Gastroenterology[JOURNAL]
Sun
200 papers
Comparative safety and efficacy of hepatic arterial infusion chemotherapy combined with targeted therapy and immunotherapy, with or without transarterial chemoembolization, in unresectable hepatocellular carcinoma: a multicenter retrospective cohort study.
Zhou R, Zhang Z, Yin X … +4 more , Zhang Y, Yan W, Xu A, Mu K
BMC Gastroenterol · 2026 May · PMID 42168880 · Full text
BACKGROUND: Interventional therapies and systemic chemotherapy are the mainstay of treatment for patients with unresectable hepatocellular carcinoma (HCC). This study aimed to generate preliminary evidence regarding the...
BACKGROUND: Interventional therapies and systemic chemotherapy are the mainstay of treatment for patients with unresectable hepatocellular carcinoma (HCC). This study aimed to generate preliminary evidence regarding the feasibility and safety of transarterial chemoembolization (TACE) combined with hepatic artery infusion chemotherapy (HAIC), targeted therapy, and immunotherapy in patients with unresectable hepatocellular carcinoma (HCC). METHODS: This retrospective study analyzed 213 patients with unresectable HCC treated with TACE plus HAIC, targeted therapy, and immunotherapy (THTI) or HAIC plus targeted therapy and immunotherapy (HTI) between July 2019 and August 2023. Propensity score matching (PSM) was used to balance potential confounders between patients in the THTI and HTI groups. Overall survival (OS) was assessed using Kaplan-Meier analysis, and the log-rank test was used for between-group comparisons. Cox proportional hazards regression models were used to identify independent influences on patient OS. RESULTS: A total of 213 patients were treated with THTI (n = 41) or HTI (n = 172). After 1:2 PSM, there were 31 patients in the THTI and 62 patients in the HTI groups. After PSM, OS was significantly better in the THTI than in the HTI groups (34.4 vs. 16.3 months, P = 0.013). The objective response rate (ORR) (38.71% vs. 45.16%, P = 0.554) and disease control rate (DCR) (80.65% vs. 79.03%, P = 0.856) were not statistically significant in the THTI and HTI groups. THTI treatment is an independent predictor of OS. All adverse events (AEs) in the THTI and HTI groups were manageable. CONCLUSION: Compared with HTI, THTI was associated with improved OS in patients with unresectable HCC, with manageable short-term AEs. Quadruple therapy showed encouraging antitumor activity in this retrospective cohort and should be considered exploratory, further large-scale prospective studies are required.
Biliary endoscopic drainage of septic ICU patients deemed emergent (BEDSIDE): a retrospective cohort study (2012-2022).
Chittajallu V, Elangovan A, Abu Omar Y … +9 more , Satyavada S, Hayat U, Vozzo C, Wong RC, Dumot JA, Glessing B, Isenberg GA, Faulx AL, Chak A
BMC Gastroenterol · 2026 May · PMID 42168878 · Full text
BACKGROUND: Mortality for severe acute cholangitis is significantly reduced after endoscopic biliary drainage. Our institution has utilized endoscopic retrograde cholangiopancreatography (ERCP) without fluoroscopy in the...
BACKGROUND: Mortality for severe acute cholangitis is significantly reduced after endoscopic biliary drainage. Our institution has utilized endoscopic retrograde cholangiopancreatography (ERCP) without fluoroscopy in the intensive care unit (ICU), termed Biliary Endoscopic Drainage of Septic ICU patients Deemed Emergent (BEDSIDE) ERCP, in rare circumstances for critically ill patients with severe acute cholangitis where timely conventional ERCP was not available and delayed biliary drainage could adversely affect clinical outcomes. The objective of this study is to describe the BEDSIDE technique and its feasibility to provide expedited biliary drainage in critically ill patients in the ICU with severe acute cholangitis where timely conventional ERCP was not available. METHODS: We performed a retrospective cohort study from 2012 to 2022 at our tertiary care hospital system of patients who underwent BEDSIDE ERCP for acute cholangitis. Data collection included demographics, hospital course, and endoscopic findings. RESULTS: We identified 14 patients who underwent BEDSIDE ERCPs. Identified patients were critically ill with high incidences of vasopressor requirements (79%), mechanical ventilation (43%), and systemic inflammatory response syndrome (SIRS) (100%). Median time from admission to ERCP was 13.6 h (range 9.3-18.5 h). BEDSIDE approach had successful biliary stent placement in 11 patients (79%), including all 5 patients with prior biliary sphincterotomies. 30-day cholangitis-related mortality was 14%. CONCLUSION: BEDSIDE ERCP is proposed as a feasible approach to expedited biliary drainage for critically ill patients in the ICU with severe acute cholangitis in the rare circumstances that timely conventional ERCP with fluoroscopy is unavailable and further delayed biliary drainage could negatively affect clinical outcomes.
Plasma metabolomic and lipidomic profiling reveals distinct molecular signatures and time-dependent remodeling in ulcerative colitis.
Bilican G, Noor NM, Haas SL … +10 more , Petrousis G, Kirman D, Moral K, Koçak E, Kablan SE, Nemutlu E, Kalkan Ç, Cindoruk M, Kekilli M, Karakan T
BMC Gastroenterol · 2026 May · PMID 42168877 · Full text
BACKGROUND: Ulcerative colitis (UC) is a chronic inflammatory bowel disease marked by relapsing mucosal inflammation. Recent data indicate that subclinical metabolic disturbances persist even in patients who have achieve...
