Gastroenterology[JOURNAL]
Sun
200 papers
Fusobacterium nucleatum exacerbates chronic atrophic gastritis in rats via mitochondrial dysfunction and inflammatory activation.
Zhao P, Fan Y, Liu H … +4 more , Jin Y, Abula Y, Abudourousuli A, Zhang Y
BMC Gastroenterol · 2026 Jun · PMID 42237224 · Full text
BACKGROUND: Chronic atrophic gastritis (CAG) is a premalignant condition with limited therapeutic strategies. The role of the oral pathogen Fusobacterium nucleatum (F. nucleatum), associated with gastrointestinal carcino...
BACKGROUND: Chronic atrophic gastritis (CAG) is a premalignant condition with limited therapeutic strategies. The role of the oral pathogen Fusobacterium nucleatum (F. nucleatum), associated with gastrointestinal carcinogenesis, in CAG remains unclear. METHODS: This study investigated whether F. nucleatum aggravates gastric mucosal injury through inflammation and mitochondrial dysfunction in CAG. A rat model of CAG was induced using N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) for 10 weeks, combined with oral gavage of F. nucleatum. Gastric pathology, bacterial colonization, serum cytokine levels, and mitochondrial membrane potential were evaluated. In vitro, human gastric epithelial cells (GES-1) were treated with MNNG and co-cultured with F. nucleatum at multiplicities of infection (MOI) of 50, 100, or 150. Cytokine concentrations in cell culture supernatants were quantified using corresponding human enzyme-linked immunosorbent assay kits. Mitochondrial membrane potential was assessed via flow cytometry. RESULTS: F. nucleatum colonized gastric tissues and intensified MNNG-induced injury, including rugal flattening, glandular atrophy, intestinal metaplasia, and inflammatory cell infiltration. It significantly increased pro-inflammatory cytokine levels and further decreased mitochondrial membrane potential. In GES-1 cells, F. nucleatum dose-dependently elevated secretion of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) and impaired mitochondrial function. CONCLUSIONS: F. nucleatum exacerbates CAG by promoting gastric inflammation and mitochondrial dysfunction. These findings may underscore the microbiota-mitochondria axis as a potential therapeutic target to prevent CAG progression.
Applications of machine learning in the diagnosis of non-alcoholic fatty liver disease: a systematic review and meta-analysis.
Qi L, Li B, Xue J … +4 more , Wu X, Bian H, Chen J, Zhao H
BMC Gastroenterol · 2026 Jun · PMID 42237222 · Full text
OBJECTIVE: To systematically evaluate and quantify the diagnostic accuracy and performance of machine ML techniques for the detection of NAFLD, and to compare the performance of ML when assisting different diagnostic mod...
OBJECTIVE: To systematically evaluate and quantify the diagnostic accuracy and performance of machine ML techniques for the detection of NAFLD, and to compare the performance of ML when assisting different diagnostic modalities, in order to provide the promising strategy for non-invasive and accurate diagnosis of NAFLD. METHODS: A literature search was performed in the PubMed, Web of Science, Cochrane Library, and EMBASE databases from the establishment of the databases to March 2025. The quality of studies and risk of bias were assessed via the QUADAS-2 and the PROBAST. Studies reporting AUC, sensitivity, and specificity were included. Data analysis and plotting were conducted using R (version 4.3.1), Stata (version 17.0), and Origin 2022. This study adhered to the PRISMA guidelines. RESULTS: A systematic review and bias assessment were conducted on 24 articles, and a meta-analysis was performed on 21 sets of data from 18 articles. The sensitivity, specificity, and AUC values for the internal validation dataset were 0.82 [95% CI 0.77-0.86], 0.81 [95% CI 0.77-0.85], and 0.88 [95% CI 0.85-0.91], respectively. For the external validation dataset, the corresponding values were 0.80 [95% CI 0.70-0.87], 0.72 [95% CI 0.56-0.84], and 0.83 [95% CI 0.80-0.86]. Heterogeneity was observed among the studies, and subgroup analysis indicated that study design, reference standard, outcome, cross-validation and model type may be potential sources of heterogeneity. ML models assisting imaging achieved higher diagnostic accuracy than those assisting clinical variables/routine serological markers. CONCLUSION: ML-assisted imaging achieved promising diagnostic accuracy for NAFLD detection, offering the potential to assist clinicians in making accurate diagnoses and improving clinical decision-making. However, the lack of external validation limited the applicability and generalizability of the model. It is necessary to conduct multi-center studies and external validation in the future.
Early warning value of serum TFF3 combined with pepsinogen ratio for monitoring the progression of gastric precancerous lesions: a retrospective study.
Huang T, He J, Mao H … +1 more , Shen B
BMC Gastroenterol · 2026 Jun · PMID 42237134 · Full text
OBJECTIVE: Gastric cancer (GC) has high mortality due to late diagnosis. Identifying which patients with gastric low-grade intraepithelial neoplasia (LGIN) will progress to high-grade intraepithelial neoplasia (HGIN) or...
