioche M
BACKGROUND: Accurate size estimation of large (≥ 20 mm) colorectal laterally spreading tumors (LSTs) is essential for procedural planning, risk stratification, and predicting technical difficulty. Yet, the reliability of...BACKGROUND: Accurate size estimation of large (≥ 20 mm) colorectal laterally spreading tumors (LSTs) is essential for procedural planning, risk stratification, and predicting technical difficulty. Yet, the reliability of visual LST size assessment among endoscopists has not been systematically evaluated. PATIENTS AND METHODS: 46 LSTs were recorded during colonoscopy. Twenty-four international expert endoscopists independently reviewed de-identified videos and provided visual estimates for (1) maximal diameter, (2) oral-anal axis, (3) left-right axis, and (4) percentage of colonic circumference involved. Each lesion was assessed twice in randomized order. Fleiss's kappa, Krippendorff's alpha, and intraclass correlation coefficients (ICC) were used to evaluate inter- and intra-rater agreement. RESULTS: A total of 1104 measurements were collected. Inter-endoscopist kappa agreement for maximal diameter was poor (κ = 0.16), with similarly poor agreement for the oral-anal (κ = 0.15) and left-right axes (κ = 0.14). The percentage of circumferential involvement demonstrated moderate reproducibility (ICC 0.74 and 0.70 across rounds). Subgroup analyses showed consistently poor agreement for larger lesions for diameter-based methods, whereas circumferential percentage estimation ranged from poor to good depending on LST size and morphology. Intra-endoscopist agreement for diameter- and axis-based approaches showed wide variability (κ range 0.01-0.67), while circumferential estimates achieved good to excellent agreement for most endoscopists. CONCLUSIONS: Visual estimation of large colorectal LST size is highly variable among expert endoscopists. Maximal diameter and axial lengths demonstrate poor inter- and intra-observer reliability. Circumferential extent is the most reproducible descriptor and may be the preferred approach for reporting LST size in clinical practice and research.
PURPOSE: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease frequently associated with inflammatory bowel disease (IBD). While PSC with IBD is recognized as a distinct entity, comparative outcome...PURPOSE: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease frequently associated with inflammatory bowel disease (IBD). While PSC with IBD is recognized as a distinct entity, comparative outcomes of PSC with IBD versus PSC alone remain uncertain. This systematic review and meta-analysis aimed to compare clinical outcomes in patients with PSC with and without comorbid IBD. METHODS: We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. MEDLINE, PubMed, Embase, Scopus, and CENTRAL were searched to October 2025. Eligible studies included adults with PSC stratified by IBD status, reporting risk of all-cause mortality or liver transplant, malignancy, graft survival, or recurrent PSC. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS: Twenty-six studies involving 23,837 patients (16,502 PSC-IBD; 7,335 PSC only) were included. PSC-IBD was associated with a significant decrease in all-cause mortality or liver transplantation compared with PSC alone (HR 0.77, 95% CI, 0.62-0.97). Subgroup analysis showed that both PSC with Crohn's disease (HR 0.67, 95% CI 0.54-0.84) or ulcerative colitis (HR 0.72, 95% CI 0.55-0.95) had a significantly lower risk of all-cause mortality or liver transplantation compared to PSC alone. Indeterminate colitis carried a higher risk compared with Crohn's disease (HR 1.57, 95% CI 1.00-2.4). PSC-IBD was associated with increased risk of hepatopancreatobiliary cancer (HR 2.37, 95% CI 1.35-4.15). There was no significant difference in risk of recurrent PSC between PSC-IBD and PSC only. CONCLUSION: PSC-IBD may be associated with a lower risk of all-cause mortality and liver transplant compared to PSC alone, although these findings should be interpreted cautiously given the limited number of studies for several outcomes. Further prospective studies are needed to refine risk stratification.