Gastroenterology[JOURNAL]
Sun
200 papers
Age-related vulnerability and clinical outcomes in acute pancreatitis: a stratified cohort study of 1,034 patients.
Yu B, Li Y, Li N … +9 more , Luo L, Lei Y, Huang X, Yang X, He C, Xia L, He W, Lu N, Zhu Y
BMC Gastroenterol · 2026 Jun · PMID 42304224 · Full text
BACKGROUND: Acute pancreatitis (AP) demonstrates substantial heterogeneity across adult age groups; however, the relative contributions of chronological age, baseline vulnerability, acute organ dysfunction, and local dis...
BACKGROUND: Acute pancreatitis (AP) demonstrates substantial heterogeneity across adult age groups; however, the relative contributions of chronological age, baseline vulnerability, acute organ dysfunction, and local disease complexity to short-term outcomes remain incompletely understood. METHODS: This retrospective cohort study included 1,034 adults admitted with AP to the First Affiliated Hospital of Nanchang University between January 2018 and April 2021. Patients were stratified into three age groups (18-40, 41-60, and 61-80 years). Clinical characteristics, organ dysfunction, local complications, interventions, and short-term outcomes were compared across age groups. Organ failure and local complications were defined according to the Revised Atlanta Classification. Multivariable regression analyses were performed to identify factors independently associated with adverse outcomes, ICU admission, and length of hospital stay (LOS). RESULTS: Hypertriglyceridemia predominated in younger adults, whereas biliary pancreatitis was most common in older patients. Older adults demonstrated higher bilirubin, blood urea nitrogen, creatinine, BISAP, and APACHE II scores. Adverse outcomes increased with age; however, after adjustment, chronological age showed only a modest independent association with adverse outcomes (adjusted OR 1.07 per 1-year increase, 95% CI 1.04-1.09). In contrast, acute respiratory failure remained the strongest predictor of adverse outcomes (adjusted OR 15.6, 95% CI 7.69-33.97). ICU admission and prolonged hospitalization were driven primarily by acute organ dysfunction and local disease complexity rather than chronological age alone. CONCLUSION: Acute pancreatitis exhibits clear age-related differences in etiology and clinical presentation. However, short-term adverse outcomes are driven predominantly by acute organ dysfunction and local disease complexity, whereas chronological age may reflect increased baseline vulnerability rather than acting as the primary determinant of disease trajectory. These findings support age-informed assessment and emphasize the importance of early recognition and management of evolving organ dysfunction.
Shared molecular signatures linking gastroesophageal reflux disease and major depressive disorder revealed by integrated machine learning.
Wang Z, Chai Y, Pi S … +13 more , Tuerxun D, Zhu Y, Liu Z, Zhang H, Li J, Wang C, Li Z, Kang Y, Li Y, Zhao N, Tian Y, Xiong K, Zhang P
BMC Gastroenterol · 2026 Jun · PMID 42298439 · Full text
BACKGROUND: Gastroesophageal reflux disease (GERD) and major depressive disorder (MDD) frequently co-occur, yet their shared molecular mechanisms remain poorly understood. This study aimed to identify a robust gene signa...
BACKGROUND: Gastroesophageal reflux disease (GERD) and major depressive disorder (MDD) frequently co-occur, yet their shared molecular mechanisms remain poorly understood. This study aimed to identify a robust gene signature linking GERD and MDD and to evaluate its clinical relevance. METHODS: Transcriptomic data from five GEO datasets were analyzed, including three GERD datasets (52 GERD samples and 23 controls) and two MDD datasets (138 MDD samples and 76 controls). The GERD datasets were integrated after batch correction for differential expression analysis, whereas the MDD datasets were analyzed separately for WGCNA, model development, and external validation. Candidate genes were identified from the intersection of GERD differentially expressed genes and MDD-associated co-expression module genes. A total of 71 machine learning models were systematically evaluated in the MDD training cohort using stratified 10-fold cross-validation, with model selection based on area under the curve (AUC). The clinical relevance of the prioritized genes was further examined in an independent cohort of 70 GERD patients, in whom gene expression was measured and depressive symptom severity was stratified into three PHQ-9-defined groups: non-depressed (n = 39), mild-to-moderate depression (n = 19), and major depression (n = 12). RESULTS: A three-gene signature (SAMD14, PROC, and NRG1) was identified. Among 71 candidate models, ridge regression achieved the best performance, with a cross-validated AUC of 0.709. After refitting, the model yielded an AUC of 0.896 (95% CI, 0.851-0.941) in the training cohort and 0.875 (95% CI, 0.712-1.000) in the external test cohort. Additional performance metrics included a sensitivity of 0.805, specificity of 0.844, accuracy of 0.818, and F1 score of 0.855 in the training set. In the clinical cohort, expression levels of SAMD14, PROC, and NRG1 differed significantly across depression severity groups (all P < 0.001). DeMeester scores also differed among groups (P < 0.001), with higher values observed in patients with more severe depressive symptoms. Correlation analysis further demonstrated significant associations between gene expression and reflux-related parameters. CONCLUSIONS: We identified a three-gene signature derived from molecular features shared between GERD and MDD. The signature showed discriminative performance for MDD classification and was associated with reflux-related clinical parameters in GERD patients. These findings support a hypothesis-generating molecular framework for investigating GERD-MDD overlap, while further prospective and mechanistic validation remains required.