OBJECTIVE: Gastric cancer (GC) has high mortality due to late diagnosis. Identifying which patients with gastric low-grade intraepithelial neoplasia (LGIN) will progress to high-grade intraepithelial neoplasia (HGIN) or early gastric cancer (EGC) remains challenging. This study aimed to develop a non-invasive method combining serum TFF3 (reflecting malignant transformation) and pepsinogen ratio (PGR, indicating gastric atrophy) to predict progression. METHODS: A retrospective multicenter study included patients with confirmed LGIN, available serum, and full follow-up. Progression to HGIN/EGC within 24 months was the primary outcome. TFF3 and PGR were measured using ELISA and chemiluminescence immunoassay, respectively. Propensity score matching (1:4) balanced baseline variables. Predictive performance was assessed via ROC analysis, logistic regression, and Cox models. RESULTS: After matching, 85 patients (17 progressors) were analyzed. Progressors had higher TFF3 (11.28 vs. 7.15 ng/mL) and lower PGR (2.78 vs. 3.62; both p < 0.001). The combined model showed superior accuracy (AUC = 0.823) versus TFF3 or PGR alone, with sensitivity of 88.2%, specificity of 89.7%, and NPV of 98.3. Progressors exhibited yearly TFF3 increase (+ 1.82 ng/mL) and PGR decrease (-0.41). TFF3 correlated with Ki-67 (ρ = 0.437, p < 0.001). CONCLUSION: The TFF3 and PGR combination is a non-invasive tool for stratifying LGIN progression risk. Its high NPV safely excludes short-term progression, enabling extended follow-up for low-risk patients and better allocation of endoscopic resources. This approach supports personalized monitoring and may help reduce gastric cancer mortality.
Bifidobacterium breve207-1 protects against later-life colitis following early-life antibiotic exposure by enhancing intestinal barrier and immune homeostasis.
Xu X, Li L, Li X … +7 more , Wang Y, Huang M, Wu H, Liang H, Ze X, He F, Shen X
BMC Gastroenterol · 2026 Jun · PMID 42237108 · Full text
BACKGROUND: The early colonization of bacteria has a significant impact on immune system development. The disruption of gut microbiota by antibiotics in early life is a major risk factor for pediatric inflammatory bowel...
BACKGROUND: The early colonization of bacteria has a significant impact on immune system development. The disruption of gut microbiota by antibiotics in early life is a major risk factor for pediatric inflammatory bowel disease. This study explores how Bifidobacterium breve 207-1 modulates gut microbiota and immune responses after early antibiotic exposure, and whether such intervention mitigates DSS-induced colitis later in life. METHODS: Newborn mice were administered with normal saline, ceftriaxone, or B. breve 207-1 from birth to day 21. The Ceftri + 207-1 + DSS group continued to receive B. breve 207-1 thereafter. Starting at day 42, all "-DSS" groups received 3% DSS drinking water to induce colitis. RESULTS: DSS increased inflammation scores versus the NS-Water group. The scores of the Ceftri + 207-1-DSS and Ceftri + 207-1-207-1 + DSS (the group receiving B. breve 207-1 continuously from birth to day 46) groups were lower than the Ceftri-DSS group (P < 0.0001). Gut microbiota analysis showed the relative abundance of Actinobacteria and Firmicutes was significantly higher in the Ceftri + 207-1-DSS group (P < 0.05). Long-term use of B. breve 207-1 from early life enhanced the relative abundance of beneficial gut bacteria, such as Bifidobacterium and Lactobacillus spp. (P < 0.05). Compared to the NS-DSS group, the Ceftri + 207-1-DSS group exhibited significantly higher concentrations of butyric and valeric acids (P < 0.05). Treatment with B. breve 207-1 during early life and its long-term usage resulted in increased levels of SCFAs (P < 0.05). Furthermore, these treatments enhanced the indices related to changes in the mucosal barrier (including mRNA for KI67 and MUC2) and colonic mechanical barrier (including mRNA for Claudin-1, ZO-1, and Occludin). With regards to systemic immune changes induced by B. breve 207-1 administration during early life, the anti-inflammatory cytokines (particularly IL-10 and TGF-β) were elevated (P < 0.05), while the pro-inflammatory cytokines (mainly IL-6 and TNF-α) were reduced (P < 0.05). CONCLUSIONS: B. breve 207-1 enhances immune development after antibiotic exposure, mitigates the severity of DSS-induced colitis later in life, likely through early remodeling of the gut microbiota and enhancement of intestinal barrier function. Our results suggest that the early postnatal period represents a strategic opportunity for probiotic intervention to confer protection against later-life colitis in the context of early antibiotic exposure. Notably, B. breve 207-1 may influence the composition of early-stage gut microbiota and subsequently affect local and systemic immune development.
Selenoprotein P deficiency in MASLD: association with insulin resistance and liver fibrosis: a prospective case-control study.
Hegazy MA, Mohamed SS, Saad EH … +6 more , Abdelghani A, El Fattah DA, Mekki MAE, Fathy M, Hassan N, Ashoush O
BMC Gastroenterol · 2026 Jun · PMID 42237107 · Full text
BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a globally escalating health concern. Selenoprotein P (SEPP1) is a hepatokine involved in selenium transport and antioxidant defense,...
BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a globally escalating health concern. Selenoprotein P (SEPP1) is a hepatokine involved in selenium transport and antioxidant defense, with conflicting data on its role in MASLD. This study investigated serum SEPP1 as a potential non-invasive biomarker for disease severity and fibrosis staging. METHODS: This prospective case-control study enrolled 160 Egyptian participants (80 MASLD, 80 healthy controls). MASLD patients were stratified by fibrosis severity using vibration-controlled transient elastography (VCTE): non-significant fibrosis (< 8 kPa, n = 40) and significant fibrosis (≥ 8 kPa, n = 40). Anthropometric, biochemical (including HOMA-IR, lipid profile, liver enzymes), and SEPP1 (ELISA) measurements were compared. RESULTS: SEPP1 levels were significantly lower in MASLD patients versus controls (p < 0.001), with the lowest levels in the significant fibrosis subgroup (p = 0.025 vs. non-significant fibrosis). SEPP1 correlated inversely with BMI (r=-0.23, p = 0.004), HOMA-IR (r=-0.25, p = 0.001), and fasting insulin (r=-0.23, p = 0.004). MASLD patients exhibited higher insulin resistance, dyslipidemia, and liver enzymes (all p < 0.001). Logistic regression identified BMI (OR = 1.4, 95% CI:1.3-1.6) and HOMA-IR (OR = 1.4, 95% CI:1.1-2.0) as independent MASLD predictors. CONCLUSIONS: Reduced SEPP1 levels are strongly associated with MASLD severity and hepatic fibrosis. Its inverse correlation with insulin resistance and stepwise decrease with advancing fibrosis position SEPP1 as a promising simple biomarker for metabolic dysfunction and non-invasive fibrosis risk stratification. This is particularly relevant in high-burden populations like Egypt, where accessible tools are urgently needed to guide early intervention, and further studies should explore whether SEPP1 modulation or selenium supplementation could mitigate liver fibrosis progression.
Pathology-Driven Epithelial Sulfide Loss Reprograms the Redox Proteome and Triggers Barrett's Esophagus.
Korbut E, Wierdak M, Vignane T … +14 more , Bakalarz D, Magierowska K, Suski M, Janmaat VT, Hankus J, Glowacka U, Farbaniec M, Wójcik-Grzybek D, Whiteman M, Kukla M, Smits R, Souza RF, Filipovic MR, Magierowski M
Gastroenterology · 2026 Jun · PMID 42235802 · Publisher ↗
BACKGROUND & AIMS: Barrett's esophagus (BE), a metaplastic transformation driven by gastroesophageal reflux disease (GERD), induces oxidative stress but the underlying redox mechanisms remain poorly understood. Protein p...
BACKGROUND & AIMS: Barrett's esophagus (BE), a metaplastic transformation driven by gastroesophageal reflux disease (GERD), induces oxidative stress but the underlying redox mechanisms remain poorly understood. Protein persulfidation (PSSH), a redox-sensitive, reversible, and antioxidative post-translational modification regulated by hydrogen sulfide (HS) metabolism, has not been explored in this context. Here, we identify epithelial PSSH as a key regulator of this premalignant process. METHODS: We applied proteomics and chemoproteomics in 2 patient cohorts to map and validate PSSH and total proteome profiles across healthy (squamous), GERD-exposed, and metaplastic epithelium. Using in vitro and in vivo models of chronic GERD and BE, we modulated HS levels genetically and pharmacologically. Mechanistic and functional effects were assessed using tissue biopsies or recombinant human proteins. RESULTS: GERD-induced oxidative loss of HS and its enhanced catabolism initiated early PSSH proteome remodeling in squamous epithelium, which expanded in BE and affected >1300 proteins in clinical samples, indicating potential biomarkers. This also included altered persulfidation of enzymes regulating accumulation of prostaglandin E (PGE), a well-established driver of BE development and progression. HS depletion accelerated metaplastic transformation, whereas HS donors reversed these effects in experimental models. PSSH of 15-hydroxyprostaglandin dehydrogenase reversibly suppressed its activity, protecting the enzyme and, unlike irreversible oxidation, allowing recovery of PGE degradation. CONCLUSIONS: These findings redefine the origin of PGE accumulation in metaplasia and establish sulfide loss and persulfidomic remodeling as central, druggable drivers of epithelial reprogramming and redox imbalance in BE pathogenesis.
Transjugular intrahepatic portosystemic shunt for hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloid.
Zhou TY, Ji K, Tao GF … +10 more , Wang HL, Zhu TY, Chen SQ, Zhang YL, Zhou GH, Wang BQ, Cao SJ, Wang KB, Jing L, Xiong B
BMC Gastroenterol · 2026 Jun · PMID 42231199 · Full text
PURPOSE: To evaluate the efficacy and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in treating pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). METHODS: We conducted a...
PURPOSE: To evaluate the efficacy and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in treating pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). METHODS: We conducted a retrospective analysis of patients diagnosed with severe PA-HSOS at our institution between January 2016 and October 2025. Baseline clinical characteristics and follow-up data were extracted from medical records. All included patients had failed prior conventional medical therapy. RESULTS: A total of 125 patients diagnosed with HSOS was screened and 33 patients ultimately included in this study, of whom 17 were male. Clinical presentations comprised ascites in 31 patients, and variceal bleeding in 2 patients. During a median follow-up of 42 months (ranging from 2 to 118 months), there were four deaths, only one related to liver failure. The overall survival rates at 1, 3 and 5 years were 93.8%, 90.3% and 82.1%, respectively. Clinical improvement was observed in most patients, with ascites resolving in 31 patients one month after the procedure, and the hepatic vein was clearly displayed on post-TIPS imaging in 26 patients, confirming successful shunt patency. Notably, no cases of overt hepatic encephalopathy were observed during the follow-up period. CONCLUSION: TIPS is associated with favorable clinical and survival outcomes in patients with PA-HSOS refractory to medical management, and represents a viable therapeutic alternative for this condition.