BACKGROUND: Ulcerative colitis (UC) is a chronic inflammatory bowel disease marked by relapsing mucosal inflammation. Recent data indicate that subclinical metabolic disturbances persist even in patients who have achieved remission. However, the temporal evolution of these molecular alterations remains poorly defined. This study examined how disease duration shapes systemic metabolic and lipidomic remodeling in UC. METHODS: Plasma samples from 58 UC patients in clinical remission and 70 age- and sex- matched healthy controls (HC) were analyzed using integrated untargeted gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS). Patients were stratified by disease duration (≤ 2 years vs. > 2 years). Multivariate and univariate analyses, including partial least squares discriminant analysis (PLS-DA), variable importance in projection (VIP) scoring, and t-tests or Mann-Whitney U test (p < 0.05), were applied, and pathway enrichment was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. RESULTS: UC patients showed distinct plasma metabolomic and lipidomic signatures compared with HC, with 15 metabolites and 126 lipid species significantly altered. Reduced pyruvic and lactic acids, together with disrupted fatty-acid and amino-acid metabolism, suggested impaired energy and redox homeostasis. Lipidomic profiling revealed broad disturbances across phosphatidylcholines, lysophosphatidylcholines, phosphatidylethanolamines, sphingomyelins, diacylglycerols, and triglycerides, reflecting persistent oxidative and inflammatory imbalance. Stratification by disease duration revealed progressive remodeling, particularly within amino-acid pathways and sphingolipid metabolism. CONCLUSIONS: Even during remission, UC exhibits systemic metabolic disequilibrium that evolves with disease chronicity. These time-dependent changes could guide the identification of metabolic biomarkers for disease monitoring and personalized therapeutic strategies.
The predictive value of abdominal fat area and volume for early recurrence of after resection hepatocellular carcinoma.
Pei M, Yin X, Wang L … +7 more , Zuo G, Li Y, Cheng J, Liu C, Chen W, Cai P, Li X
BMC Gastroenterol · 2026 May · PMID 42163157 · Full text
BACKGROUND: Abdominal fat area has been reported to be associated with early recurrence (ER) after surgical resection of hepatocellular carcinoma (HCC). This study aimed to compare the predictive value of abdominal fat a...
BACKGROUND: Abdominal fat area has been reported to be associated with early recurrence (ER) after surgical resection of hepatocellular carcinoma (HCC). This study aimed to compare the predictive value of abdominal fat area and volume for ER after resection of HCC. METHODS: We retrospectively included 161 patients with single HCC ≤5 cm who underwent resection from May 2015 to June 2021. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured at L3, L4, and L5 vertebral levels, and L4-derived parameters were retained for subsequent analyses. Visceral fat volume (VFV) and subcutaneous fat volume (SFV) were assessed from the diaphragm to lower margin of L5. Multivariate analyses were performed to identify predictors of ER. Receiver operating characteristic (ROC) curves were used to compare predictive values. RESULTS: Multivariate analysis identified VFA and VFV as independent risk factors for ER. ROC analysis showed similar predictive values for VFA (AUC: 0.712) and VFV (AUC: 0.730; p = 0.307). The patients were divided into two groups based on tumor size: group A [(d) ≤ 3 cm] and group B [3 cm < (d) ≤ 5 cm]. VFA demonstrated a higher predictive value for group A (AUC: 0.796) compared to group B (AUC: 0.636) (p = 0.049). CONCLUSIONS: Both VFA and VFV showed comparable predictive value for ER in patients with single HCC ≤5 cm, and VFA appeared to have better predictive performance in patients with tumor diameter ≤ 3 cm.
A randomized controlled superiority trial of 1 L (Plenvu) versus 2 L (Moviprep) polyethelene glycol plus ascorbate in a FIT-based colorectal cancer screening setting (PLEMO).
Roepstorff S, Bryrup T, Rasmussen M
BMC Gastroenterol · 2026 May · PMID 42163134 · Full text
BACKGROUND: Sufficient cleansing of the colonic mucosa is of great importance during colonoscopy emphasizing the need for effective preparation agents. Studies evaluating the efficacy of a novel 1 L polyethylene glycol w...