Prevalence and clinical determinants of diabetic gastroparesis in type 2 diabetes: a symptom- and scintigraphy-based cross-sectional study.
Abokresha MM, Tousb MAW, Elden MEE … +2 more , Diab WA, Taha BO
BMC Gastroenterol · 2026 Jun · PMID 42298424 · Full text
BACKGROUND: Diabetic gastroparesis (DG) is a frequently underdiagnosed complication of type 2 diabetes mellitus (T2D), characterized by delayed gastric emptying without mechanical obstruction. Its nonspecific symptoms of...
BACKGROUND: Diabetic gastroparesis (DG) is a frequently underdiagnosed complication of type 2 diabetes mellitus (T2D), characterized by delayed gastric emptying without mechanical obstruction. Its nonspecific symptoms often lead to delayed diagnosis and suboptimal management. OBJECTIVE: To assess the prevalence and clinical predictors of DG in patients with T2D, and to investigate the relationship between gastrointestinal symptoms and objectively measured delayed gastric emptying. METHODS: A cross-sectional study included 130 randomly selected patients with T2D attending a tertiary care outpatient clinic. Comprehensive clinical assessment, metabolic profiling, and screening for diabetes-related complications were performed. Symptoms suggestive of DG were assessed using the Gastroparesis Cardinal Symptom Index (GCSI), while delayed gastric emptying was objectively confirmed using gastric emptying scintigraphy (GES) with a standardized low-fat radiolabeled meal. RESULTS: Delayed gastric emptying was observed in 13.1% of participants. Patients with delayed gastric emptying had significantly higher body mass index (BMI), longer duration of diabetes, and poorer glycemic control compared with those without delayed emptying (all p < 0.05). Multivariate analysis identified HbA1c (OR 6.99), BMI (OR 3.89), and duration of diabetes (OR 2.75) as independent predictors of delayed gastric emptying. Symptom-based gastroparesis according to GCSI showed limited agreement with scintigraphic delayed gastric emptying. CONCLUSION: DG appears to be a clinically relevant but potentially underrecognized complication of T2D. Poor glycemic control, obesity, and longer duration of diabetes are associated with delayed gastric emptying. Limited agreement between symptom severity and objectively measured gastric emptying supports the continued role of gastric emptying scintigraphy as the diagnostic reference standard. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov (U.S. National Library of Medicine registry) CLINICAL TRIAL NUMBER: NCT05584462.
A network meta-analysis of strategies for endoscopic submucosal dissection procedures from the perspectives of efficacy, duration and safety.
Liu G, Chang T, Wang W … +3 more , Guo Z, Wei Z, Yang Y
BMC Gastroenterol · 2026 Jun · PMID 42298420 · Full text
BACKGROUND: Endoscopic submucosal dissection (ESD) is a well-accepted endoscopic resection modality for early-stage gastrointestinal tumors. Over the past decades, progressive refinements in instruments, traction methods...
BACKGROUND: Endoscopic submucosal dissection (ESD) is a well-accepted endoscopic resection modality for early-stage gastrointestinal tumors. Over the past decades, progressive refinements in instruments, traction methods, and closure techniques have enhanced the safety and efficacy of ESD, and ESD further evolves into conventional ESD (C-ESD), traction-assisted ESD (T-ESD), and underwater ESD (U-ESD). The three modalities have their distinct benefits and are complementary to each other in clinical practice. At the same time, they compete with one another, presenting a challenge to operators with respect to which to select in specific scenarios. OBJECTIVE: To conduct a network meta-analysis to make comparisons of the three approaches of ESD, with a focus on key endpoints including their operative duration, resection rate, R0 resection rate, and adverse event incidence. METHODS: A computerized search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases. The literature was evaluated using the PRISMA 2020 framework. The netmeta package was used for pairwise and network meta-analysis. Continuous outcomes were pooled as mean differences, and dichotomous outcomes were pooled as risk ratios. When continuous data were reported as medians with interquartile ranges or ranges, values were converted to approximate means and standard deviations before pooling. RESULTS: Nine English-language randomized controlled trials involving 919 participants were included. The pooled absolute estimates showed that T-ESD and U-ESD had higher procedure speeds than C-ESD (19.61 and 18.99 vs. 15.20 mm/min, respectively) and shorter median procedure times (55.02 and 58.51 vs. 70.20 min, respectively). For adverse events, the absolute rates were 7.8% for T-ESD, 6.3% for U-ESD, and 10.8% for C-ESD. For R0 resection, the corresponding rates were 92.0%, 92.0%, and 91.1%, and for en bloc resection they were 97.9%, 97.0%, and 96.0%. According to SUCRA ranking, T-ESD ranked highest for procedure speed (0.76), median procedure time (0.83), en bloc resection (0.87), and R0 resection (0.65), whereas U-ESD ranked highest for adverse events (0.78). These rankings were interpreted together with effect estimates and confidence intervals. CONCLUSION: Compared with C-ESD, U-ESD and T-ESD showed favorable trends for different procedural endpoints, but the certainty of superiority varied across outcomes. T-ESD ranked highest for procedure speed, median procedure time, en bloc resection, and R0 resection, whereas U-ESD ranked highest for adverse events. Because several dichotomous outcomes had confidence intervals crossing the null value, SUCRA-based rankings should be interpreted as comparative probability rankings rather than definitive proof of clinical superiority.