A simple scoring system to estimate adenoma detection rate from polyp detection: a two-center observational study.
Dong Z, Li Y, Xiao Z … +3 more , Li F, Xu S, Ji D
BMC Gastroenterol · 2026 Jun · PMID 42231194 · Full text
PURPOSE: The calculation of adenoma detection rate (ADR) requires pathological information, which makes it time-consuming. We aimed to develop a scoring system to estimate ADR from polyp detection accurately. METHODS: Th...
PURPOSE: The calculation of adenoma detection rate (ADR) requires pathological information, which makes it time-consuming. We aimed to develop a scoring system to estimate ADR from polyp detection accurately. METHODS: The two-center retrospective study included colonoscopy and pathological data, which were divided into training, internal, and external validation cohorts. The factors associated with pathologically confirmed adenoma detection in patients with polyps were identified using the logistic regression model. The scores were assigned based on β-coefficient. The performance of the scoring system was evaluated by the Bland-Altman plot. RESULTS: Patient age, maximum size of polyps, and number of proximal or distal polyps of any size, except distal diminutive polyps, were significantly associated with pathologically confirmed adenoma detection in patients with polyps. Based on regression coefficients, scores were assigned as follows: age ≥ 70 years, positive; any proximal polyps, positive; distal polyps ≥ 10 mm, positive; age 60 ~ 69 years, 1 point; per distal small polyps, 1 point. Pathologically confirmed adenoma detection was predicted when a patient met any positive criterion or, in the absence of these positive items, had a total score > 1 point. The scoring system showed a high proportion of acceptable estimations when the difference between estimated and actual ADR was less than 2%. In clinically relevant conditions with a small number of samples, the proportion of acceptable estimations rose gradually and achieved its highest level when the number of samples increased to 300. CONCLUSION: Our scoring system performed well in estimating ADR from polyp detection. 300 colonoscopies per endoscopist was the best number of samples when the scoring system was used.
An unusual superior mesenteric arteriovenous malformation causing obscure gastrointestinal bleeding: a case report.
Alashqar M, Abu Kamesh MI, Alsadi R … +2 more , Khader M, Qasrawi H
BMC Gastroenterol · 2026 Jun · PMID 42231181 · Full text
BACKGROUND: Lower gastrointestinal bleeding (LGIB) frequently presents a diagnostic challenge, particularly in liver cirrhosis and portal hypertension patients, as it accounts for about 20-25% of major gastrointestinal b...
BACKGROUND: Lower gastrointestinal bleeding (LGIB) frequently presents a diagnostic challenge, particularly in liver cirrhosis and portal hypertension patients, as it accounts for about 20-25% of major gastrointestinal bleeding cases. The presence of multiple possible sources of bleeding, among which vascular abnormalities, increases the risk of recurrent bleeding, and clinically significant anemia. Mesenteric arteriovenous malformations (AVMs) are one of the rare high-flow vascular lesions that may lead to gastrointestinal bleeding through arterial blood being diverted to the veins and venous hypertension. As the findings of an endoscopic examination can be unclear, cross-sectional angiographic imaging is indispensable for diagnosis and treatment planning. CASE PRESENTATION: A 71-year-old man with decompensated alcoholic liver cirrhosis and a history of recurrent gastrointestinal bleeding presented with two days of hematochezia and worsening anemia. Despite prior endoscopic treatment of esophageal varices, gastric antral vascular ectasia, and colonic AVMs, no active bleeding source was identified on repeat endoscopy. Contrast- enhanced computed tomography angiography demonstrated a high-flow mesenteric vascular nidus supplied by the superior mesenteric artery, with early venous drainage into the right renal vein, consistent with a mesenteric arteriovenous malformation. The patient was successfully managed with endovascular embolization, resulting in stabilization of hemoglobin levels and cessation of overt gastrointestinal bleeding. CONCLUSION: In patients with liver cirrhosis having various sites of possible bleeding, mesenteric arteriovenous malformations must be included in the differential diagnosis of obscure or recurrent lower gastrointestinal bleeding. This case highlights an exceptionally rare vascular configuration, with arterial supply from the superior mesenteric artery and anomalous systemic venous drainage into the right renal vein. Comprehensive angiographic imaging is essential for accurate diagnosis, anatomical characterization, and appropriate management of these complex vascular lesions.
Pneumatosis cystoides intestinalis mimicking colonic subepithelial tumors with spontaneous resolution after relocation from a high-altitude region: a case report.
Zhao X, Zeng Q, Chen Y … +2 more , Fan S, Zhang S
BMC Gastroenterol · 2026 Jun · PMID 42226148 · Full text
BACKGROUND: Pneumatosis cystoides intestinalis(PCI) is a relatively rare condition with a pathogenesis that remains incompletely understood. It is typically managed through conservative medical treatment, with surgical i...
