Gastroenterology[JOURNAL]
Sun
200 papers
Outcomes for a digital prescription mobile application for adults with irritable bowel syndrome: an uncontrolled trial.
Butt MF, Reghefaoui M, Bush D … +6 more , Aliyu A, Darie AM, Mohanan A, Sibelli A, Card TR, Corsetti M
BMC Gastroenterol · 2026 Jun · PMID 42271261 · Full text
BACKGROUND: Behavioral therapies are effective in the management of irritable bowel syndrome (IBS). Mahana™ IBS is a mobile phone application designed to deliver 10 sessions (10-12 weeks) of gut-directed cognitive behavi...
BACKGROUND: Behavioral therapies are effective in the management of irritable bowel syndrome (IBS). Mahana™ IBS is a mobile phone application designed to deliver 10 sessions (10-12 weeks) of gut-directed cognitive behavioral therapy (CBT) to adults with IBS. OBJECTIVES: To evaluate patient compliance with the Mahana™ mobile phone CBT application and the change in gastrointestinal and psychological symptoms in a real-world UK setting. METHODS: This single-center prospective study recruited adults with Rome IV IBS from a tertiary care outpatient setting. At baseline and 12-week follow-up, patients completed questionnaires assessing gastrointestinal symptoms (IBS symptom severity scale [IBS-SSS]), depression (patient health questionnaire-9 [PHQ-9]), and anxiety (generalized anxiety disorder-7 [GAD-7]). RESULTS: Thirty patients (20/30 female, mean [SD] age 44.57 [14.70]) consented to treatment and completed pre-intervention questionnaires, among whom 20 (66.7%) provided follow-up questionnaire data. Among the 20 individuals with two-point data, there was a statistically significant reduction in the IBS-SSS (P<0.001), GAD-7 (P=0.02), and PHQ-9 (P=0.04) scores. Fourteen (70%) patients reported a clinically significant improvement (≥50 point reduction) in the IBS-SSS; these individuals tended to be older (P=0.04) and male (P=0.04). Patients with IBS-diarrhea reported the greatest improvement in the IBS-SSS versus those with IBS-constipation and IBS-mixed subtypes. The baseline IBS-SSS (P=0.35), GAD-7 (P=0.19) and PHQ-9 (P=0.19) scores were not significantly different between persons who completed the entire CBT intervention versus those who did not. CONCLUSION: This study provides preliminary evidence that the Mahana™ IBS CBT application is associated with a statistically significant improvement in gastrointestinal and psychological symptoms in a real-world UK clinical setting. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov (trial registration number: NCT07008404) on 6 June 2025.
Distal Recirculation of Enteral contents Augmented Mechanically (DREAM) Promotes Intestinal Adaptation and Restores Enterohepatic Signaling in Short Bowel Syndrome.
Mehta S, Kurashima K, Manithody C … +21 more , Ohkura T, Morfin S, Bagwe A, Syn M, Sims A, Kolli S, Whalen C, Jain A, Guzman M, Besmer S, Jain S, Buchanan P, Pereira K, Lin CJ, Hartmann B, Holst JJ, Long J, Miyata S, McHale M, Hutchinson C, Jain AK
Gastroenterology · 2026 Jun · PMID 42269947 · Publisher ↗
BACKGROUND & AIMS: Short bowel syndrome (SBS) leads to malabsorption and intestinal failure-associated liver disease. Intestinal adaptation (IA) driven by sustained enteral nutrition (EN) is essential, but EN delivery is...
BACKGROUND & AIMS: Short bowel syndrome (SBS) leads to malabsorption and intestinal failure-associated liver disease. Intestinal adaptation (IA) driven by sustained enteral nutrition (EN) is essential, but EN delivery is limited after major resection. We developed DREAM (Distal Recirculation of Enteral contents Augmented Mechanically), which enables complete EN despite SBS, and enhances IA. We evaluated its efficacy in a translational large-animal model. METHODS: The study randomized 20 neonatal pigs to EN (control), SBS (75% resection), or DREAM. Growth, serum biochemistry, cytokines, intestinal morphology, barrier integrity, hepatic histology, and gene expression (quantitative polymerase chain reaction, RNA sequencing, Kyoto Encyclopedia of Genes and Genomes, and Gene Ontology enrichment) were analyzed. RESULTS: DREAM prevented hepatic and intestinal injury seen in SBS. Serum bilirubin (0.11 vs 5.14 mg/dL, P = .0008), γ-glutamyl transferase (23.2 vs 114.6 IU/L, P < .0001), and bile acids (9.7 vs 39 μmol/L, P = .0026) were significantly lower. Inflammatory cytokines (interferon-γ, P = .0296; interleukin 1β, P = .0349; and interleukin 6, P = .0189) and portal lipopolysaccharide (P = .0130) markedly improved. DREAM enhanced IA, increasing linear gut density (0.38 vs 0.209 g/cm, P < .0001), villus-to-crypt ratio (P = .0026), glucagon-like peptide 2 (P < .0001) and restored occludin and E-cadherin (P < .001). Hepatic bile salt export pump and cholesterol 7α-hydroxylase regulation were preserved (P = .0373 and P = .0034), and intestinal farnesoid X receptor, Takeda G-protein-coupled receptor 5, and epidermal growth factor signaling were reactivated (P < .01). Transcriptomic analysis confirmed improvements in metabolic, absorptive, and immune pathways. DREAM effluent demonstrated >80% macronutrient absorption within 6 hours (P < .0001). CONCLUSION: DREAM enables full EN in SBS, restoring absorption, mucosal integrity, and gut-liver homeostasis while preventing intestinal failure-associated liver disease. This approach represents a promising translational advance in SBS therapy.