One- versus two-sample fecal immunochemical testing for colorectal cancer screening: a systematic review and meta-analysis of participation, diagnostic performance, and cost-effectiveness.
Ye L, Hou QL, Peng H … +1 more , Yang Q
BMC Gastroenterol · 2026 Jun · PMID 42298417 · Full text
BACKGROUND: Whether collecting one or two fecal samples for immunochemical testing (FIT) optimizes colorectal cancer screening outcomes remains unclear. METHODS: We systematically searched multiple databases until Octobe...
BACKGROUND: Whether collecting one or two fecal samples for immunochemical testing (FIT) optimizes colorectal cancer screening outcomes remains unclear. METHODS: We systematically searched multiple databases until October 2025 for studies directly comparing 1-FIT and 2-FIT strategies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes. RESULTS: Five studies (n = 45,888) and three economic evaluations were included. Participation was higher with 1-FIT (RR = 1.05, P < 0.0001), while 2-FIT had a higher positivity rate (RR = 0.65, P < 0.0001). Although 2-FIT detected more CRC (RR = 0.62, P = 0.02), advanced neoplasia and advanced adenoma detection were similar. The 2-FIT strategy had higher sensitivity (RR = 0.64, P = 0.04) but lower specificity (RR = 1.70, P < 0.001) than 1-FIT. A pivotal finding was that the 1-FIT strategy demonstrated a superior positive predictive value (PPV) for both advanced neoplasia (RR = 1.21, P = 0.004) and advanced adenoma (RR = 1.41, P < 0.0001), which translated into a substantially lower demand for colonoscopy (RR = 0.64, P < 0.0001) Economic evaluations consistently favored 1-FIT across different healthcare systems. CONCLUSION: Although the 2-FIT strategy improves test sensitivity, it fails to enhance advanced neoplasia detection while substantially increasing colonoscopy demand due to its reduced positive predictive value. In contrast, the 1-FIT strategy preserves screening efficacy with superior participation rates, resource utilization, and cost-effectiveness. We recommend 1-FIT as the preferred strategy in settings with constrained colonoscopy resources, while reserving 2-FIT for resource-abundant environments where maximizing sensitivity justifies the additional economic and operational costs (Scheme 1). TRIAL REGISTRATION: The research protocol was prospectively registered in the PROSPERO registry, bearing the registration identifier CRD420251153202.
Inflammatory bowel disease outcomes among hospitalized homeless individuals.
Mungle T, Charu V, Okafor PN
BMC Gastroenterol · 2026 Jun · PMID 42298396 · Full text
BACKGROUND: There is a paucity of outcome data among homeless individuals with inflammatory bowel diseases (IBD). We reported rates of homelessness among inpatients with Crohn's disease (CD) and ulcerative colitis (UC) a...
BACKGROUND: There is a paucity of outcome data among homeless individuals with inflammatory bowel diseases (IBD). We reported rates of homelessness among inpatients with Crohn's disease (CD) and ulcerative colitis (UC) and examined inpatient outcomes. METHODS: The Healthcare Utilization Project (HCUP) State Inpatient Databases from New York, Arizona, Massachusetts and Florida for 2013 and 2014 were used to identify adults ≥ 18 years admitted with IBD identified by ICD-9 codes. Homeless patients were propensity score matched using a one-to-ten greedy nearest-neighbor approach to non-homeless patients to balance the distribution of baseline covariates. Differences in mortality, endoscopy utilization, surgical treatment and post-operative complications were reported as odds ratios with 95% confidence intervals (CI). RESULTS: A total of 115,008 IBD hospitalizations were identified of which 61% (n = 70,457) were CD discharges while 39% (n = 44,551) were UC discharges. Homelessness was associated with 0.7% (n = 469) of CD discharges and 0.9% (n = 415) of UC discharges. Mortality and endoscopy utilization rates were comparable between homeless and non-homeless patients with CD and UC. Surgical treatment was also broadly similar except for lower odds of bowel resection among homeless IBD patients with UC compared to domiciled IBD patients with UC (OR: 0.41, 95% CI: 0.20 to 0.84). Post-operative complications were also comparable except for lower rates of venous thromboembolism among homeless patients with CD (OR: 0.61, 95% CI: 0.38 to 0.97) whereas it was higher for homeless patients with UC (OR: 1.58, 95% CI: 1.08 to 2.30). CONCLUSIONS: Homeless IBD patients have comparable inpatient outcomes with non-homeless IBD patients.
Evaluation of fatty liver disease self-care applications: a systematic review and evaluation of apps using the mobile application rating scale (MARS).