BACKGROUND: Pneumatosis cystoides intestinalis(PCI) is a relatively rare condition with a pathogenesis that remains incompletely understood. It is typically managed through conservative medical treatment, with surgical intervention considered when necessary. We report a case of PCI in which the lesions resolved spontaneously after diagnostic endoscopic submucosal dissection (ESD). CASE PRESENTATION: A 51-year-old female, who had resided long-term at high altitude, presented with persistent abdominal pain and increased bowel movements. Routine blood tests and biochemical profiles showed no significant abnormalities. Colonoscopy revealed multiple submucosal protrusions in the ascending colon, which firm on probing with biopsy forceps. Endoscopic ultrasound demonstrated hyperechoic with acoustic shadowing. In combination with findings from contrast-enhanced abdominal CT, ESD was performed to remove one of the larger protrusions. Pathological examination confirmed the diagnosis of PCI. More than two years later, follow-up colonoscopy and contrast-enhanced abdominal CT revealed complete resolution of the lesions. Notably, the patient had not received any treatment during this period, aside from a change in her place of residence. CONCLUSIONS: This case illustrates a rare but clinically important presentation of colonic PCI mimickingfirm subepithelial lesions, with documented complete resolution on both colonoscopy and CT after relocation from a high-altitude region.
Combining preoperative clinical and ultrasound radiomic features to predict the predominant component of combined hepatocellular carcinoma-cholangiocarcinoma.
Yang Y, Liang W, Pang J … +7 more , Bai X, Wen R, Wu Y, Peng J, Yang H, He Y, Gao R
BMC Gastroenterol · 2026 Jun · PMID 42226136 · Full text
BACKGROUND: As a rare subtype of primary liver cancer that contains both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) components, combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) is characte...
BACKGROUND: As a rare subtype of primary liver cancer that contains both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) components, combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) is characterized by strong invasiveness and poor prognosis. The proportion of HCC and CCA components is closely related to the prognosis of patients. This study aimed to develop a combined model integrating preoperative ultrasound radiomic features and clinical data to non-invasively predict the predominant component in cHCC-CCA. METHODS: The study included 60 histopathologically confirmed cHCC-CCA patients, divided into high hepatocellular carcinoma percentage (HCC%) group (n = 33, HCC% > 50) and low HCC% group (n = 27, HCC% ≤ 50). A predominant component prediction model for cHCC-CCA was developed using radiomic features extracted from four distinct region of interest (ROI) to identify the optimal radiomic model: tumor alone (ROI), tumor plus 5 mm peritumoral margin (defined as ROI+peritumor 1), tumor plus 10 mm peritumoral margin (defined as ROI+peritumor 2), and tumor plus 20 mm peritumoral margin (defined as ROI+peritumor 3). Univariate and multivariate logistic regression analyses were performed to evaluate the predictive value of preoperative clinical parameters as potential indicators of the predominant component predictors. Ultimately, a combined model integrating the optimal radiomic features and clinical data was constructed, with the final predictive model visualized using nomogram. RESULTS: The model developed based on ROI+peritumor 2 demonstrated optimal predictive performance and was defined as the optimal radiomic model [training set area under the curve (AUC) = 0.853, test set AUC = 0.806, overall set AUC = 0.832]. Through multivariate logistic regression analysis, we identified two preoperative indicators: tumor maximum diameter and total bilirubin. Compared with both the optimal radiomic model and the clinical model, the combined model demonstrated superior predictive capability for the predominant component in preoperative cHCC-CCA patients (training set AUC = 0.877, 95% CI: 0.775-0.980; test set AUC = 0.847, 95% CI: 0.657-1.00; overall set AUC = 0.851, 95% CI: 0.756-0.945). Decision curve analysis demonstrated that the combined model exhibited favorable clinical utility. CONCLUSIONS: Combination of ultrasound-based radiomics with tumor maximum diameter and total bilirubin levels holds significant value for the preoperative identification of HCC% in cHCC-CCA.
Divergent roles of endoscopic Kyoto classification and serological Li's scoring in immediate and long-term gastric cancer risk stratification: a 4-year longitudinal study.
Lin J, Su H, Pan J … +3 more , Zhou L, Zhou Q, Du J
BMC Gastroenterol · 2026 Jun · PMID 42226123 · Full text
BACKGROUND: Early detection of gastric cancer (GC) is crucial for improving prognosis. This study aimed to address the paucity of longitudinal evidence by validating and comparing the long-term predictive efficacy of the...