BACKGROUND: Sufficient cleansing of the colonic mucosa is of great importance during colonoscopy emphasizing the need for effective preparation agents. Studies evaluating the efficacy of a novel 1 L polyethylene glycol with ascorbate (1 L-PEG-Asc), Plenvu, versus standard 2 L polyethylene glycol with ascorbate (2 L-PEG-Asc), Moviprep, have shown promising results regarding bowel cleansing. Nonetheless superiority of 1 L-PEG-Asc has not been shown. METHODS: In this single-center randomized controlled superiority trial, participants of the Danish national colorectal cancer screening program scheduled for colonoscopy were randomized to either 1 L-PEG-Asc or 2 L-PEG-Asc administered as evening/morning split-dose. Primary endpoint was efficacy of the bowel preparation assessed as bowel cleansing success according to Boston Bowel Preparation Scale (BBPS), adequate defined as BBPS ≥ 2 in each segment. Secondary outcomes included excellent bowel preparation defined as BBPS = 3 in each segment, nausea, vomiting, willingness to repeat the cleansing, and lesion detection defined as polyp, adenoma, sessile serrated lesion, and cancer detection. RESULTS: 1275 participants were randomized to 1 L-PEG-Asc (n = 629) or 2 L-PEG-Asc (n = 646). 1 L-PEG-Asc achieved superior frequencies for adequate (92.2% vs. 86.1%, p < 0.001) and excellent preparation (59.2% vs. 43.8%, p < 0.001). Nausea (57.4% vs. 46.6%, p < 0.001) and vomiting (13.9% vs. 8.7%, p = 0.006) were more frequent in the 1 L-PEG-Asc group. Despite this, more participants were willing to repeat cleansing with this agent again (82% vs. 76%, p = 0.009). No difference was seen among lesion detection between the groups. CONCLUSIONS: 1 L-PEG-Asc showed superior bowel cleansing efficacy, but increased rates of vomit and nausea compared to 2 L-PEG-Asc. Despite this, willingness to repeat the cleansing with the same agent was more frequent in the 1 L-PEG-Asc group. TRIAL REGISTRATION: EudraCT number: 2018-003304-39. Trial registration date 29/10 2018, study start date 17/10 2019.
Divergent associations of phosphate levels with organ failure between ICU and non-ICU populations with acute pancreatitis.
Li XY, Zhong CY, Zeng R … +3 more , He JJ, Hu R, Liu Y
BMC Gastroenterol · 2026 May · PMID 42163101 · Full text
BACKGROUND: Acute pancreatitis lacks reliable early predictors of disease severity. Serum phosphate has been shown to be associated with the severity and mortality of acute pancreatitis, but its utility is uncertain. OBJ...
BACKGROUND: Acute pancreatitis lacks reliable early predictors of disease severity. Serum phosphate has been shown to be associated with the severity and mortality of acute pancreatitis, but its utility is uncertain. OBJECTIVE: To assess the association between serum phosphate and organ failure in AP, and determine if it differs between ICU and non-ICU settings. METHODS: Retrospective cohort study using MIMIC-IV (n = 2,973) and eICU databases (n = 216). The primary outcome was organ failure (acute kidney injury, respiratory failure, or shock). Secondary outcomes included hypotension (SBP < 90 mmHg) and mechanical ventilation. Logistic regression was performed, stratified by ICU admission, with analyses progressively adjusted for demographics and key biochemical covariates. RESULTS: Among non-ICU patients, serum phosphate showed a significant inverse association with organ failure (adjusted OR: 0.67, 95%CI: 0.53-0.85, P = 0.001). In ICU patients, phosphate was not associated with the primary outcome. However, in the ICU setting, phosphate levels demonstrated significant positive associations with both hypotension and the need for mechanical ventilation. These associations remained significant after multiple testing corrections and were consistent across both independent databases (P < 0.05). CONCLUSION: The association between serum phosphate and clinical outcomes in AP patients without chronic kidney disease is context-dependent. Hypophosphatemia is associated with organ failure in non-ICU patients, while in critically ill ICU patients, hyperphosphatemia is linked to severe respiratory/circulatory compromise. The association between serum phosphate and clinical outcomes varies with disease severity, necessitating consideration of clinical setting.
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Vestergaard MV, Larsen L, Jess T
Gastroenterology · 2026 May · PMID 42162773 · Publisher ↗
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Fecal Microbiota Transplantation for Symptom Improvement in Patients With Irritable Bowel Syndrome: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Aumpan N, Watanabe J, Yuan Y … +4 more , Kanno T, Leontiadis GI, Chan FKL, Moayyedi P
Gastroenterology · 2026 May · PMID 42162772 · Publisher ↗
BACKGROUND & AIMS: Fecal microbiota transplantation (FMT) could improve symptoms of irritable bowel syndrome (IBS) in some previous trials. We updated a prior meta-analysis of randomized controlled trials (RCTs) determin...
BACKGROUND & AIMS: Fecal microbiota transplantation (FMT) could improve symptoms of irritable bowel syndrome (IBS) in some previous trials. We updated a prior meta-analysis of randomized controlled trials (RCTs) determining this issue. METHODS: We searched CENTRAL, MEDLINE, and Embase (via Ovid) from inception to February 20, 2026, to identify potential studies. We included RCTs that reported the proportion of patients with IBS symptom improvement assessed between 4 and 24 weeks after FMT. For primary outcome, we estimated risk ratios (RR) of proportion of patients with IBS symptoms not improved. Data were pooled using a random effects model. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Thirteen RCTs involving 693 patients were eligible for this review. For the intention-to-treat analysis, FMT may reduce IBS symptoms at 12 weeks compared with placebo, but the evidence is very uncertain (RR of symptom not improved with FMT compared with placebo = 0.72; 95% confidence interval [CI], 0.50-1.03). However, in the per-protocol analysis, FMT was statistically significant at improving symptoms (RR, 0.67; 95% CI, 0.46-0.97). Overall adverse events were not different in both groups (RR, 0.98; 95% CI, 0.75-1.29). The subgroup analysis reported IBS symptom improvement using a single dose of FMT (RR, 0.62; 95% CI, 0.41-0.93), and when IBS was diagnosed by Rome IV criteria (RR, 0.38; 95% CI, 0.17-0.86). CONCLUSIONS: This systematic review suggested there was very low certainty of evidence that FMT improved IBS symptoms. FMT was effective in some subgroup analyses and in the overall per-protocol analysis, but this needs to be interpreted with caution. (Registration number: PROSPERO CRD420251086189.).