IBDome: An Integrated Molecular, Histopathological, and Clinical Atlas of Inflammatory Bowel Diseases.
Plattner C, Sturm G, Kühl AA … +22 more , Atreya R, Carollo S, Rieder D, Gronauer R, Günther M, Ormanns S, Manzl C, Wirtz S, Meneghetti AR, Hegazy AN, Patankar JV, Carrero ZI, Grabherr F, Meyer M, TRR241 IBDome Consortium, Adolph TE, Tilg H, Neurath MF, Kather JN, Becker C, Siegmund B, Trajanoski Z
Gastroenterology · 2026 Jun · PMID 42269946 · Publisher ↗
BACKGROUND & AIMS: Multiomic and multimodal datasets with detailed clinical annotations offer significant potential to advance understanding of inflammatory bowel diseases (IBDs), refine diagnostics, and enable personali...
BACKGROUND & AIMS: Multiomic and multimodal datasets with detailed clinical annotations offer significant potential to advance understanding of inflammatory bowel diseases (IBDs), refine diagnostics, and enable personalized therapeutic strategies. METHODS: In this multicohort study, an extensive multiomic and multimodal analysis of 1002 clinically annotated patients with IBD and non-IBD controls was performed, incorporating whole-exome and RNA sequencing of normal and inflamed gut tissues, serum proteomics, and histopathological assessments from images of H&E-stained tissue sections. RESULTS: Transcriptomic profiles of normal and inflamed tissues revealed distinct site-specific inflammatory signatures in Crohn's disease and ulcerative colitis. Leveraging serum proteomics, an inflammatory protein severity signature that reflects underlying intestinal molecular inflammation was developed. Furthermore, foundation model-based deep learning accurately predicted histologic disease activity scores and enabled Crohn's disease vs ulcerative colitis classification from images of H&E-stained intestinal tissue sections, offering a robust tool for clinical evaluation. CONCLUSIONS: This integrative, publicly available multiomics resource for IBD research highlights the potential of combining multiomics and advanced computational approaches to improve understanding and management of IBD.
Beyond Calorie Counting: Is Circadian Alignment Key to Metabolic Health in Crohn's Disease?
Sun L, Ye W
Gastroenterology · 2026 Jun · PMID 42269945 · Publisher ↗
Abstract loading — click title to view on PubMed.
The impact of early enteral nutrition on length of hospital stay in adult severe acute pancreatitis: a retrospective cohort study.
Li S, Zhang S
Minerva Gastroenterol (Torino) · 2026 Jun · PMID 42267915 · Publisher ↗
BACKGROUND: To investigate the impact of early enteral nutrition on hospital stay in adults with severe acute pancreatitis (SAP). METHODS: Retrospective analysis of clinical data from adult SAP patients admitted between...
BACKGROUND: To investigate the impact of early enteral nutrition on hospital stay in adults with severe acute pancreatitis (SAP). METHODS: Retrospective analysis of clinical data from adult SAP patients admitted between January 2023 and June 2023. Patients were divided into early enteral nutrition (63 cases) and late enteral nutrition (69 cases) groups. General information, admission blood parameters, white blood cell count, CRP levels, and length of hospital stay were compared between the groups. Pearson correlation analysis explored the relationship between timing of enteral nutrition and hospital stay. RESULTS: No significant differences in general information and admission blood parameters between groups. Both groups showed significant decreases in white blood cell count (WBC) and CRP levels following the initiation of enteral nutrition. After enteral nutrition intervention, the early enteral nutrition group had significantly lower WBC and CRP concentration than the late enteral nutrition group. Average length of hospital stay and ICU stay were significantly shorter in the early enteral nutrition group. Correlation analysis showed a positive correlation between timing of enteral nutrition and average length of hospital stay and ICU stay in SAP patients. CONCLUSIONS: Early enteral nutrition has significant advantages over late enteral nutrition in improving inflammatory response and reducing length of hospital stay and ICU stay.
Validation of the C-WATCH score for predicting severity in patients with upper gastrointestinal bleeding at a tertiary public hospital in Lima, Peru.
Espinoza-Ríos J, Ruiz-Cortez R, Santiago B … +1 more , Tenorio JH
BMC Gastroenterol · 2026 Jun · PMID 42251293 · Full text
BACKGROUND: Upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, with mortality rates reaching 14% in some settings. Despite advances in management, mortality has remaine...
