El-Din ZS, Abdelsameea E, Awad SM
… +4 more, Arab DE, Elsabaawy M, Salama M, Mohamed AN
BMC Gastroenterol
· 2026 May · PMID 42215872
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BACKGROUND: One of serious side effects of liver cirrhosis is spontaneous bacterial peritonitis (SBP), which is defined by existence of infected ascites without a discernible secondary source of infection. One possible m...BACKGROUND: One of serious side effects of liver cirrhosis is spontaneous bacterial peritonitis (SBP), which is defined by existence of infected ascites without a discernible secondary source of infection. One possible mechanism for development of SBP is microbial translocation. OBJECTIVE: To ascertain prevalence, microbiological profile and outcomes of spontaneous bacterial and fungal peritonitis in Egyptian patients with liver cirrhosis. METHODS: Three hundred cirrhotic patients with ascites who were hospitalized for spontaneous peritonitis (SP) participated in cross-sectional research. Laboratory investigations using bacterial and fungal cultures were carried out. RESULTS: All participants with diagnosis of SP were included. Their mean age was 59.50 years, and 68.7% of them were men. In addition, 13.7% of subjects had spontaneous fungal peritonitis, whereas 47.3% of participants had SBP. Of SBP cases, 50.7% (n = 72) had gram negative (-ve) bacteria isolated from them, whereas 49.3% (n = 70) had gram positive (+ ve) bacteria. Streptococcus 8.5% (n = 12) was the commenest gram-positive isolate, followed by Staphylococcus aureus 33.8%(n = 48). On the other hand, Klebsiella 29.6% (n = 42) was the commenest gram-negative isolate, followed by Escherichia coli 14.4%(n = 19). The outcome of SBP cases with and without multidrug resistance do not differ significantly. On multivariate analysis, femal (p = 0.013), low ascitic protein level and high ascitic lactate dehydrogenase (LDH) (p = 0.018, p = 0.014) were significant independent predictors for SFP. CONCLUSION: SBP and SFP frequently provide serious life-threatening dangers in cirrhotic patients with ascites. Alertness for SFP is increased with low ascitic protein level and high ascitic LDH.
Gezer Y, Tayşi MR, Tarakçı A
… +17 more, Alkan S, Kaya S, Çelik Z, Alan Doğan S, Bayhan E, Özer Kökkızıl S, Tumer D, Doğan A, Demircioğlu T, Evlice O, Basutçu A, Yılmaz ZB, Memişoğlu F, Salduz E, Sağlam Kandemir E, Yüksel M, Ömeroğlu E
BMC Gastroenterol
· 2026 May · PMID 42215869
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BACKGROUND: The coexistence of metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic hepatitis B (CHB) may influence liver fibrosis, but the relationship between these conditions remains unclear. M...BACKGROUND: The coexistence of metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic hepatitis B (CHB) may influence liver fibrosis, but the relationship between these conditions remains unclear. MASLD may also affect the performance of non-invasive tests (NITs) in CHB. Recently developed NITs, such as FIB-8 and FIB-9, were designed for MASLD patients but have not been assessed in those with both CHB and MASLD. This study aimed to comparatively assess the diagnostic performance of various NITs for predicting significant fibrosis in CHB patients stratified by MASLD status. METHODS: In this multicenter retrospective study, CHB patients who underwent liver biopsy were analyzed. Significant fibrosis was defined as ISHAK stage ≥ 3, and hepatic steatosis as ≥ 5% fat accumulation on biopsy. The performance of 20 NITs in predicting significant fibrosis was assessed in the overall cohort and in MASLD-positive and MASLD negative groups. RESULTS: A total of 1545 patients were included, of whom 328 (21.2%) were MASLD-positive. More than half of the MASLD-positive patients had a single cardiometabolic risk factor. In the MASLD-negative group, FIB-4 showed the highest area under the receiver operating characteristic curve (AUROC) value (0.660), whereas in the MASLD-positive group, the highest AUROC was observed for FIB-8 (0.728). Furthermore, the FIB-8, Lok, and ATA scores demonstrated significantly higher AUROC values in the MASLD-positive group than in the MASLD-negative group (0.728, 0.726, and 0.716 vs. 0.535, 0.590, and 0.600, respectively; p = 0.008, 0.002, and 0.008). No significant differences were observed in the performance of the remaining NITs according to MASLD status. CONCLUSIONS: The diagnostic performance of NITs for predicting significant fibrosis in CHB patients varies according to MASLD status. FIB-8, Lok, and ATA scores demonstrated significantly higher diagnostic accuracy in MASLD-positive patients, suggesting that metabolic factors may influence the discriminative capacity of fibrosis markers. Nevertheless, all evaluated NITs demonstrated low-to-moderate diagnostic performance across all groups, limiting their standalone clinical utility and highlighting the need for more accurate non-invasive fibrosis models in this population. TRIAL REGISTRATION: Not applicable.