Bridging Genetics and Bedside Decisions in Inflammatory Bowel Disease: Utility Metrics for Susceptibility Polygenic Scores.
Zhao Z, Zhao X, Zhang G
Gastroenterology · 2026 May · PMID 42162771 · Publisher ↗
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Generative AI versus evidence-based resources in clinical decision-making by gastroenterology residents: an AIGO experiment.
Pagnini C, Ceccarelli L, DI Paolo MC … +7 more , Ferrara F, Castellana C, Landi S, Mocci G, Vassallo R, Usai Satta P, Bellini M
Minerva Gastroenterol (Torino) · 2026 May · PMID 42159550 · Publisher ↗
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Primary liver cancer at tertiary healthcare facility in Guinea: a cross-sectional study.
Diallo D, Diallo K, Diallo MS … +7 more , Diallo AT, Sow O, Kadio KJO, Barry TM, Sylla IS, Sylla D, Pineau P
BMC Gastroenterol · 2026 May · PMID 42157121 · Full text
BACKGROUND: Guinea has the highest incidence of hepatocellular carcinoma (HCC) in Sub-Saharan Africa (> 21 cases/100,000 habitants/year). This high incidence is largely attributed to the combination of a high prevalence...
BACKGROUND: Guinea has the highest incidence of hepatocellular carcinoma (HCC) in Sub-Saharan Africa (> 21 cases/100,000 habitants/year). This high incidence is largely attributed to the combination of a high prevalence of chronic hepatitis B virus (HBV) infection and significant exposure to aflatoxin B1 (AFB1), a known carcinogen. However, the clinical presentation of HCC in Guinea has not been well-documented to date. METHODS: We conducted a retrospective analysis of 216 HCC cases from patients who received care between 2015 and 2023 at the Donka University Hospital in Conakry, the main tertiary care institution of the country. Demographical, clinical, and biological data were extracted from medical records and analyzed using both descriptive and inferential statistics. RESULTS: The median age of patients was relatively young, at 43.0 years (IQR = 34.5-55.0) with a male-to-female ratio of 3.1 (162/54). Half of the male patients were younger than 41 years. Chronic HBV infection was the predominant risk factor accounting for 75.0% of cases. Almost all patients have been exposed to HBV at some moment of their lives (total anti-HBc seropositivity: 92.2%). Chronic HBV infection was rarely replicative with only 7.8% of patients tested positive for HBeAg. Hepatitis C virus Infection was observed in a small subset of cases (7.9%). Toxic risk factors such as alcohol (12.5%) or tobacco (19.4%) were also rather infrequent. HBV-infected patients were significantly younger than non-HBV patients (median age: 40.0 vs. 50.5 years, p = 0.0109). Susu ethnicity, a Mande-speaking group primarily residing in Guinea's coastal plain was associated with an earlier onset of HCC than other ethnic groups (median age: 37.0 vs. 46.0 years, p = 0.0007). CONCLUSIONS: HBV infection is the major risk factor of HCC in Guinea with an earlier onset of the disease by nearly a decade compared to other risk factors. A notable ethnic variation was observed with Susu patients displaying a predisposition to early HCC. Further molecular research is needed to precisely assess the potential role of AFB1 in liver carcinogenesis of Guinean populations.
Characteristic pathological findings of achalasia behind unresectable esophageal cancer with pathological complete response after chemotherapy: a case report and literature review.
Okamoto K, Miyata T, Asakawa T … +12 more , Furuse K, Maruyama K, Motoyama S, Nagayama T, Nishiki H, Hashimoto A, Tomita Y, Fujita H, Inaki N, Kinami S, Ninomiya I, Takamura H
BMC Gastroenterol · 2026 May · PMID 42157118 · Full text
BACKGROUND: Esophageal achalasia is a rare disease characterized by impaired peristalsis throughout the esophagus, marked esophageal dilation, and nonorganic stenosis of the lower esophagus due to degeneration of the Aue...
BACKGROUND: Esophageal achalasia is a rare disease characterized by impaired peristalsis throughout the esophagus, marked esophageal dilation, and nonorganic stenosis of the lower esophagus due to degeneration of the Auerbach's plexus, and it is a known risk factor for esophageal cancer. To the best of our knowledge, this is the first reported case of achalasia‑associated advanced esophageal squamous cell carcinoma successfully treated using a multidisciplinary approach. CASE PRESENTATION: A 69-year-old female presented to our department with a 10-yr history of dysphagia and vomiting, accompanied by worsening hematemesis and passage disturbance. Esophagogastroduodenoscopy revealed a protruding lesion with stricture in the mid-to-lower thoracic esophagus, and biopsy confirmed squamous cell carcinoma. Further evaluation revealed unresectable advanced esophageal cancer with multiple lymph node metastases involving the dorsal descending aorta and left supraclavicular region. Following induction chemotherapy, marked shrinkage and disappearance of the primary tumor and metastatic lymph node were observed. However, nonorganic narrowing of the esophagogastric junction, along with esophageal tortuosity and dilation, persisted, leading to a diagnosis of esophageal achalasia. The patient subsequently underwent conversion thoracoscopic esophagectomy with the intent of achieving radical resection. Histopathological examination of the resected specimen demonstrated pathological complete response of both the primary tumor and lymph nodes, resulting in curative resection. Additionally, a reduction in the Auerbach's plexus and intramural nerve fibers was observed, consistent with achalasia. One year after surgery, paraaortic lymph node recurrence was detected and treated with local radiotherapy. Despite subsequent chemotherapy for recurrence, the patient ultimately died of cancer 25 months after surgery. This case represents a rare instance of conversion surgery achieving pathological complete response following induction chemotherapy for unresectable advanced esophageal cancer associated with achalasia. CONCLUSION: We report this case with a comparison of histopathological findings to those of other esophageal cancer cases with pathological complete response encountered at our institution, along with a review of the relevant literature.