Mohammadzadeh N, Daeechini AH, Paghe A … +2 more , Laktarashi HV, Esmaeeli E
BMC Gastroenterol · 2026 Jun · PMID 42298386 · Full text
BACKGROUND: The use of mobile health applications (apps) has a significant impact on lifestyle changes, especially in chronic diseases such as fatty liver disease, and provides a good opportunity for self-care and lifest...
BACKGROUND: The use of mobile health applications (apps) has a significant impact on lifestyle changes, especially in chronic diseases such as fatty liver disease, and provides a good opportunity for self-care and lifestyle improvement. This study aimed to systematically evaluate the quality of self-care mobile applications for fatty liver patients based on the MARS rating features. METHODS: Using related keywords from Google Play and App Combo stores, applications related to fatty liver disease self-care were searched and included in the study. The quality of the applications was then evaluated by four experts using the MARS questionnaire. RESULTS: 58 apps were identified and screened according to the exclusion criteria, and 10 applications were included in the study. The average MARS score across all included applications was 3.06 out of 5, with the majority of the apps achieving a minimum acceptability score of 3.0. The highest score was related to the functional dimension with an overall average of 4.2 and the lowest score was related to the subjective quality dimension with an overall average of 2.5. CONCLUSIONS: Mobile applications in self-care for fatty liver disease in this study were evaluated at an acceptable level, and most of the applications provided comprehensive information about the disease and dietary recommendations. However, in providing some secondary features, such as providing a specific diet, communicating with a specialist, and reminders, they need to be improved, which can help to increase the effectiveness of the apps.
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Fishel ML, Flick MJ, Zhang C … +2 more , Cao S, Han B
Gastroenterology · 2026 Jun · PMID 42297050 · Publisher ↗
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Validated Early Detection Metrics Reduce the Population Requiring Liver Fibrosis Screening.
van Kleef LA, Pustjens J, Schneider CV … +14 more , Pera G, Toran P, Michel M, Schneider KM, Holleboom AG, Cabezas MC, Tushuizen ME, Janssen HLA, Schattenberg JM, Gines P, Francque SM, Younossi ZM, Krag A, Brouwer WP
Gastroenterology · 2026 Jun · PMID 42297049 · Publisher ↗
BACKGROUND & AIMS: Current guideline-defined indicators for fibrosis screening identify a large proportion of the general population, burdening health care resources. We aimed to evaluate and refine indicators for fibros...
BACKGROUND & AIMS: Current guideline-defined indicators for fibrosis screening identify a large proportion of the general population, burdening health care resources. We aimed to evaluate and refine indicators for fibrosis screening. METHODS: We included adults aged 18-80 years from the National Health and Nutrition Examination Survey 2017-2020 data with a body mass index ≥18.5 kg/m without excessive alcohol use. We obtained the weighted proportions of individuals across stratified screening indicators and targeted only subgroups with ≥10% liver stiffness measurement (LSM ≥8 kPa) risk for screening. These refined criteria were validated and linked with liver-related events in 4 general-population cohorts. RESULTS: The derivation cohort included 5904 adults (8.9% LSM ≥8 kPa). Current guidelines identified 60%-76% as screening-eligible, yielding an LSM ≥8 kPa prevalence of 11%-14% among those screening eligible and 2% among those not eligible. Our refined strategy targeted 22% for screening, increasing prevalence to 28% among those screening-eligible, while maintaining low prevalence (4%) in those not eligible. In the pooled validation cohort (n = 13,295; 7.0% LSM ≥8 kPa), 14% met the refined criteria. Results remained consistent across thresholds: LSM ≥8, ≥10, and ≥12 kPa prevalence among screening-eligible individuals was 22%, 13%, and 8%, respectively, and 4%, 2%, and 1% among those not eligible. In the UK Biobank (n = 282,852), individuals meeting the refined criteria had an approximately 6-fold higher 10-year risk of incident cirrhosis (0.99% vs 0.18%) and liver-related death (0.40% vs 0.07%). CONCLUSIONS: Current recommendations target 60%-76% of adults for fibrosis screening. Our refined strategy reduced this to 10%-22%, achieving significantly higher disease prevalence among those eligible for screening, while maintaining a very low risk of increased LSM or liver-related events in those not eligible for screening.
Short-chain fatty acids of intestinal origin attenuate protein-bound uremic toxins in patients with chronic kidney disease by protecting the intestinal barrier: a pooled analysis of multiple studies with individualized intervention strategies.
Wang M, Li Y, Fu Z … +8 more , Liu Y, He Y, Gao C, Li Y, Wu H, Yuan Y, Chen L, Li L
BMC Gastroenterol · 2026 Jun · PMID 42289655 · Full text
BACKGROUND: Patients with chronic kidney disease (CKD) present a disordered short-chain fatty acid (SCFA)-intestinal barrier-protein-bound uremic toxin (PBUT) axis, while clinical guidelines lack strategies for PBUT sour...