BACKGROUND: Upper gastrointestinal bleeding (UGIB) remains one of the most common emergencies in gastroenterology, with mortality rates reaching 14% in some settings. Despite advances in management, mortality has remained relatively unchanged. Several risk stratification tools, including Glasgow-Blatchford, AIMS65, and Rockall scores, are used to predict adverse outcomes. More recently, the C-WATCH score has been proposed as a simplified alternative. We aimed to validate the ability of the C-WATCH score to predict severity in patients with UGIB in a tertiary public hospital in Lima, Peru. METHODS: We conducted a prospective diagnostic accuracy study comparing the discriminative performance of C-WATCH, AIMS65, Glasgow-Blatchford, and Rockall (pre- and post-endoscopic) scores. The outcomes assessed included 30-day mortality, the need for transfusion of ≥ 2 units of packed red blood cells and rebleeding. Discrimination was assessed using area under the receiver operating characteristic curve (AUROC) and pairwise comparisons were performed using the DeLong test. RESULTS: A total of 235 patients were included; 59.6% (n = 140) were male, with a mean age of 61.0 ± 16.5 years. The thirty-day mortality rate was 4.7% (n = 11). The most frequent etiologies were gastric ulcers (31.1%, n = 73), esophageal varices (25.1%, n = 59), and duodenal ulcers (16.6%, n = 39). For mortality prediction, the AUROC was highest for C-WATCH (0.83, 95% CI 0.72-0.94), followed by AIMS65 (0.81, 95% CI 0.70-0.93), post-endoscopic Rockall (0.80, 95% CI 0.72-0.88), Glasgow-Blatchford (0.69, 95% CI 0.53-0.85) and pre-endoscopic Rockall (0.63, 95% CI 0.47-0.79). However, pairwise comparisons using the DeLong test showed no statistically significant differences between C-WATCH and comparator scores after Bonferroni correction. Similar findings were obtained for predicting transfusion ≥ 2 units. All scores demonstrated poor performance for rebleeding prediction (AUROC < 0.58) and no statistically significant differences. CONCLUSIONS: C-WATCH score demonstrated comparable performance for predicting 30-day mortality and transfusion requirements compared with AIMS65, Glasgow-Blatchford, and Rockall scores. All scores showed limited ability to predict rebleeding.
Impact of Availability of Computer-Aided Detection Devices on Adenoma Detection During Colonoscopy: A Cluster Randomized Study.
Dominitz JA, Gawron AJ, McKee GB … +2 more , Hoggatt KJ, Kaltenbach T
Gastroenterology · 2026 Jun · PMID 42250891 · Publisher ↗
BACKGROUND & AIMS: Endoscopists' colonoscopy adenoma detection rates (ADRs) are inversely associated with their patients' risk of postcolonoscopy colorectal cancer death. Although randomized controlled trials have found...
BACKGROUND & AIMS: Endoscopists' colonoscopy adenoma detection rates (ADRs) are inversely associated with their patients' risk of postcolonoscopy colorectal cancer death. Although randomized controlled trials have found that computer-aided detection (CADe) devices significantly improve ADRs, real-world studies have generally failed to demonstrate a benefit. METHODS: In this pragmatic quality improvement study, randomly selected Veterans Health Administration facilities were equipped with CADe devices between October 2022 and February 2023. Control facilities were assigned a random deployment date. Adenoma detection was determined for colonoscopies, and mixed effects logistic regression was used to assess the independent effect of CADe availability on colonoscopy outcomes. RESULTS: Colonoscopy data were available from 269 endoscopists at 42 facilities with CADe performing 71,594 pre- and 35,399 postdeployment colonoscopies; and from 547 endoscopists at 97 control facilities performing 151,792 pre- and 75,415 postdeployment colonoscopies. Comparing post- with predeployment colonoscopies, the absolute increase in ADR was 4.2 percentage points (95% CI, 3.48 to 4.74 percentage points), from 50.7% to 54.9%, at CADe sites and ADR decreased by 0.7 percentage points (95% CI, -1.16 to -0.28 percentage points), from 51.8% to 51.1%, at control sites. Using multivariable regression, CADe availability was associated with a significantly increased odds of adenoma detection (odds ratio, 1.22; 95% CI, 1.15 to 1.28), but was not associated with detection of other lesions or changes in withdrawal time. Baseline endoscopist ADR quintiles were not associated with the impact of CADe availability on ADR. CONCLUSIONS: Availability of CADe devices was associated with a significant increase in adenoma detection compared with usual care. The impact on cancer outcomes and potential endoscopist deskilling remains undetermined. CLINICALTRIALS: gov Number: NCT05888623.
A Subphenotype of Obesity With Reduced Enteroendocrine Glucagon-Like Peptide 1 Synthesis and Enhanced Tirzepatide Response.
Ticho AL, McRae AN, Cifuentes L … +12 more , Fredrick T, Anazco D, Espinosa MA, Garcia Cordova JM, Romanos M, Villamarin J, Johnson S, Lennon R, Hurtado Andrade MD, Chen J, Camilleri M, Acosta AJ
Gastroenterology · 2026 Jun · PMID 42250890 · Full text
BACKGROUND & AIMS: Obesity is a heterogeneous disease characterized by different pathophysiological and behavioral traits that influence response to glucagon-like peptide 1 (GLP-1)-based therapies. We previously identifi...