Helicobacter pylori infection among the Dayak community in Kuching Division, Sarawak: findings from a community-based study.
Cheah WL, Mushtaq S, Sim SK … +1 more , Henry Sum Agong CB
BMC Gastroenterol · 2026 May · PMID 42157117 · Full text
PURPOSE: Helicobacter pylori is a primary driver of peptic ulcer disease and gastric adenocarcinoma, yet epidemiological data regarding its prevalence among indigenous communities in Sarawak are scarce. This study aimed...
PURPOSE: Helicobacter pylori is a primary driver of peptic ulcer disease and gastric adenocarcinoma, yet epidemiological data regarding its prevalence among indigenous communities in Sarawak are scarce. This study aimed to determine the H. pylori seroprevalence and identify associated socio-demographic and lifestyle factors within the Dayak population. METHOD: It was a cross-sectional study carried out in rural areas of Kuching Division. Data was collected using blood sampling, interview-guided questionnaires, and anthropometric measurements. The questionnaire included socio-demographic profiles, history of illness, smoking habit, alcohol consumption, physical activity, and dietary intake. Factor analysis was used to identify dietary patterns. Health profile including helicobacter pylori infection status, blood pressure and body mass index were collected. RESULT: A total of 199 respondents aged 18 to 91 years from six villages participated in this study, yielding a response rate of 96.6%. About 60% of the respondents were found to be overweight or obese, and 48.7% had hypertension. Blood test analysis detected H. pylori antibodies in 46.2% of the respondents. In the multivariate analysis, several factors were found to be significantly associated with the presence of H. pylori antibodies: increasing age (OR: 1.042, 95% CI: 1.011-1.074), lower systolic blood pressure (OR: 0.967, 95% CI: 0.941-0.994), high physical activity level (OR: 0.278, 95% CI: 0.121-0.640), and medium intake of nutritious food and dairy (OR: 3.364, 95% CI: 1.394-8.117). CONCLUSION: Implementing community-level screening programs is essential for early detection and targeted intervention, which could ultimately reduce the burden of infection and its associated complications.
Circular RNAs in hepatocellular carcinoma: a systematic qualitative review of regulatory mechanisms, therapeutic resistance, and clinical translation.
Zhang B, Zheng N, Wang J … +2 more , Sun G, Huang C
BMC Gastroenterol · 2026 May · PMID 42157114 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) is characterized by high mortality, frequent recurrence, and limited long-term benefit from systemic therapy and radiotherapy. Circular RNAs (circRNAs), a class of covalently cl...
BACKGROUND: Hepatocellular carcinoma (HCC) is characterized by high mortality, frequent recurrence, and limited long-term benefit from systemic therapy and radiotherapy. Circular RNAs (circRNAs), a class of covalently closed non-coding RNAs with high molecular stability and tissue-specific expression, have emerged as important regulators of HCC biology and treatment response. METHODS: We searched PubMed from database inception to May 2, 2026 and manually screened the reference lists of eligible studies and relevant reviews for studies investigating circRNA-related molecular mechanisms, tumor progression, therapeutic resistance, radiotherapy response, or translational applications in HCC. A total of 694 records were identified in PubMed, 694 records were screened after duplicate removal, and 42 studies were included in the qualitative synthesis. Original studies involving human tissues, clinical cohorts, cell lines, or animal models were eligible. Title/abstract screening, full-text assessment, and data extraction were performed independently by two reviewers, with disagreements resolved by consensus or senior-author adjudication. Given substantial heterogeneity in study design, model systems, molecular endpoints, and reported outcomes, findings were synthesized qualitatively rather than by meta-analysis, and a structured qualitative evidence appraisal was used to weight mechanistic and translational conclusions. RESULTS: The included evidence indicates that circRNAs participate in HCC progression through miRNA sponging, RNA-binding protein interactions, transcriptional regulation, epigenetic modulation, and, in selected contexts, translational activity. Distinct oncogenic and tumor-suppressive circRNAs converge on pathways related to proliferation, epithelial-mesenchymal transition, metastasis, ferroptosis, stemness, and DNA-damage repair. CircRNAs were also associated with sorafenib and lenvatinib response, radioresistance, and radiosensitivity. Emerging translational applications include tissue and liquid-biopsy biomarkers, especially exosomal circRNAs, as well as junction-targeted oligonucleotide strategies. CONCLUSIONS: Current evidence supports circRNAs as mechanistically relevant regulators and promising translational candidates in HCC. However, progress toward clinical application is constrained by etiologic heterogeneity, limited standardization, incomplete specificity validation for therapeutic targeting, and the lack of multicenter prospective validation studies.