Gastroenterology
· 2026 May · PMID 42214560
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BACKGROUND & AIMS: The cause of Crohn's disease (CD) remains unclear; however, evidence suggests fiber intake may play a role. We aimed to investigate the association between intake of total fiber and select fermentable...BACKGROUND & AIMS: The cause of Crohn's disease (CD) remains unclear; however, evidence suggests fiber intake may play a role. We aimed to investigate the association between intake of total fiber and select fermentable fiber subtypes and future risk of CD in an at-risk population. METHODS: The Genetic, Environmental, Microbial Project prospectively followed asymptomatic first-degree relatives of individuals with CD. Habitual intake of total fiber and select fiber subtypes was estimated from baseline food frequency questionnaires and biologic samples were collected. Incident CD was confirmed during follow-up. Cox proportional hazards models estimated hazard ratios (HRs) for CD. Associations between fiber subtype intake and urinary fractional excretion of lactulose-mannitol ratio, C-reactive protein, gut microbiota (16S ribosomal RNA sequencing), and serum proteomics (Olink) were evaluated using multivariable regression models. RESULTS: During a median follow-up of 8.5 years of 3314 first-degree relatives, 94 developed CD. Higher β-glucan (HR, 0.70; 95% confidence interval, 0.54-0.92) and inulin (HR, 0.68; 95% confidence interval, 0.49-0.96) intake were associated with lower CD risk. Associations were strongest in those with higher baseline relative abundance of Erysipelotrichaceae UCG-003, but weaker with higher Colidextribacter. Higher β-glucan and inulin intake were associated with lower lactulose-mannitol ratio, lower abundance of pathobionts (Ruminococcus torques and Lachnoclostridium), and lower concentrations of inflammation- and barrier-related proteins, including C-reactive protein, triggering receptor expressed on myeloid cells-1, oncostatin M, and matrix metalloproteinase 9. CONCLUSIONS: Higher estimated β-glucan and inulin intake was associated with preserved gut barrier function, lower systemic inflammatory markers, and lower CD risk, which was modified by the microbial context. These findings support microbiome-informed dietary strategies and intervention trials for CD prevention.
Wu YH, Li TC, Li CI
… +4 more, Liu CS, Cho DY, Lin CH, Lin CC
BMC Gastroenterol
· 2026 May · PMID 42210157
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BACKGROUND: Inflammatory bowel disease (IBD) has shown a steadily rising prevalence in Asian populations over recent decades, coinciding with rapid industrialization, Westernized dietary habits, and lifestyle changes. Th...BACKGROUND: Inflammatory bowel disease (IBD) has shown a steadily rising prevalence in Asian populations over recent decades, coinciding with rapid industrialization, Westernized dietary habits, and lifestyle changes. This study aimed to report the annual trends and sociodemographic-specific rates of the prevalence and incidence of diagnosed IBD in Taiwan from 2011 to 2021. METHODS: A population-based study of all residents enrolled in the National Health Insurance (NHI) program, the Catastrophic Illness Patient Database, was conducted to identify patients diagnosed with IBD. The annual prevalence and incidence of diagnosed IBD were identified using International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) diagnostic codes, stratified by age, sex, insurance premium, and degree of urbanization. Logistic regression analyses were performed to estimate odds ratios for associated risk factors; while Joinpoint regression analyses were used to assess temporal trends in age-standardized annual prevalence and incidence from 2011 to 2021. RESULTS: The age-standardized annual prevalence of IBD more than doubled from 9.56 per 100,000 persons in 2011 to 19.54 per 100,000 in 2021 (annual percent change [APC]: 7.35%), while incidence rates rose from 0.89 to 2.46 per 100,000 persons over the same period (APC: 11.04%). Males consistently showed higher prevalence and incidence rates than females throughout the study period. Prevalence was highest among individuals aged 50-60 years, those with high income levels, and residents of highly urbanized areas, whereas incidence peaked in the 40-50-year age group and was also elevated among individuals with high income. CONCLUSIONS: Nationwide NHI data showed a substantial increase in IBD prevalence and incidence in Taiwan from 2011 to 2021, with a disproportionately increased burden among men, middle-aged individuals, high-income groups, and residents of highly urbanized areas.