BACKGROUND & AIMS: Obesity is a heterogeneous disease characterized by different pathophysiological and behavioral traits that influence response to glucagon-like peptide 1 (GLP-1)-based therapies. We previously identified an obesity phenotype characterized by fast gastric emptying (GE) and increased postprandial hunger. We aimed to elucidate pathophysiological mechanisms in this phenotype by evaluating plasma enteroendocrine hormones and mucosal gene expression and to evaluate treatment response to tirzepatide across subphenotypes. METHODS: A total of 483 adults with obesity underwent solid meal GE (SGE by scintigraphy), postprandial appetite assessment using a visual analogue scale, and plasma enteroendocrine hormone profiling. Gaussian mixed modeling identified phenotypic clusters. Associations with plasma short-chain fatty acids and fecal metagenomics were explored. A separate cohort (n = 31) underwent colonic mucosal biopsies with quantification of GCG (GLP-1) and PYY messenger RNA. Retrospective evaluation of weight loss in participants treated with tirzepatide among each cluster was performed (n = 61). RESULTS: Three clusters were identified based on SGE and GLP-1. One cluster demonstrated fast SGE, increased postprandial hunger, and discordantly low postprandial GLP-1 (termed dc-GE/GLP-1; n = 130 [26.9%]), as well as lower plasma peptide YY and cholecystokinin. dc-GE/GLP-1 showed higher plasma short-chain fatty acid levels, without significant differences in fecal microbial composition. Compared with concordant clusters (c-GE/GLP-1; n = 353 [73.1%]), dc-GE/GLP-1 had decreased mucosal messenger RNA expression of GCG (GLP-1) and PYY. At 6 months of tirzepatide, dc-GE/GLP-1 was associated with greater weight loss compared with c-GE/GLP-1 (21.5% vs 11.7%). CONCLUSIONS: We identified a subphenotype of obesity with fast GE and discordantly low GLP-1 plasma levels, reduced mucosal hormone synthesis, and enhanced weight loss to tirzepatide. Further studies are needed to identify mechanisms contributing to GLP-1 deficiency in this subphenotype of obesity.
Positive-Regulatory Domain Zinc Finger Protein 9 Deficiency Drives Mosaic Promoter Deletions in Sporadic Hirschsprung Disease and Supports Blood-Based Molecular Stratification.
Zhu Y, Zuo X, Song K … +20 more , Yao Y, Huang L, He Q, Liu Z, Zheng Y, Xie X, Zhao X, He Y, Zhong W, Hu T, Liu Z, Chen J, Huang S, Lai X, Xu X, Zhong W, Zeng J, Zhou W, Xia H, Zhang Y
Gastroenterology · 2026 Jun · PMID 42250889 · Publisher ↗
BACKGROUND & AIMS: Hirschsprung disease (HSCR) is a congenital enteric neuropathy with distal aganglionosis and dysmotility. Germline mutations explain many familial cases, but most sporadic cases lack a molecular explan...
BACKGROUND & AIMS: Hirschsprung disease (HSCR) is a congenital enteric neuropathy with distal aganglionosis and dysmotility. Germline mutations explain many familial cases, but most sporadic cases lack a molecular explanation. We sought noncanonical mechanisms and blood-accessible biomarkers. METHODS: We performed RNA-sequencing (RNA-seq) on paired aganglionic and ganglionic colon biopsy specimens from 103 sporadic HSCR patients, with control colon samples (n = 22). Blood whole-genome sequencing (WGS) was available for 41 patients with RNA-seq profiles. We assessed positive-regulatory domain zinc finger protein 9 (PRDM9) in patient tissues, perturbed prdm9 in zebrafish and mice, and performed mechanistic profiling in PRDM9-knockout human-induced pluripotent stem cell-derived enteric neural crest cells. Mosaic promoter deletions (MPDs) were called from colon WGS (n = 30; matched blood, n = 27) and summarized as a blood MPD score in blood WGS cohorts (discovery: 89 HSCR and 43 controls; validation: 165 HSCR and 42 controls), alone and combined with the polygenic risk score. RESULTS: A predominant subgroup (79.6% [82 of 103]) showed coordinated repression of neurogenesis programs. Promoter motif enrichment implicated PRDM9, which we localized to normal enteric nervous system but found down-regulated in aganglionic tissue with promoter hypermethylation. Prdm9 perturbation reduced HuC/D-positive differentiated enteric neurons and impaired motility in zebrafish and mice. In enteric neural crest cells, PRDM9 loss redistributed DNA double-strand breaks toward promoters and enhancers, generated MPDs at neurogenesis loci, and correlated with transcriptional repression and impaired neuronal differentiation. Blood MPD score discriminated HSCR from controls in a discovery cohort (area under the receiver operating characteristic curve [AUROC], 0.78) and an independent validation cohort (AUROC, 0.82), and improved with polygenic risk score (AUROC, 0.89 and 0.91, respectively). CONCLUSIONS: PRDM9 deficiency links ectopic DNA breaks to MPDs and impaired enteric neuronal differentiation in a predominant molecular subgroup within sporadic HSCR and enables complementary, noninvasive molecular stratification.
Upskilling, Deskilling, or Never Skilling: Who Benefits From Artificial Intelligence in Colonoscopy?
Weinberg D, Bretthauer M
Gastroenterology · 2026 Jun · PMID 42250888 · Publisher ↗
Abstract loading — click title to view on PubMed.