Vedolizumab for stricturing Crohn's disease of the terminal ileum - an international multicenter cohort study.
El Ouali S, Baker ME, Lu C … +20 more , Medellin A, Bruining DH, Fletcher JG, Inoue A, Regueiro M, Ottichilo RK, Schoenoff S, Rosentreter R, Bena J, Qazi T, Holubar SD, Gauriloff S, Gandhi NS, Falloon K, Sleiman J, Cohen BL, Goren I, Balci N, Rieder F, Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium
BMC Gastroenterol · 2026 May · PMID 42157112 · Full text
OBJECTIVE: Crohn's disease (CD) frequently progresses to stricturing complications. Anti-stricture therapies are lacking, and anti-inflammatory therapies are hence the mainstay of medical treatment. However, data on the...
OBJECTIVE: Crohn's disease (CD) frequently progresses to stricturing complications. Anti-stricture therapies are lacking, and anti-inflammatory therapies are hence the mainstay of medical treatment. However, data on the efficacy of vedolizumab in stricturing CD are not available. We therefore aimed to assess outcomes of vedolizumab in this setting. DESIGN/METHOD: We evaluated adult patients who received vedolizumab within 6 months of imaging-confirmed symptomatic ileal stricturing CD (CONSTRICT criteria) in a multicenter observational cohort study. Images were centrally read by an expert radiologist with experience in IBD imaging. Outcomes were rates of intervention (composite endpoint for endoscopic balloon dilation (EBD) or surgery during follow-up), EBD, surgery, obstructive symptoms, and vedolizumab persistence. RESULTS: Forty-four patients were included (61% female, median age 52 years); 64% had an anastomotic stricture; 84% had received prior biologics. Median follow-up was 17 months. Cumulative intervention rates were 23%, 44% and 50% of patients at 12, 24 and 48 months, respectively. 52% of patients reported symptom resolution, of whom 26% subsequently developed symptoms during follow-up. Vedolizumab persistence was 82%, 74% and 59% at 12, 24 and 48 months. Anastomotic stricture was inversely associated with intervention (HR0.21, P = 0.012) and surgery (HR0.11, P = 0.013). Higher obstructive symptom index (HR4.47, P = 0.040) and degree of prestenotic bowel dilatation (HR1.09, P = 0.030) were associated with recurrent obstructive symptoms. Elevated baseline CRP was associated with vedolizumab discontinuation (HR1.96, P = 0.014). CONCLUSION: Vedolizumab appears to be a treatment option in CD patients with terminal ileal strictures, especially in patients with anastomotic strictures, without obstructive symptoms or prestenotic bowel dilatation. Validation in prospective controlled studies is needed.
Association between iron status and inflammation markers with GDF15 and BMP6 in inflammatory bowel disease: a single center cross-sectional study.
Üstün Y, Yanık S, Uçar F … +4 more , Üstün AY, Erdal H, Coşkun Y, Yüksel İ
BMC Gastroenterol · 2026 May · PMID 42157106 · Full text
BACKGROUND: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic disorders with relapsing and remitting disease courses. Several clinical indicators and biomarkers ha...
BACKGROUND: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic disorders with relapsing and remitting disease courses. Several clinical indicators and biomarkers have been evaluated for their clinical utility in assessing disease prognosis and monitoring disease activity. This study evaluated the utility of growth differentiation factor-15 (GDF15) and bone morphogenetic protein-6 (BMP6) in inflammatory pathways and iron regulation in IBD. METHODS: Between September 2015 and March 2016, this single-center, cross-sectional study included 40 CD patients, 29 UC patients, and 70 healthy controls. The disease activity was measured using the Mayo score and the Crohn's Disease Activity Index (CDAI). Serum iron, hematological indices, inflammatory markers, and the novel biomarkers BMP6 and GDF15 as determined by ELISA were evaluated. RESULTS: Both the CD and UC groups showed significantly lower serum iron (p < 0.001), reduced mean corpuscular hemoglobin concentration, and higher red cell distribution width than the control group. Inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were elevated in IBD, particularly during active disease, with CRP increasing significantly in active UC compared to remission (p = 0.040). In contrast, BMP6 and GDF15 levels did not differ significantly between the disease groups or activity states. Nonetheless, GDF15 demonstrated moderate positive correlations with serum iron (r = 0.314), hemoglobin (r = 0.320), and mean corpuscular hemoglobin concentration (MCHC) (r = 0.344), suggesting a link to erythropoietic or iron-related processes rather than inflammation. CONCLUSIONS: Conventional markers reliably confirmed iron deficiency and inflammation in IBD. BMP6 and GDF15 levels did not differ significantly across disease states, indicating limited utility as markers of disease activity. Notably, GDF15 was positively correlated with serum iron, hemoglobin, and MCHC, suggesting its association with iron metabolism rather than active inflammation. Larger longitudinal studies are warranted to validate this potential role. TRIAL REGISTRATION: Not applicable.
Trends in mortality from liver cancer with hepatic fibrosis/cirrhosis in the United States, 1999-2020: a retrospective population-based study.
Peng S, Zhao X, Wang X … +4 more , Ding H, Nie Y, Qi J, Zhu Q
BMC Gastroenterol · 2026 May · PMID 42157090 · Full text
BACKGROUND: Hepatic fibrosis and cirrhosis represent an important pathological continuum in the progression of chronic liver disease to primary liver cancer and are associated with poor prognosis. This study aimed to ass...