BACKGROUND: Patients with chronic kidney disease (CKD) present a disordered short-chain fatty acid (SCFA)-intestinal barrier-protein-bound uremic toxin (PBUT) axis, while clinical guidelines lack strategies for PBUT source reduction. This study explored the regulatory effects of SCFAs to support individualized interventions for CKD patients. METHODS: A non-individual participant data pooled analysis was conducted on 4 studies (3 cross-sectional, 1 randomized controlled trial) including 320 CKD patients and 53 healthy controls. Correlation, mediation, subgroup, and dose-response analyses were performed to assess SCFAs, intestinal barrier, PBUTs, and renal function. RESULTS: SCFA-producing bacteria were significantly reduced in CKD patients (P < 0.001). Butyric acid was negatively correlated with p-cresyl sulfate (rₛ=-0.423, P < 0.001). The intestinal barrier mediated 37.2% of the SCFA-PBUT regulatory effect. Synbiotic and low-protein high-fiber diets optimally reduced PBUTs, with greater benefits in CKD stages 4-5 (P interaction = 0.031). High-fiber diets were safe in non-dialysis patients. CONCLUSIONS: SCFAs attenuate PBUT accumulation by protecting the intestinal barrier, which may improve CKD prognosis. Synbiotic and low-protein high-fiber diets are effective interventions, especially for advanced CKD.
Preoperative and perioperative predictors of prolonged hospital stay after uncomplicated elective laparoscopic cholecystectomy: a retrospective cohort study.
Topcu R, Kaymak T, Yüksek MA … +5 more , Aslan O, Kaymak EY, Sezikli İ, Canal K, Perçem AK
BMC Gastroenterol · 2026 Jun · PMID 42286470 · Full text
BACKGROUND: Although laparoscopic cholecystectomy is considered the gold standard for benign gallbladder disease and is typically associated with short hospitalization, a subset of patients experience prolonged length of...
BACKGROUND: Although laparoscopic cholecystectomy is considered the gold standard for benign gallbladder disease and is typically associated with short hospitalization, a subset of patients experience prolonged length of stay (LOS), increasing healthcare costs and resource utilization. Early identification of patients at risk for extended hospitalization may facilitate perioperative optimization and discharge planning. This study aimed to identify perioperative predictors of prolonged hospital stay following uncomplicated elective laparoscopic cholecystectomy and to evaluate the discriminative performance of a multivariable predictive model. METHODS: In this single-center retrospective cohort study, 718 adult patients who underwent uncomplicated elective laparoscopic cholecystectomy between January 2024 and August 2025 were analyzed. Patients with conversion to open surgery, reoperation, or major postoperative complications were excluded from the primary analysis and evaluated separately as an Extended Cohort (n = 31). Prolonged hospital stay was defined as LOS > 2 days. Preoperative variables included demographic characteristics, ASA score, preoperative imaging findings, and prior biliary interventions, while operative duration and surgeon experience were assessed as intraoperative variables. Variables with p < 0.10 in univariate analysis were entered into a multivariable logistic regression model. Model discrimination was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Of the 718 patients, 263 (36.6%) experienced prolonged hospitalization. In multivariable analysis, increasing age (OR 1.02 per year, 95% CI 1.00-1.03, p = 0.009), higher ASA score (OR 1.28, 95% CI 1.05-1.56, p = 0.015), longer operative duration (OR 1.03 per minute, 95% CI 1.02-1.04, p < 0.001), higher preoperative imaging score (OR 1.25, 95% CI 1.09-1.43, p = 0.002), and prior ERCP (OR 2.45, 95% CI 1.24-4.84, p = 0.010) were independently associated with prolonged LOS. Surgeon experience was not significantly associated with hospital stay after adjustment. The multivariable model demonstrated good discriminative ability (AUC 0.76), outperforming operative duration alone (AUC 0.59) and the preoperative-only model (AUC 0.69). CONCLUSION: Prolonged hospital stay following uncomplicated laparoscopic cholecystectomy is primarily driven by patient characteristics and disease severity rather than surgeon experience. A structured perioperative risk model incorporating clinical, radiological, and intraoperative variables may improve discharge planning and optimize hospital resource utilization. The proposed model applies to uncomplicated elective procedures, whereas complication-related hospitalization represents a distinct clinical entity requiring separate predictive frameworks. Prospective multicenter validation is warranted.
Changing etiological spectrum of cirrhosis in China: a systematic review and meta-analysis.
He C, Liu P, Liu X … +3 more , Cai P, Fu X, Li J
BMC Gastroenterol · 2026 Jun · PMID 42286454 · Full text
BACKGROUND: Cirrhosis remains a major public health challenge in China and has historically been driven mainly by chronic viral hepatitis. However, alcohol-related liver disease and metabolic liver disease have received...