Acute Liver Failure in a Patient with Myasthenia Gravis.
Tang T, Jain D, Block PD
Gastroenterology · 2026 Jun · PMID 42250887 · Publisher ↗
Abstract loading — click title to view on PubMed.
Dual GIP/GLP-1 receptor agonist tirzepatide ameliorates hepatic steatosis and inflammatory responses in a MASLD mouse model associated with the CCL2/CCR2 axis.
Pan Y, Song F, Liu X … +4 more , Zhang Y, Zhang J, Song G, Ren L
BMC Gastroenterol · 2026 Jun · PMID 42249304 · Full text
BACKGROUND/OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common multisystem chronic progressive liver disease with a rising burden. Tirzepatide (TZP), a dual agonist of glucose-depende...
BACKGROUND/OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common multisystem chronic progressive liver disease with a rising burden. Tirzepatide (TZP), a dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, has shown beneficial hepatic effects, but the related molecular mechanisms remain unclear. The aim of this study was to investigate the hepatic molecular signatures associated with TZP in MASLD. METHODS: A MASLD mouse model was established using a high-fat, high-fructose (HFHFr) diet. Male C57BL/8J mice (n = 32) were randomized to four groups: control (CON), HFHFr, HFHFr + semaglutide (Sema), and HFHFr + TZP. Hepatic transcriptomic and proteomic profiles were generated by RNA sequencing and liquid chromatography-mass spectrometry (LC-MS), respectively. Key molecular targets were validated by quantitative real-time PCR and immunoblotting of liver tissue. RESULTS: HFHFr feeding induced hyperglycaemia, increased HOMA-IR, elevated ALT/AST, and marked hepatic steatosis and inflammatory injury. Both Sema and TZP ameliorated these abnormalities. TZP was associated with lower hepatosomatic index, improved fasting glucose and HOMA-IR, and reduced hepatic MCP-1, IL-1β, TNF-α and GSDMD, with partial restoration of IL-10. Integrated liver transcriptomic-proteomic profiling highlighted chemokine signaling and PI3K-AKT pathway signatures to be associated with TZP. Further targeted validation showed that TZP treatment was associated with reduced hepatic CCL2/CCR2 axis components, and decreased PI3K abundance and lower AKT phosphorylation. CONCLUSION: TZP ameliorated hepatic steatosis and attenuated inflammatory responses in HFHFr-induced MASLD and was associated with downregulation of the CCL2/CCR2-linked chemokine signaling and PI3K-AKT-related inflammatory responses.
Training satisfaction, competency gaps and well-being in gastroenterology residency in Spain: results of a national SEPD survey.
Iborra M, Martín-Arranz MD, Gómez-Camarero J … +5 more , Gómez-Rodríguez R, Iglesias-Garcia J, Orive-Calzada A, Téllez L, Argüelles-Arias F
BMC Gastroenterol · 2026 Jun · PMID 42249282 · Full text
OBJECTIVE: To explore the training experience, competency needs and professional wellbeing of Gastroenterology trainees in Spain, with a particular focus on factors associated with burnout. METHODS: We conducted a cross-...
OBJECTIVE: To explore the training experience, competency needs and professional wellbeing of Gastroenterology trainees in Spain, with a particular focus on factors associated with burnout. METHODS: We conducted a cross-sectional study using an anonymous online survey distributed to residents (R1-R4) and young specialists (≤ 5 years after completing the training program). The survey collected information on training satisfaction, perceived competency gaps, working conditions, and burnout. Responses were collected using 5-point Likert scales. Descriptive analyses, subgroup comparisons and logistic regression models were used to identify factors associated with burnout. RESULTS: A total of 241 responses were obtained (60.6% women; mean age 30.2 ± 3.6 years). Nearly all participants trained in university hospitals (97.5%) and most in tertiary centres (82.6%). Overall satisfaction with the training program was 3.99 ± 0.71/5, with practical training rated more favourably (4.25 ± 0.71) than theoretical training (3.30 ± 0.98). The main areas identified as needing reinforcement were clinical nutrition (26.0%), digestive ultrasonography (25.2%) and endoscopy (23.3%). Burnout was reported by 63.5% of respondents. Lack of adequate rest was strongly associated with higher burnout risk, while satisfaction with working conditions showed a protective effect, an association that remained significant in multivariate analysis. Additionally, 89.5% believed that an additional year would improve their preparation, and 97.1% considered that a five-year program would be sufficient to acquire the necessary competencies. CONCLUSIONS: While practical training is highly valued, gaps persist in theoretical education and key technical areas. Burnout is common and closely linked to insufficient rest and dissatisfaction with working conditions. The strong support for extending residency to five years suggests that this measure may not only enhance training quality but also promote wellbeing and a more balanced acquisition of competencies.
Association of red blood cell distribution width to albumin ratio with all-cause and cardiovascular mortality among adults with MASLD.
Ni ZB, Huang LZ, Yao QR … +5 more , Li Q, Li J, Huang WF, Zhang JY, Wang YQ
BMC Gastroenterol · 2026 Jun · PMID 42243742 · Full text
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health burden. Identifying robust prognostic biomarkers is crucial for early risk stratification. The red blood cell distri...