BACKGROUND: Early detection of gastric cancer (GC) is crucial for improving prognosis. This study aimed to address the paucity of longitudinal evidence by validating and comparing the long-term predictive efficacy of the serology-based Li's scoring system and the endoscopic Kyoto classification for GC risk stratification in a Chinese population. METHODS: This retrospective, single-center cohort study included 5801 patients who underwent esophagogastroduodenoscopy between April 2017 and December 2023. We conducted a cross-sectional analysis to evaluate the diagnostic accuracy of both systems using receiver operating characteristic (ROC) curves. A longitudinal analysis of 2836 patients with a median follow-up of 4.05 years was performed using Cox proportional hazards models and Kaplan-Meier curves to assess long-term predictive value for GC development. RESULTS: Cross-sectional evaluation revealed that the Kyoto classification outperformed Li's scoring system in gastric cancer discrimination, yielding a significantly higher AUC (0.898, 95% CI: 0.859-0.938) than Li's scoring system (0.760, 95% CI: 0.692-0.827), P = 0.011. These findings suggest that endoscopic-based assessment provides more precise initial risk stratification than serological scoring alone. The primary contribution of this study is the longitudinal analysis, which demonstrated that Li's scoring system more effectively identified individuals at high long-term risk; the high-risk group had a significantly higher hazard ratio (HR) for developing GC compared to the low-risk group (HR = 4.27, 95% CI: 2.13-8.54, P < 0.001). The annual GC incidence was markedly higher in the high-risk group defined by Li's scoring system (2.29%) compared to that defined by the Kyoto classification (1.23%). CONCLUSION: Both Li's scoring system and the Kyoto classification are effective for gastric cancer risk assessment, yet they serve potentially complementary clinical roles. The Kyoto classification demonstrates significantly superior immediate discriminative power, while the serology-based Li's scoring system shows promising prognostic value for longitudinal risk stratification, suggesting its potential utility as a preliminary non-invasive triage tool. However, further prospective multicenter validation studies and formal cost-effectiveness evaluations are needed before an integrated screening strategy can be recommended for large-scale population implementation.
Is routine placement of hemoclips during endoscopic retrograde cholangiopancreatography necessary for preventing delayed bleeding?
Ma ZW, Gong XJ, Zheng G … +4 more , Hu FR, Zhang Q, Chen YJ, Wang B
BMC Gastroenterol · 2026 Jun · PMID 42226121 · Full text
OBJECTIVE: This study aimed to investigate the necessity and safety of routinely placing prophylactic hemoclips at the duodenal papilla during endoscopic retrograde cholangiopancreatography to prevent delayed bleeding. M...
OBJECTIVE: This study aimed to investigate the necessity and safety of routinely placing prophylactic hemoclips at the duodenal papilla during endoscopic retrograde cholangiopancreatography to prevent delayed bleeding. METHODS: A retrospective analysis was conducted on the clinical data of 265 patients who underwent endoscopic retrograde cholangiopancreatography at the Department of Hepatobiliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from April 2021 to April 2025. The study focused on the impact of prophylactic hemoclip placement at the duodenal papilla during ERCP using a "small incision + dilation" technique with different sizes of dilation balloons. Patients were divided into an observation group (n = 109) and a control group (n = 156). The observation group received endoscopic retrograde cholangiopancreatography plus prophylactic hemoclip placement, while the control group received only endoscopic retrograde cholangiopancreatography. The study compared changes in amylase, alanine aminotransferase, aspartate aminotransferase, neutrophils, lymphocytes, red blood cells, and platelet counts at 3 h and 24 h post-procedure between the two groups. Additionally, the incidence of post endoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, delayed bleeding, and gastrointestinal perforation, as well as the length of hospital stay, were analyzed. RESULTS: The observation group had significantly higher 24-hour amylase and platelet levels compared to the control group (P < 0.05). Subgroup analysis based on the use of 0.6 cm, 0.8 cm, 1.0 cm, and 1.2 cm dilation balloons showed that, when comparing between groups, there were statistically significant differences in 24-hour amylase, lymphocyte, and red blood cell levels (P < 0.05). The 24-hour amylase levels, from highest to lowest, were: 0.6 cm, no balloon, 1.0 cm, 0.8 cm, and 1.2 cm. The 24-hour lymphocyte levels, from highest to lowest, were: 1.2 cm, 0.8 cm, no balloon, 1.0 cm, and 0.6 cm. The 24-hour red blood cell levels, from highest to lowest, were: 0.8 cm, 0.6 cm, no balloon, 1.2 cm, and 1.0 cm. Within the 0.6 cm subgroup, the observation group had significantly higher 24-hour amylase levels compared to the control group (P < 0.05), while no significant differences were observed in other subgroups. CONCLUSION: For small and clearly defined bleeding sites during endoscopic retrograde cholangiopancreatography, the placement of endoscopic hemoclips is recommended to reduce the risk of postoperative bleeding and perforation. This method is convenient and effective. However, this study suggests that prophylactic hemoclip placement during dilation with diameters < 0.8 cm may lead to increased amylase levels and a higher risk of pancreatitis. Therefore, prophylactic hemoclip placement is not recommended when the dilation diameter is < 0.8 cm, unless it is necessary.
Validity of a seven-gene signature as a non-invasive biomarker for cirrhosis: a cross-sectional study in Egyptian patients with HBV infection.
El-Kader AA, El-Meguid MA, Zayed N … +3 more , Alem SA, Barkat A, Dawood RM
BMC Gastroenterol · 2026 Jun · PMID 42226117 · Full text
BACKGROUND: Hepatitis B virus (HBV) infection poses a significant public health challenge, leading to liver cirrhosis and hepatocellular carcinoma (HCC). The clinical course of HBV infection is influenced by viral, envir...