BACKGROUND: Cirrhosis remains a major public health challenge in China and has historically been driven mainly by chronic viral hepatitis. However, alcohol-related liver disease and metabolic liver disease have received increasing attention in recent decades. Changes in hepatitis B vaccination, antiviral therapy, blood safety, alcohol consumption, and metabolic risk factors may have altered the reported etiological profile of cirrhosis. Existing evidence remains largely region-specific, hospital-based, or limited to particular time periods. This systematic review and meta-analysis aimed to characterize the reported etiological spectrum of cirrhosis in mainland China and to describe temporal and regional patterns. METHODS: We searched PubMed, Scopus, Embase, Web of Science, CNKI, Wanfang Data, and Sinomed for studies published from January 1990 to December 2025. Observational studies reporting the etiological distribution of cirrhosis in adults or children in mainland China were included. For adults, the principal etiological ranking was based on mutually exclusive categories, with single reported etiologies and explicitly reported mixed etiologies analyzed separately. Temporal and regional analyses used inclusive factor-related groupings, in which mixed etiologies contributed to each relevant etiological factor. For children, broad reported etiological categories were summarized because many pediatric studies did not fully subclassify post-hepatitic cirrhosis by viral subtype. Pooled proportions were estimated using random-effects models, and heterogeneity was assessed using the I² statistic. RESULTS: A total of 71 studies were included, comprising 59 studies contributing adult data and 12 studies contributing pediatric data. In adults, hepatitis B virus (HBV)-only cirrhosis was the most frequently reported single etiology, with a pooled proportion of 54.5% (95% CI: 51.2-57.8), followed by alcohol-only cirrhosis at 11.8% (95% CI: 10.1-13.6) and hepatitis C virus (HCV)-only cirrhosis at 5.9% (95% CI: 4.3-7.7). Cryptogenic cirrhosis accounted for 5.3% (95% CI: 4.1-6.6), and schistosomiasis-related cirrhosis accounted for 3.9% (95% CI: 0.7-9.4). In children, viral/post-hepatitic cirrhosis was the most frequently reported broad category, accounting for 47.9% (95% CI: 33.3-62.6). In inclusive temporal and regional analyses among adults, HBV-related cirrhosis remained the most frequently reported factor-related grouping across study periods and regions, while alcohol-related cirrhosis showed non-monotonic temporal variation and was highest in 2020-2025. CONCLUSION: HBV remains the leading reported etiology of cirrhosis in mainland China, although the reported etiological profile has become more diverse over time. Alcohol-related cirrhosis, HCV-related regional burden, and under-recognized metabolic liver disease warrant further attention. Given substantial heterogeneity, these estimates should be interpreted as descriptive summaries rather than nationally uniform proportions. These findings support continued HBV prevention and treatment, expanded HCV screening, linkage to care, and direct-acting antivirals (DAAs) treatment coverage, improved ascertainment of metabolic liver disease, and more standardized reporting of mixed-etiology cirrhosis.
Effectiveness and safety of vedolizumab in real-world studies in Asian patients with inflammatory bowel disease: a systematic review and meta-analysis.
Gu Y, Zhang X, Gu L … +1 more , Zou D
BMC Gastroenterol · 2026 Jun · PMID 42277696 · Full text
BACKGROUND: To evaluate the real-world effectiveness and safety of vedolizumab (VDZ) in Asian patients with IBD, including Crohn's disease (CD) and Ulcerative colitis (UC). METHODS: We systematically searched PubMed, EMB...
BACKGROUND: To evaluate the real-world effectiveness and safety of vedolizumab (VDZ) in Asian patients with IBD, including Crohn's disease (CD) and Ulcerative colitis (UC). METHODS: We systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CBM, CNKI, Wanfang, and VIP for real-world studies assessing intravenous VDZ in Asian IBD patients. Primary outcomes were clinical remission, response and endoscopic remission. Secondary outcomes encompassed corticosteroid-free clinical remission, endoscopic response, complete endoscopic remission, C-reactive protein remission, faecal calprotectin normalization, treatment persistence rate and safety variables. Meta-analysis was performed for CD and UC across induction (6-14 weeks), medium term (22-30 weeks), and long term (over 48 weeks) using a random-effects model. RESULTS: Twenty-nine studies with 2395 patients were included. Induction clinical remission and response was 61.15% and 57.48% for CD, and 40.07% and 64.72% for UC. Medium-term clinical remission and response was 60.72% and 64.32% for CD, and 43.51% and 64.87% for UC. Long-term clinical remission and response for CD was 45.83% and 44.55%, for UC was 56.14% and 61.35%. Endoscopic remission improved across induction, medium term, and long-term for CD (11.11%, 18.41% and 36.42%) and UC (43.19%, 54.27% and 66.72%). Within the longest follow up of 52 weeks, adverse event rate ranged widely from 6.67% to 61.54% for CD and 29.69% to 75.38% for UC. Chinese patients and both biologic-naïve and biologic-experienced patients showed similar favorable outcomes. CONCLUSION: VDZ demonstrated overall favourable effectiveness in Asian IBD patients, with a safety profile aligned with global data. TRIAL REGISTRATION: The protocol was registered on National Institution for Health and Care Research (registration number CRD420251000408).
Associations of bilirubin, albumin, and the ALBI index with gastric cancer risk: a smoking-stratified prospective cohort study in men.
Shin JW, Lee JW, Minh NT … +1 more , Jee SH
BMC Gastroenterol · 2026 Jun · PMID 42277685 · Full text
BACKGROUND: Bilirubin and albumin are endogenous antioxidants, and the ALBI index may reflect systemic oxidative stress. However, their associations with gastric cancer risk, especially by smoking status in healthy popul...