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health burden. Identifying robust prognostic biomarkers is crucial for early risk stratification. The red blood cell distribution width to albumin ratio (RAR) has emerged as a potential biomarker reflecting inflammation and nutritional status. This study aimed to evaluate the association between RAR and both all-cause and cardiovascular mortality among adults with MASLD. METHODS: Data from the National Health and Nutrition Examination Survey 1999-2018 were analyzed. MASLD was defined using the United States Fatty Liver Index (USFLI ≥ 30), combined with cardiometabolic criteria. Participants were categorized into RAR quartiles. Weighted Cox proportional hazards models, Fine-Gray competing risk models, and restricted cubic splines were employed to the association between RAR and mortality. Stratified and sensitivity analyses were conducted to test robustness. RESULTS: Among 6,287 MASLD patients (mean age 51.39 years, 42.69% female), there were 1,161 all-cause deaths and 324 cardiovascular deaths over a median follow-up of 9.2 years. In the fully adjusted Model 3, individuals in the highest RAR quartile had a higher risk of all-cause mortality (hazard ratio [HR] = 2.41, 95% confidence interval [CI] = 1.87-3.10, P < 0.001) and cardiovascular mortality (HR = 3.39, 95% CI = 2.17-5.31, P < 0.001) compared to those in the lowest quartile. Each unit increase in RAR was associated with a 93% increase in all-cause mortality (HR = 1.93, 95% CI = 1.62-2.30, P < 0.001) and a 130% increase in cardiovascular mortality (HR = 2.30, 95% CI = 1.83-2.90, P < 0.001). No significant nonlinear associations were found. A significant age interaction was observed in all-cause mortality (P for interaction < 0.05), with stronger associations seen among younger individuals. Sensitivity analyses confirmed the robustness of these findings. CONCLUSIONS: Higher RAR levels were significantly associated with increased all-cause and cardiovascular mortality in adults with MASLD. RAR holds potential as a risk stratification tool for MASLD adults in clinical practice.
Post-splenectomy early biochemical trajectories and predictors in 935 patients with Wilson disease: a group-based trajectory modeling study.
Shi X, Zhu S, Sang N … +4 more , Jin L, Peng H, Chen J, Yu Q
BMC Gastroenterol · 2026 Jun · PMID 42243705 · Full text
BACKGROUND: Splenectomy is commonly used to alleviate portal hypertension-related hypersplenism in patients with Wilson's disease (WD) cirrhosis. However, early post-splenectomy biochemical responses vary substantially a...
BACKGROUND: Splenectomy is commonly used to alleviate portal hypertension-related hypersplenism in patients with Wilson's disease (WD) cirrhosis. However, early post-splenectomy biochemical responses vary substantially among individuals, and objective tools to characterize these dynamic patterns remain limited. This study aimed to identify early postoperative biochemical trajectories after splenectomy in patients with WD and to determine preoperative factors associated with unfavorable trajectory patterns. METHODS: We retrospectively analyzed 935 WD patients undergoing splenectomy (2001-2019). Serial ALT, AST, TBIL, and ALB were measured preoperatively and on postoperative days 1, 7, 14, and 21. Group-based trajectory models (GBTM) classified early postoperative biochemical patterns. Model selection was informed by comparison across multiple class solutions (K = 1-4), with K = 2 selected as the most parsimonious and clinically interpretable solution while avoiding very small subgroup proportions in higher-order models. Multivariable logistic regression identified predictors of unfavorable trajectories. RESULTS: GBTM identified two distinct trajectories for each biomarker. Unfavorable trajectory rates were 20.3% (ALT), 12.7% (AST), 13.6% (TBIL), and 46.1% (ALB). Model comparison supported the selection of K = 2 as the most parsimonious and clinically interpretable solution, while avoiding very small subgroup proportions in higher-order models. Higher Child-Pugh class strongly predicted unfavorable ALB and TBIL patterns. Sensitivity analyses excluding Child-Pugh yielded consistent results. CONCLUSIONS: Early post-splenectomy biochemical trajectories in WD exhibit heterogeneous patterns. These trajectories reflect short-term dynamic responses rather than definitive improvement in intrinsic hepatic function. The identified predictors may provide signals for early risk stratification but require validation against long-term outcomes.
Risk factors for residual cancer and lymph node metastasis after non-curative endoscopic resection of colorectal cancer: a multicenter retrospective study.
Oh SY, Oh HH, Kim YI … +9 more , Kim DH, Joo YE, Kim HS, Kang WK, Lee JL, Yoon YS, Kim CW, Park IJ, Lim SB
BMC Gastroenterol · 2026 Jun · PMID 42243702 · Full text
BACKGROUND AND AIMS: Following a non-curative endoscopic resection of T1 colorectal cancer, current guidelines recommend additional surgery based on high-risk pathological features. However, the actual rates of residual...