BACKGROUND: Hepatitis B virus (HBV) infection poses a significant public health challenge, leading to liver cirrhosis and hepatocellular carcinoma (HCC). The clinical course of HBV infection is influenced by viral, environmental, and host genetic variants. Recently, a Cirrhosis Risk Score (CRS) based on seven genetic variants has been developed to identify individuals at risk of developing cirrhosis. This study aimed to assess the predictive value of seven gene signatures in Egyptian patients with HBV infection as molecular biomarkers for cirrhosis. METHODS: In this cross-sectional study, 170 HBV-infected patients exhibiting various degrees of liver fibrosis were recruited. Genotyping for the seven gene SNPs was performed using allelic discrimination assays. Subsequently, the non-invasive scores APRI and FIB-4 were computed and compared with CRS values. Furthermore, an in silico analysis was performed to examine the alterations in gene expression associated with the progression of fibrosis. RESULTS: The findings revealed a significantly higher prevalence of high CRS scores in late fibrosis (p = 0.006). The mean of CRS was higher in late than in early fibrosis (0.70 vs. 0.60; P = 0.003). However, APRI and FIB-4 scores did not differ significantly across the groups. The ROC analysis indicated that the CRS score can distinguish between patients with early and late fibrosis, with an AUC of 0.63 (p = 0.0034). The risk genotypes in DEGS1 (rs4290029), STXBP5L (rs17740066), and AQP2 (rs2878771) were associated with late fibrosis. According to the in silico analysis, there is a remarkable upregulation of DEGS1 and a downregulation of STXBP5L in late fibrosis as compared to early fibrosis. While the AQP2 showed no significant variation between early and late fibrosis. CONCLUSION: The CRS score showed a modest predictive ability in HBV-infected Egyptian patients; it can be used in conjunction with imaging and clinical tools to improve risk stratification. Moreover, DEGS1, STXBP5L, and AQP2 genetic variants demonstrated a significant association with cirrhosis risk. However, only the DEGS1 and STXBP5L genes showed dysregulated expression levels, suggesting their potential relevance as diagnostic biomarkers in liver fibrosis.
Dietary Therapy Potential to Recapitulate Faecalibacterium prausnitzii-Driven OXPHOS-Dependent Immunoregulation in Pediatric Crohn's Disease.
Ghiboub M, de Jonge WJ, Van Limbergen JE
Gastroenterology · 2026 May · PMID 42219117 · Publisher ↗
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Endoscopic band ligation as a safe and effective minimally invasive treatment for large esophageal hemangioma: a case report.
Luo YX, Niu WW, Zhang H … +5 more , Shi XD, Shi LM, Li SH, Xing JJ, Wang N
BMC Gastroenterol · 2026 May · PMID 42218390 · Full text
BACKGROUND: Hemangioma most commonly occurs in the head and neck, rarely affects the digestive tract, and often presents without any clinical signs. The treatment of esophageal hemangioma has been widely reported interna...
BACKGROUND: Hemangioma most commonly occurs in the head and neck, rarely affects the digestive tract, and often presents without any clinical signs. The treatment of esophageal hemangioma has been widely reported internationally. However, reports on the sole application of endoscopic band ligation for the treatment of esophageal hemangioma are relatively rare. CASE PRESENTATION: The patient was a 47-year-old woman with a large esophageal hemangioma initially misdiagnosed as isolated esophageal varices. The lesion was a single varicose vein (1.2 cm in diameter) located on the left wall of the esophagus, approximately 23 cm to 28 cm from the incisors. Endoscopic ultrasound revealed thickened variceal walls with a honeycomb-like heterogeneous hypoechoic pattern, and Doppler imaging detected blood flow signals. CT indicated a venous mass (1.3 cm × 1.2 cm × 5 cm) in the mid-esophagus with a honeycomb-like internal structure, which was highly suggestive of esophageal hemangioma. No arterial origin was observed, the superior and inferior venae cava appeared normal, and there were no signs of cirrhosis. The esophageal hemangioma was endoscopically ligated twice. Four months later, repeat examination revealed smooth mucosa at the surgical site and complete disappearance of the esophageal hemangioma with the formation of a white scar. CONCLUSIONS: This case suggests that endoscopic band ligation may be a safe and effective minimally invasive treatment for large esophageal hemangioma.
Erythrocyte Turnover: Unaddressed Confounder of PEth Prognosis in Alcohol-Related Liver Disease.
Ou Z, Xu M
Gastroenterology · 2026 May · PMID 42217554 · Publisher ↗
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Torp N, Johansen S, Israelsen M … +1 more , Krag A
Gastroenterology · 2026 May · PMID 42217553 · Publisher ↗
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Clinical characteristics of hospitalized patients with benign gallbladder disease: a large-scale retrospective analysis.
Zhang H, Zhang C, Qiu C … +5 more , Xiang Y, Jiang Z, Zheng L, Hu H, Yang Y
BMC Gastroenterol · 2026 May · PMID 42216122 · Full text
BACKGROUND: Benign gallbladder disease, including gallstones, gallbladder polyps, and gallbladder adenomyosis, is one of the most common disorders of the digestive system worldwide and poses a substantial clinical and ec...