BACKGROUND: Bilirubin and albumin are endogenous antioxidants, and the ALBI index may reflect systemic oxidative stress. However, their associations with gastric cancer risk, especially by smoking status in healthy populations, remain unclear. METHODS: This study utilized data from the KCPS-II cohort, including a total of 83,371 men participants without cancer at baseline. During a mean follow-up period of 13.5 years, 1,162 cases of gastric cancer were identified. Serum total bilirubin, albumin, and the ALBI index were analyzed according to smoking status. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with additional analyses conducted using quartiles and trend tests. RESULTS: A 1 SD increase in total bilirubin was significantly inversely associated with gastric cancer among ever-smokers (HR: 0.80, 95% CI: 0.65-0.98). A similar inverse association was observed among former smokers (HR: 0.73, 95% CI: 0.53-1.00). Albumin showed the strongest inverse association with gastric cancer among ever-smokers (HR: 0.59, 95% CI: 0.45-0.77), with consistent associations observed in both current and former smokers (HR: 0.60, 95% CI: 0.42-0.86; HR: 0.62, 95% CI: 0.41-0.92, respectively). The ALBI index was also significantly inversely associated with gastric cancer among ever-smokers (HR: 0.74, 95% CI: 0.56-0.99). In contrast, none of the three biomarkers showed statistically significant associations with gastric cancer among never smokers. CONCLUSIONS: This study suggests that serum bilirubin, albumin, and the ALBI index may serve as useful antioxidant biomarkers for predicting gastric cancer risk, particularly showing strong inverse associations among smokers.
Use of medications to treat inflammatory bowel diseases before and during pregnancy in Switzerland between 2012 and 2019: an observational study using the claims-based MAMA cohort.
Gerbier E, Abolhassani N, Dupuis M … +10 more , Oppliger B, Kandhasamy S, Favre G, Maisonneuve E, Winterfeld U, Legardeur H, Ceulemans M, Baud D, Spoendlin J, Panchaud A
BMC Gastroenterol · 2026 Jun · PMID 42277663 · Full text
BACKGROUND: Effective management of Inflammatory bowel diseases (IBD) before and during pregnancy is crucial as women with well-controlled IBD at conception tend to remain in remission throughout pregnancy, experiencing...
BACKGROUND: Effective management of Inflammatory bowel diseases (IBD) before and during pregnancy is crucial as women with well-controlled IBD at conception tend to remain in remission throughout pregnancy, experiencing outcomes similar to women without IBD. Most IBD medications are considered safe during pregnancy, except for methotrexate. Despite reassuring data, previous studies have highlighted that women often have negative perceptions and fears related to IBD medications, leading to poor adherence. There is a lack of data regarding how IBD is treated before and during pregnancy in Switzerland. We aimed to assess the prevalence and usage patterns of various IBD medications in Switzerland before and during pregnancy over time. METHODS: A descriptive study using the MAMA cohort based on Swiss health insurance claims from 2012 to 2019. We identified pregnancies with a pharmaceutical cost group (PCG) indicating IBD and at least one dispensed IBD medication before pregnancy. We defined three groups based on dispensation timing: continuers (dispensation in pre-pregnancy and in or after trimester 2), switchers (different dispensation between pre-pregnancy and in or after trimester 2), and discontinuers (dispensation in pre-pregnancy but no dispensation in or after trimester 2). RESULTS: Among 84,317 deliveries, 0.4% had a PCG code for IBD with an IBD medication dispensed in pre-pregnancy. Half of these pregnancies were exposed to Aminosalicylates, with a consistent proportion over time. Pregnancies exposed to biologics seemed to increase over time, while immunosuppressant use remained steady. Roughly one-third with IBD medication before pregnancy discontinued treatment, a consistent rate throughout the study. CONCLUSIONS: Aminosalicylates were the most dispensed medication to treat IBD despite the lack of evidence to support their use as first-line therapy. The increase in biologics' dispensations likely reflects the growing evidence on the safety of these medications during pregnancy. One in three women discontinued all treatment during pregnancy, with a stable proportion over time. It is not known whether women discontinued treatment due to quiescent disease or concerns about medication harm. If the latter, these women should be identified and counseled, preferably during the pre-conception period, about the risks and benefits of disease and treatment.
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Tavaglione F, Loomba R
Gastroenterology · 2026 Jun · PMID 42276383 · Publisher ↗
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Generalizability of the MetALD-ALD Prediction Index in Asian Populations.
Fujii H, Tobita H, Nakajima A
Gastroenterology · 2026 Jun · PMID 42276382 · Publisher ↗
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The influence of self-care-related constructs on medication adherence in inflammatory bowel disease: a scoping review.
Martella P, Schiavoni E, Napolitano D … +1 more , Cocchieri A
Minerva Gastroenterol (Torino) · 2026 Jun · PMID 42272335 · Publisher ↗
BACKGROUND: Self-care is increasingly recognized as a key determinant of outcomes in inflammatory bowel disease (IBD), yet its relationship with medication adherence remains inconsistently mapped. This scoping review aim...