BACKGROUND AND AIMS: Following a non-curative endoscopic resection of T1 colorectal cancer, current guidelines recommend additional surgery based on high-risk pathological features. However, the actual rates of residual disease, such as residual cancer and lymph node metastasis (LNM), remain unclear and risk factors vary significantly across studies. We aimed to determine the true incidence of residual cancer and LNM and identify independent risk factors to guide surgical decision-making. METHODS: This multicenter retrospective study included patients who underwent radical surgery after non-curative endoscopic resection of T1 colorectal cancer at four hospitals between 2015 and 2020. Non-curative resection was defined by positive margins, deep submucosal invasion (≥ 1000 μm), poor differentiation, lymphovascular invasion, or high-grade tumor budding in accordance with current guidelines. RESULTS: Among 517 patients, residual cancer was found in 3.7% and LNM in 7.7% of the cases. Independent predictors of residual cancer were ESD procedure (OR 9.87, P < 0.001), piecemeal resection (OR 5.51, P = 0.017), positive lateral margin (OR 5.88, P = 0.004), and positive deep margin (OR 10.30, P = 0.003). For LNM, submucosal invasion depth ≥ 1000 μm (OR 4.66, P = 0.015), poor differentiation (OR 4.30, P = 0.026), lymphovascular invasion (OR 2.42, P = 0.016), and positive deep margin (OR 2.26, P = 0.018) were significant risk factors. Risk increased substantially with cumulative factors: patients with 0-1 risk factors had minimal residual cancer rates (< 1%), while those with ≥ 2 factors showed exponentially higher risks. CONCLUSIONS: The actual incidence of residual cancer and LNM after non-curative endoscopic resection is relatively low. A stepwise framework that evaluates local completeness and LNM risk independently and then integrates the two assessments may support individualized decision-making, potentially sparing low-risk patients from radical surgery while ensuring appropriate intervention for high-risk patients.
Construction and validation of a machine learning-based prediction model for social isolation in patients with colorectal cancer after stoma surgery.
Zhang W, Qu L
BMC Gastroenterol · 2026 Jun · PMID 42243692 · Full text
OBJECTIVE: To investigate the current status and influencing factors of social alienation in patients with enterostomy after colorectal cancer surgery, and to establish a risk prediction model for social alienation in th...
OBJECTIVE: To investigate the current status and influencing factors of social alienation in patients with enterostomy after colorectal cancer surgery, and to establish a risk prediction model for social alienation in this population. METHODS: A total of 507 enterostomy patients treated in the General Surgery (Colorectal Division), Oncology Department, and Wound Ostomy Clinic of a tertiary hospital in Jinzhou from March 2025 to January 2026 were enrolled by convenience sampling. The dataset was randomly divided into a training set and a validation set at a ratio of 7:3. Risk factors were screened by LASSO regression combined with Logistic regression. Five machine learning algorithms, including Logistic regression (LG), support vector machine (SVM), naive Bayes, K-nearest neighbor (KNN), and extreme gradient boosting (XGBoost), were employed to establish prediction models for social alienation. The predictive performance was evaluated and compared using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. Calibration curves and decision curve analysis (DCA) were used to assess model fitness and clinical utility. RESULTS: Among 507 included patients, 211 developed social alienation, with a prevalence rate of 41.6%. The SVM model achieved the optimal performance among the five models, with an AUC of 0.835 (95%CI: 0.772-0.899), sensitivity of 0.698, accuracy of 0.782, precision of 0.759, specificity of 0.841, and F1-score of 0.727. The calibration curve indicated favorable consistency between predicted and observed probabilities. The Hosmer-Lemeshow test yielded a χ value of 3.091 (P = 0.929). DCA revealed that the model provided high net benefit across the entire threshold range, suggesting excellent clinical applicability. CONCLUSION: The SVM model shows superior performance in predicting the risk of social alienation in enterostomy patients after colorectal cancer surgery and can serve as a screening tool for early identification in clinical practice.
A linear clinical prediction model and nomogram evaluating risk of portal vein thrombosis in liver cirrhosis.
Wang Z, Jiang F, Jin J … +2 more , Li Y, Jiang J
BMC Gastroenterol · 2026 Jun · PMID 42243688 · Full text
INTRODUCTION: As one of the complications of liver cirrhosis, portal vein thrombosis (PVT) brings a significant clinical challenge. To find the predictive clinical variables evaluating the probability of PVT, a predictio...
INTRODUCTION: As one of the complications of liver cirrhosis, portal vein thrombosis (PVT) brings a significant clinical challenge. To find the predictive clinical variables evaluating the probability of PVT, a prediction model was established and a nomogram was built for visualization. MATERIALS AND METHODS: Our study selected 245 cirrhosis patients admitted in First Hospital of Jilin University during August 2020 to June 2024, the majority of whom were admitted during July 2022 to June 2023. All patients were randomly separated into a training set and a validation set. Binary logistic and Lasso regression were used to establish predictive models with the occurrence of PVT events within 24 months after discharge as the clinical outcome. RESULTS: In discovery set, 64 (26.1%) of them had events of PVT within 24 months after their discharge. A linear model "ASP" was constructed with logarithm of alkaline phosphatase (LogALP), splenectomy and portal vein width selected for predicting PVT risk, preformed with its AUC reached 0.793, 0.750 and 0.760 in training, internal validation and external validation set, respectively. CONCLUSION: We finally screened out three clinical variables identifying high-risk PVT patients in liver cirrhosis beforehand. ALP level might be a potential clinical parameter connected to PVT, but need to be further verified.