BACKGROUND: Hepatic fibrosis and cirrhosis represent an important pathological continuum in the progression of chronic liver disease to primary liver cancer and are associated with poor prognosis. This study aimed to assess long-term mortality trends in liver cancer with hepatic fibrosis/cirrhosis coding in the United States from 1999 to 2020 and to examine disparities across demographic and geographic subgroups. METHODS: Death certificate data from 1999 to 2020 were obtained from the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) and 95% confidence intervals (CIs) were calculated. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC), identify inflection points, and compare temporal trends between groups. RESULTS: During the study period, 446,959 primary liver cancer deaths were recorded in the United States, of which 48,970 (10.96%) had hepatic fibrosis/cirrhosis-related codes documented on death certificates. The overall liver cancer AAMR was 5.928 per 100,000 population and showed a significant upward trend over the full study period (AAPC = 1.79%, P < 0.001), although a declining inflection point appeared after 2016. The AAMR for liver cancer with hepatic fibrosis/cirrhosis coding was 0.646 per 100,000 population and increased more rapidly (AAPC = 3.03%, P < 0.001). Subgroup analysis showed that the mortality rate was substantially higher in males (AAMR = 1.054) than in females (AAMR = 0.266), whereas the rate of increase was faster among females (AAPC = 4.09% vs. 2.62%). Hispanic or Latino individuals had the highest mortality rate (AAMR = 1.271). Nonmetropolitan areas experienced the most rapid increase in mortality (AAPC = 5.06%). Racial/ethnic analyses showed a significant increase among non-Hispanic White individuals (AAPC = 2.90%), whereas non-Hispanic Asian or Pacific Islander individuals exhibited a divergent pattern characterized by declining overall liver cancer mortality but stable mortality in the fibrosis/cirrhosis-coded subgroup. CONCLUSIONS: Over the past two decades, mortality from liver cancer with hepatic fibrosis/cirrhosis coding increased more rapidly than overall primary liver cancer mortality in the United States, indicating a growing epidemiologic burden in this coded subgroup. This pattern was particularly notable among males, Hispanic or Latino individuals, and nonmetropolitan residents. These findings support strengthening prevention and early management of progressive chronic liver disease while improving surveillance and care for populations at risk of advanced fibrosis/cirrhosis, with particular attention to health inequities.
Association between metabolic syndrome and 90-day mortality in acute-on-chronic liver failure patients based on propensity score matching and prognostic model construction.
Hu Y, Zhang F, Zhang F … +1 more , Xiang P
BMC Gastroenterol · 2026 May · PMID 42157040 · Full text
BACKGROUND: This study aimed to evaluate the association between metabolic syndrome (MetS) and clinical outcomes in patients hospitalized for acute-on-chronic liver failure (ACLF), and to establish a prognostic predictio...
BACKGROUND: This study aimed to evaluate the association between metabolic syndrome (MetS) and clinical outcomes in patients hospitalized for acute-on-chronic liver failure (ACLF), and to establish a prognostic prediction model incorporating MetS. METHODS: A retrospective cohort study was conducted involving 303 ACLF patients admitted to a tertiary hospital between May 2023 and May 2025. Patients were categorized into two groups based on their MetS status (MetS group vs. non-MetS group). The primary outcome was 90-day all-cause mortality. Propensity score matching (PSM) was employed to balance baseline characteristics. The association was assessed using multivariable Cox regression and logistic regression analyses after adjusting for confounders. Based on the results of the multivariable analysis, a nomogram model for predicting 90-day mortality was constructed. The model's discriminative ability, calibration, and clinical utility were evaluated in both the training and testing sets using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS: After PSM, 206 patients (103 in the MetS group and 103 in the non-MetS group) were included in the final analysis. The 90-day mortality rate was significantly higher in the MetS group than in the non-MetS group (49.51% vs. 27.18%, p < 0.001). Multivariate Cox regression analysis showed that MetS, age, alanine aminotransferase (ALT), artificial liver support system (ALSS), transfusion times (TT), international normalized ratio (INR), C-reactive protein (CRP) and hepatocellular carcinoma (HCC) were independent predictors of 90-day death risk in patients with ACLF. The nomogram prediction model constructed based on these variables demonstrated excellent discriminative ability in both the training set (area under the curve, AUC = 0.877) and the testing set (AUC = 0.820). The calibration curve showed a high consistency between the predicted probabilities and the actual observations. Decision curve analysis confirmed the model's favorable net clinical benefit. CONCLUSION: MetS is an independent predictor of poor short-term prognosis in patients with ACLF, significantly increasing the risk of mortality. This study established a nomogram prediction model that integrates MetS, which can accurately assess patients' short-term mortality risk and may assist clinicians in early risk stratification.
Gastroenteritis in middle-aged and elderly adults in rural China: associations with sociodemographic, lifestyle, and dietary factors.
Gao Y, Pan D, Su M … +11 more , Wang Y, Han J, Wang X, Yan Q, Xu J, Zhang Z, Yang L, Xia H, Liao W, Wang S, Sun G
BMC Gastroenterol · 2026 May · PMID 42151867 · Full text
BACKGROUND: Gastroenteritis remains a common gastrointestinal disorder with health and socioeconomic impacts. However, data on its epidemiological characteristics in rural areas of China are limited. This study aimed to...