BACKGROUND: Benign gallbladder disease, including gallstones, gallbladder polyps, and gallbladder adenomyosis, is one of the most common disorders of the digestive system worldwide and poses a substantial clinical and economic burden. Despite its high prevalence, the clinical characteristics and risk profiles of hospitalized patients with benign gallbladder disease are not well defined, especially compared with population-based screening cohorts. This study aimed to analyze the clinical characteristics of hospitalized patients with benign gallbladder disease using a large dataset and to compare these findings with those reported in physical examination populations. METHODS: A total of 36,298 patients admitted to the gallstone center of a tertiary hospital in Shanghai between 2019 and 2024 for benign gallbladder disease were included in the study. Basic patient information was collected from the electronic medical records system in accordance with the international classification of diseases. Descriptive statistics and Multinomial logistic regression methods were employed to analyze the clinical characteristics of patients and identify risk factors associated with gallbladder inflammatory conditions. RESULTS: The mean age of patients with gallstones was 50.21 ± 15.31 years, 43.90 ± 13.53 years for gallbladder polyps, and 49.36 ± 13.28 years for gallbladder adenomyosis. The male-to-female ratio in the gallstone population was approximately 1:1.38 (13,175:18,304), gallbladder polyps was 1.03:1(male: female = 3198:3113) and gallbladder adenomyosis was 1:1.28(male: female = 1057:1351); the risk of gallbladder stones in menstruating women was 0.625 times that in postmenopausal women (95% CI: 0.575-0.680, p < 0.0001), and gallbladder polyps were 1.555 times(95% CI: 1.439-1.680, p < 0.0001). Multinomial logistic regression analysis demonstrated that age, male, gallstones, common bile duct stones(CBDS) and diabetes mellitus(DM) were significantly associated with the inflammatory state of the gallbladder(all p < 0.001). CONCLUSIONS: Gallstones is the primary cause of hospitalisation for benign gallbladder disease, and the risk is higher in postmenopausal women. Middle age, male, gallstones, CBDS and DM are identified as risk factors for gallbladder inflammation. Although gallbladder polyps and adenomyosis showed patterns similar to those in general populations, findings from hospitalized cohorts may not fully represent broader, unscreened populations due to a higher prevalence of severe or symptomatic cases.
Effect of remimazolam on postoperative delirium in elderly patients undergoing laparoscopic radical resection for colorectal cancer: a randomized controlled trial.
Xu S, Wan Q, Li T … +3 more , Shu Y, Guo Y, Li J
BMC Gastroenterol · 2026 May · PMID 42215906 · Full text
BACKGROUND: Our study aimed to compare remimazolam, midazolam, and no sedative on postoperative delirium (POD) incidence, cognitive function, inflammation, and recovery in elderly colorectal cancer (CRC) laparoscopic rad...
BACKGROUND: Our study aimed to compare remimazolam, midazolam, and no sedative on postoperative delirium (POD) incidence, cognitive function, inflammation, and recovery in elderly colorectal cancer (CRC) laparoscopic radical resection patients. METHODS: In this single-center, randomized, double-blind trial, 60 patients aged ≥ 60 years were assigned to the Control, Remimazolam, or Midazolam groups (n = 20 each). Anesthesia included remimazolam (6 mg/kg/h for 5 min), midazolam (0.04 mg/kg) before induction, or no sedative. Primary outcome was POD incidence (diagnosed using the Confusion Assessment Method (CAM) algorithm. Secondary outcomes included CAM/Mini-Mental State Examination (MMSE) scores, serum interleukin-6 (IL-6) and S-100 protein (S-100) levels, intraoperative metrics, and recovery times. Data were analyzed using chi-square, ANOVA, and Kruskal-Wallis tests (P < 0.05). RESULTS: Remimazolam significantly reduced POD incidence (5%) compared to the Control (30%) and Midazolam (40%) groups (P = 0.021). At postoperative day 7, compared to the Midazolam group, the Remimazolam group showed both significantly lower CAM scores (12.00 [11.00-13.00] vs. 13.50 [12.00-20.75]) and higher MMSE scores (29.00 [28.00-29.00] vs. 28.00 [21.25-28.00]) (both P = 0.029). Compared to the Control group, the Remimazolam group had numerically lower CAM scores and higher MMSE scores, but these differences were not statistically significant (P = 0.340 for both comparisons). Serum IL-6 levels in the Remimazolam group were consistently and significantly lower than those in the Midazolam group at all measured postoperative time points (Postoperative 1, 3, and 7; all P < 0.05). Compared to the Control group, the Remimazolam group also exhibited significantly lower IL-6 levels on postoperative 1 and postoperative 3 (both P = 0.005), but this difference was no longer significant by postoperative 7 (P = 1.000). Awakening (8.00 [6.00-10.00] min) and extubation times (2.50 [1.25-4.00] min) were significantly shorter with remimazolam (P < 0.001 and P = 0.019, respectively). No significant differences were observed in intraoperative metrics. CONCLUSION: Remimazolam reduced POD incidence and demonstrated faster postoperative recovery in elderly patients undergoing laparoscopic CRC surgery. While remimazolam showed cognitive and anti-inflammatory benefits relative to midazolam, its advantages over the control group were less pronounced. The most consistent clinical advantage was faster postoperative recovery, as evidenced by significantly shorter awakening and extubation times. These findings suggest that remimazolam is a promising alternative, particularly compared with midazolam, warranting further multicenter validation. CLINICAL TRIAL NUMBER: ChiCTR2000034677; Registration Date: 2020/07/14.
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