Association of a novel Fat-Muscle-BMI Index (FMBI) with NAFLD, liver fibrosis, and atherosclerotic cardiovascular disease risk: a cross-sectional study in 1,592 Chinese adults.
Wu X, Hou X, Yin J … +4 more , Li Y, Xiong C, Liu H, Meng H
BMC Gastroenterol · 2026 Jun · PMID 42243685 · Full text
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a global burden with unmet non-invasive biomarker needs; BMI and FMRs have limitations, and their combined index FMBI is unstudied. We aim to explore FMBI's associ...
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a global burden with unmet non-invasive biomarker needs; BMI and FMRs have limitations, and their combined index FMBI is unstudied. We aim to explore FMBI's association with NAFLD, associated liver fibrosis and atherosclerotic cardiovascular disease risk (ASCVD) risk. METHODS: This retrospective study enrolled 1592 eligible participants aged 40-79 years from a Chinese hospital. The Fat-Muscle-BMI Index (FMBI) was calculated as Fat-to-muscle ratio (FMR) × Body mass index (BMI). Multivariable logistic/linear regression with three hierarchical models analyzed FMBI's associations with NAFLD, hepatic fibrosis and ASCVD; restricted cubic splines (RCS, subgroup and sensitivity/E-value analyses validated the findings. RESULTS: Higher FMBI quartiles exhibited a progressive increase in NAFLD prevalence (46.0% to 72.4%, P < 0.001). FMBI demonstrated a significant linear positive monotonic relationship with NAFLD (OR = 1.20 per unit increment, P < 0.001), with risk rising markedly as FMBI increased-particularly when FMBI ≥ 10. A significant additive interaction between FMR and smoking was observed (AP = 0.37, P = 0.010). Additionally, FMBI is independently associated with ASCVD risk (β = 0.32, P = 0.001) and hepatic fibrosis (OR = 1.79 for Q4 vs. Q1, P = 0.008) in NAFLD patients. E-value analysis confirmed the robustness of these findings to unmeasured confounding. CONCLUSION: This study identifies FMBI as a robust NAFLD biomarker exhibiting linear dose-response, additive synergy with smoking, and independent prediction of hepatic fibrosis and ASCVD risk, supporting its use in targeted NAFLD management.
ETV4 as a potential target gene for alleviating proliferation metastasis of HCC.
Yuan Y, Tan Q, Zhu M … +3 more , Chen L, Sun D, Liang Y
BMC Gastroenterol · 2026 Jun · PMID 42237239 · Full text
BACKGROUND: Hepatocellular carcinoma (HCC) develops and progresses via the RAF/MERK/ERK signaling pathway. Sorafenib, a first-line therapy for advanced HCC, inhibits the RAF gene. However, RAF dimerization and ERK activa...
BACKGROUND: Hepatocellular carcinoma (HCC) develops and progresses via the RAF/MERK/ERK signaling pathway. Sorafenib, a first-line therapy for advanced HCC, inhibits the RAF gene. However, RAF dimerization and ERK activation caused by RAF inhibition in HCC, and this paradoxical RAF/MERK/ERK activation is one of the reasons for Sorafenib resistance in liver cell carcinoma. ETV4 is an ERK downstream gene, hence inhibiting it may help to reduce treatment resistance in HCC. The human hepatoma cell line HepG2.2.15 was used as an HCC tumor cell model, while the HL-7702 cell line was used as a human normal hepatocytes cell model. In order to find out the function of ETV4, Small interfering RNA (siRNA) was used to knock down ETV4 gene. Experiments on cell phenotype and function were performed to test the effects of knocking down ETV4. MATERIALS AND METHODS: There were four groups in vitro: control group, siRNA-NC group, siRNA-ETV4 group and normal group. Cultured 5 × 10/100ul cells in 96-plate-well and 2 × 10/2 ml cells in 6-plate-well. Cell proliferation assays include small interfering RNA transfection, real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR), Western blot analysis, migration and invasion assays, flow cytometry, and chromatin immunoprecipitation (ChIP) assay. In vivo, nude mouse xenograft model was established by short hairpin RNA, including tumor volume measurement, western blotting, immunohistochemistry assay. One-way ANOVA was used to test for a statistically significant difference. RESULTS: Silencing of ETV4 decreased RNA expression of ERK1, ERK2, MMP1, and MMP9, as well as the protein levels of p-ERK, MMP1, and MMP9. Cell proliferation, migration, and invasion were also reduced with low ETV4 expression. Furthermore, apoptosis of HCC cells increased in low expression of ETV4 group. HCC cells were obstructed in G2/M cell cycle phase and decreased quantity in the DNA preparation in the G0/G1 phase. Knockdown ETV4 decreased KI67 and Vimentin in the tumor tissues, while the protein level of E-cadherin was significantly increased. ETV4 enriched at the MMP1-EBS3 and MMP9-EBS4 regions in HCC. CONCLUSION: ETV4 is a key gene connecting the RAF/MER/ERK pathway and the MMP family in tumor growth and development, especially in HCC. This study provides functional and mechanistic evidence suggesting that ETV4 knockdown limits the progression of HCC. This effect is mediated by the reduction of tumor cell proliferation and migration, which may occur, at least in part, through the modulation of the ERK/ETV4/MMPs axis.
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