BMC Gastroenterol
· 2026 May · PMID 42210107
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BACKGROUND: Patient-centered care (PCC) and shared decision-making (SDM) are internationally recognized as the preferred approaches to patient care. However, implementation in daily clinical practice remains challenging...BACKGROUND: Patient-centered care (PCC) and shared decision-making (SDM) are internationally recognized as the preferred approaches to patient care. However, implementation in daily clinical practice remains challenging as sustainable behavioral change requires a multifaceted approach. We developed and evaluated a training program consisting of an e-learning, skills training, deliberate practice and a group reflection session, aimed at improving gastroenterologists' patient-centered attitudes and SDM skills. METHODS: Before and after training, we assessed preferred and self-reported actual patient care behavior (disease-centered vs. patient-centered) by visual analogue scale (VAS) and attitudes towards PCC with the Patient-Practitioner Orientation Scale (PPOS). Open-ended questions exploring participants' concepts of patient-centeredness were analyzed using thematic analysis. Recorded patient consultations were analyzed using the OPTION and Four Habits Coding Scale (4HCS) to evaluate observed SDM and patient-centered communication behaviors. RESULTS: Twenty-three gastroenterology healthcare professionals completed the training program, showing significant improvements in attitudes towards patient-centeredness (baseline mean total PPOS 4.73 [SD 0.37], 95% CI of difference 0.04-0.44) and self-reported patient-centered behavior (baseline mean VAS 49 [18], 95% CI of difference 6.08-23.81) after the intervention. High levels of patient-centered behavior and SDM skills were observed in recorded consultations (mean 4HCS 72 [12], mean OPTION 44 [16]). Thematic analysis of responses to open-ended questions highlighted the relationship between healthcare provider (HCP) and patient as a core foundation for PCC, emphasizing trust, clear communication, and understanding patients' context. After the training, participants described increased attention to eliciting patients' values and preferences and explicitly acknowledging decisions to be made. CONCLUSION: A dedicated training program increased gastroenterology professionals' patient-centered attitude and application of patient-centered SDM skills. These findings support the use of dedicated training to facilitate the implementation of PCC and SDM in clinical gastroenterology practice.
BMC Gastroenterol
· 2026 May · PMID 42210102
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Liver hepatocellular carcinoma (LIHC) is a leading cause of cancer-related mortality worldwide, with limited therapeutic options and poor prognosis, particularly at advanced stages. Identifying key molecular drivers invo...Liver hepatocellular carcinoma (LIHC) is a leading cause of cancer-related mortality worldwide, with limited therapeutic options and poor prognosis, particularly at advanced stages. Identifying key molecular drivers involved in LIHC progression is critical for improving diagnosis and treatment strategies. In this study, we performed an integrated bioinformatics analysis using four independent GEO datasets (GSE19665, GSE54236, GSE55092, and GSE84598) to identify differentially expressed genes (DEGs) associated with LIHC. A total of 147 common DEGs were identified, and protein-protein interaction network analysis revealed CCNA2, MAD2L1, AURKA, and PTTG1 as central hub genes. Functional enrichment analyses indicated that these genes are primarily involved in cell cycle regulation, mitosis, and chromosomal stability. Expression analyses using TCGA-based databases demonstrated significant upregulation of these hub genes at both mRNA and protein levels in LIHC tissues compared with normal liver tissues. Elevated expression was associated with advanced tumor stage, poor overall survival, immune cell infiltration, and altered drug sensitivity, highlighting their clinical relevance. Promoter methylation analysis suggested that epigenetic regulation may contribute to gene dysregulation, while genetic alterations were infrequent. Experimental validation using RT-qPCR confirmed overexpression of hub genes in LIHC cell lines. Furthermore, siRNA-mediated knockdown of these genes significantly suppressed proliferation, colony formation, and migration in HepG2 and Huh7 cells. Collectively, these findings identify CCNA2, MAD2L1, AURKA, and PTTG1 as key oncogenic drivers and potential biomarkers and therapeutic targets in LIHC.