BACKGROUND: Gastroenteritis remains a common gastrointestinal disorder with health and socioeconomic impacts. However, data on its epidemiological characteristics in rural areas of China are limited. This study aimed to investigate the factors associated with gastroenteritis among adults in a rural population in China. METHODS: This cross-sectional study analyzed data from the Early Diagnosis and Early Treatment Project of Esophageal Cancer (2011-2017). A total of 11,518 participants aged 35-75 years completed face-to-face questionnaires. Univariate and multivariate logistic regression models estimated crude and adjusted odds ratios with 95% confidence intervals. RESULTS: Of all participants, 2,849 were diagnosed with gastroenteritis. Increased risk was associated with female, increased BMI, annual income, fast eating, irregular diet, high blood pressure, salty diet, spicy diet, excessive smoking, exposure to secondhand smoke, and consumption of fatty meats, corn, cornmeal, pickled foods, and fried foods. Higher intake of vegetables, fruits, and animal liver was linked to reduced risk. CONCLUSIONS: Gastroenteritis in rural Huai'an is closely associated with tobacco use, unhealthy dietary habits, and environmental exposures. Public health interventions focusing on smoking cessation, dietary improvement, and environmental health promotion may provide support for its primary prevention in this population.
Analysis of factors associated with comorbid anxiety and depression in patients with functional dyspepsia: a cross‑sectional study.
Sun J, Sufeila S, Wang X … +2 more , Ding Y, Jiang T
BMC Gastroenterol · 2026 May · PMID 42151843 · Full text
OBJECTIVE: To explore factors associated with comorbid anxiety and depression (CAD) in patients with functional dyspepsia (FD) and to compare the performance of logistic regression models (LRM) and decision tree models (...
OBJECTIVE: To explore factors associated with comorbid anxiety and depression (CAD) in patients with functional dyspepsia (FD) and to compare the performance of logistic regression models (LRM) and decision tree models (DTM) in risk identification and assessment. METHODS: A cross‑sectional design was used. A total of 1,227 FD patients were recruited from a tertiary hospital in Xinjiang between January 2023 and August 2024. Assessments included the Generalized Anxiety Disorder‑7 scale (GAD‑7), Patient Health Questionnaire‑9 (PHQ‑9), Gastrointestinal Symptom Rating Scale (GSRS), Multidimensional Health Locus of Control Scale (MHLC), and the Simplified Nepean Dyspepsia Index (SF‑NDI). Candidate variables were selected based on clinical knowledge and a causal framework (informed by directed acyclic graph principles). Binary logistic regression and a decision tree model using the CRT algorithm were used to analyse factors associated with CAD. To ensure fair comparison, the data were randomly split into a training set (70%) and a test set (30%), and both models were developed on the same training set and evaluated on the same test set. The decision tree was subjected to 10‑fold cross‑validation, and the logistic regression was assessed using the Hosmer‑Lemeshow goodness‑of‑fit test. A sensitivity analysis was performed using a higher cut‑off (≥ 10 on both GAD‑7 and PHQ‑9). ROC curves were plotted to compare the discriminative ability of the two models. RESULTS: The detection rate of CAD was higher in female FD patients (33.9%) than in males (26.3%). Logistic regression showed that a higher score for powerful others health locus of control (PHLC) (OR = 1.022, 95% CI: 1.001-1.043, P = 0.038), more severe gastrointestinal symptoms (OR = 1.050, 95% CI: 1.033-1.068, P < 0.001), and a higher SF‑NDI score (OR = 1.029, 95% CI: 1.012-1.048, P = 0.002) were associated with a higher likelihood of CAD; male sex, older age and higher education level were protective factors. In the decision tree model, SF‑NDI was the most important factor (normalised importance = 100%), followed by GSRS (68%), sex (52%), age (47%), education level (39%), chance health locus of control (CHLC, 33%) and PHLC (30%). On the test set, the LRM achieved an AUC of 0.710 (95% CI: 0.679-0.741) with a sensitivity of 74.1% and specificity of 58.1%; the DTM achieved an AUC of 0.764 (95% CI: 0.736-0.792) with a sensitivity of 71.4% and specificity of 66.6%. The mean AUC from 10‑fold cross‑validation was 0.708 ± 0.012 for the LRM and 0.759 ± 0.015 for the DTM. The Hosmer‑Lemeshow test gave P = 0.292, indicating good calibration of the logistic regression. In the sensitivity analysis using a cut‑off of ≥ 10, the direction and magnitude of effects for core variables remained largely unchanged (GSRS: OR = 1.047, P < 0.001; SF‑NDI: OR = 1.026, P = 0.003; PHLC: OR = 1.020, P = 0.048). Sex‑stratified analysis showed that SF‑NDI, GSRS, CHLC and age were the main factors in males, whereas PHLC and education level were additionally influential in females. CONCLUSION: CAD in FD patients is clearly associated with sex, age, education level, health locus of control orientation, severity of gastrointestinal symptoms, and disease‑related quality of life. Logistic regression and decision tree models each have advantages in identifying associated factors and assessing risk; using them jointly can help clinicians identify high‑risk individuals early and develop personalised, integrated physical and psychological interventions.
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