BACKGROUND: Self-care is increasingly recognized as a key determinant of outcomes in inflammatory bowel disease (IBD), yet its relationship with medication adherence remains inconsistently mapped. This scoping review aimed to explore how self-care-related constructs, including self-efficacy and patient activation are associated with medication adherence. METHODS: A scoping review was conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched using terms related to IBD, self-care or self-management, including self-efficacy, patient activation and medication adherence. Primary studies involving adult outpatients were included. Study selection and data charting were performed by two reviewers, with discrepancies resolved through discussion with a third supervisor. RESULTS: The search identified 699 records; after removing 164 duplicates, 535 records were screened. Eleven full texts were assessed, and five studies were included. Evidence was heterogeneous and included interventional and observational designs. Interventions supporting self-management, such as nurse-led counselling and practical tools, were associated with improved adherence. Telemedicine monitoring improved patient activation but not self-efficacy. Observational evidence suggested that higher self-efficacy and lower regimen complexity were associated with better adherence. CONCLUSIONS: Available evidence suggests that self-care-related constructs, particularly self-efficacy and patient activation, may be associated with medication adherence in IBD outpatients. However, the literature remains limited and heterogeneous. Further theory-informed and adequately powered studies are needed.
Machine learning models to predict the recurrence of common bile duct stones after ERCP.
Han X, Ye M, Tian Y … +3 more , Long Q, Tang Q, Zhu H
BMC Gastroenterol · 2026 Jun · PMID 42271287 · Full text
OBJECTIVE: To construct predictive models for the recurrence of common bile duct stones (CBDS) following endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This retrospective study analyzed data from 1,130 p...
OBJECTIVE: To construct predictive models for the recurrence of common bile duct stones (CBDS) following endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This retrospective study analyzed data from 1,130 patients who were randomly divided into a training set (70%) and a test set (30%). Feature selection was performed using the boruta algorithm and multivariable logistic regression (LR), followed by addressing data imbalance through the Synthetic Minority Over-sampling Technique (SMOTE). Predictive models were developed utilizing random forest (RF), extreme gradient boosting (XGBoost), and LR. We optimized these models through random search and ten-fold cross-validation to identify the best parameters. After model development, we compared their area under the curve (AUC), accuracy, recall, precision, F1-score, and decision curve analysis (DCA) to select the most optimal model. Ultimately, the optimal model was interpreted using shapley additive explanations (SHAP). RESULTS: Eight risk factors were identified and used to construct the predictive model, including clinical course, stone diameter, presence of multiple stones, use of biliary stents, alcohol consumption, history of biliary tract operations, presence of CBD stenosis, and endoscopic papillary balloon dilation. The RF model outperformed XGBoost and LR in terms of AUC, accuracy, recall, precision, F1-score, and DCA. The SHAP summary plot, waterfall plot, and force plot provided both overall and local explanations of the RF model. CONCLUSION: This study successfully identifies high-risk individuals for recurrent CBDS post-ERCP and offers valuable insights for machine learning-assisted clinical decision-making.
TACE, lenvatinib, and PD-1 inhibitors in unresectable advanced hepatocellular carcinoma: an exploratory retrospective cohort study.
Zhao H, Li T, Zhang Y … +2 more , Song Y, Li M
BMC Gastroenterol · 2026 Jun · PMID 42271264 · Full text
BACKGROUND: For patients with unresectable advanced hepatocellular carcinoma (HCC), therapeutic options are limited, and transarterial chemoembolization (TACE) alone often yields suboptimal outcomes. This study aimed to...
BACKGROUND: For patients with unresectable advanced hepatocellular carcinoma (HCC), therapeutic options are limited, and transarterial chemoembolization (TACE) alone often yields suboptimal outcomes. This study aimed to evaluate clinical outcomes and recorded safety events associated with combining TACE, lenvatinib, and programmed cell death protein 1 (PD-1) inhibitors for HCC. METHODS: A retrospective cohort study was conducted involving 209 patients with unresectable advanced HCC treated from June 2016 to December 2022. Patients were divided into the TACE + len group (n = 96) and the TACE + len+PD-1 group (n = 113). Tumor response, recorded adverse events, treatment exposure, OS, and PFS were analyzed. Propensity score-based IPTW was performed using baseline demographic and clinical variables to reduce measured baseline imbalance. RESULTS: After IPTW adjustment, baseline covariates achieved acceptable balance. Median OS was 16.49 months in the TACE + len+PD-1 group and 13.37 months in the TACE + len group; IPTW-weighted Cox regression showed an association between triple therapy and longer OS (HR = 0.591, 95% CI 0.417-0.836, P = 0.003). Median PFS was 10.02 months and 3.42 months, respectively, and the IPTW-weighted HR for PFS was 0.638 (95% CI 0.479-0.848, P = 0.002). Grade ≥ 3 adverse events occurred in 18.58% and 14.58% of patients, respectively (P = 0.440). CONCLUSION: In this exploratory retrospective cohort, adding PD-1 inhibitors to TACE plus lenvatinib was associated with improved tumor response and longer OS/PFS after IPTW adjustment, without a significant increase in recorded Grade ≥ 3 adverse events. These findings require prospective validation.
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