Prasad S, Nagda J, Ahuja A
… +2 more, Agrawal S, Parmar V
BMC Gastroenterol
· 2026 May · PMID 42204478
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BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitor-induced intestinal angioedema is a rare but clinically significant adverse drug reaction. Isolated visceral involvement, occurring without the cutaneous, orophary...BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitor-induced intestinal angioedema is a rare but clinically significant adverse drug reaction. Isolated visceral involvement, occurring without the cutaneous, oropharyngeal, or laryngeal manifestations classically associated with ACE inhibitor angioedema, is particularly under-recognised and is repeatedly mistaken for common gastrointestinal disorders. Most reported cases describe symptom onset within hours to days of initiation; cases with subacute onset over several weeks-mimicking a functional bowel disorder-are far less well characterised. CASE PRESENTATION: A 54-year-old Indian woman with essential hypertension developed recurrent diffuse abdominal pain, intermittent loose stools, and nausea approximately six weeks after starting enalapril 10 mg once daily. She had no urticaria, pruritus, facial swelling, or oropharyngeal involvement. Vital signs were stable, and abdominal examination demonstrated mild diffuse tenderness without peritoneal signs. She was managed at peripheral facilities for presumed acute gastroenteritis and subsequently irritable bowel syndrome, with no meaningful response to standard therapy. Comprehensive evaluation excluded infectious, inflammatory, autoimmune, and hereditary causes; serum complement C4 was normal. The clinical diagnosis of ACE inhibitor-induced isolated intestinal angioedema was made on the basis of (i) angioedema-type presentation in the absence of urticaria or pruritus, (ii) temporal association with enalapril, (iii) exclusion of alternative aetiologies, and (iv) complete resolution following drug withdrawal. Causality was assessed as "probable" by the Naranjo Adverse Drug Reaction Probability Scale (score 7) and by the WHO-UMC criteria. After a structured wash-out, the patient was transitioned to losartan, with sustained blood pressure control and no recurrence over three months of follow-up. CONCLUSIONS: ACE inhibitor-induced angioedema can present as isolated intestinal involvement and may evolve over weeks rather than hours, closely mimicking a functional bowel disorder. A meticulous medication history, formal causality assessment, and an empirical drug-withdrawal trial should be considered in any patient with unexplained, treatment-refractory gastrointestinal symptoms taking an ACE inhibitor.
Chatsuntiprapa S, Bannangkoon K, Tubtawee T
… +1 more, Ina N
BMC Gastroenterol
· 2026 May · PMID 42204461
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PURPOSE: The prognostic value of sarcopenic obesity is controversial in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). This study aimed to deconstruct the sarcopenic obesity ph...PURPOSE: The prognostic value of sarcopenic obesity is controversial in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). This study aimed to deconstruct the sarcopenic obesity phenotype to clarify the independent prognostic impacts of sarcopenia and visceral obesity. METHODS: We retrospectively analyzed 415 patients with unresectable HCC who underwent TACE between 2009 and 2020. Skeletal muscle index (SMI) and visceral fat area (VFA) were measured from baseline CT scans at the L3 vertebra level. Sarcopenia (SMI ≤ 36.2 cm²/m² in males, ≤ 29.6 cm²/m² in females) and visceral obesity (VFA ≥ 100 cm²) were defined using Asian-specific cutoffs. Overall survival (OS) was analyzed using Kaplan-Meier and Cox proportional hazards models, with sex-stratified analysis. RESULTS: Among 415 patients (72% male, median follow-up 21.4 months), sarcopenia prevalence was 34% and visceral obesity 59%. In sex-stratified analysis, sarcopenia predicted mortality in males and reduced the median OS by 11 months (14.4 vs. 25.4 months, p < 0.001), but not in females (23.4 vs. 22.8 months, p = 0.900). Visceral obesity showed no prognostic impact in either sex. In sex-stratified multivariate analysis adjusting for Child-Pugh class, tumor burden, BCLC stage, and AFP, sarcopenia remained independently associated with mortality in males (adjusted hazard ratio [HR] = 1.41, 95% CI: 1.06-1.86, p = 0.018) but not in females (adjusted HR = 0.84, 95% CI: 0.55-1.27, p = 0.404; p for interaction = 0.070), while visceral obesity and sarcopenic obesity composite showed no prognostic value in either sex. CONCLUSION: The sarcopenic obesity composite phenotype lacks prognostic value in TACE-treated HCC patients. Sarcopenia independently predicts mortality in males but not females, while visceral obesity shows no independent prognostic significance. Clinical risk stratification could consider sarcopenia assessment in male patients rather than composite phenotypes.
BMC Gastroenterol
· 2026 May · PMID 42204448
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BACKGROUND: Prolonged immobilization in patients with severe acute pancreatitis (SAP) leads to profound physical deconditioning, yet structured rehabilitation protocols remain underexplored in this population. OBJECTIVE:...BACKGROUND: Prolonged immobilization in patients with severe acute pancreatitis (SAP) leads to profound physical deconditioning, yet structured rehabilitation protocols remain underexplored in this population. OBJECTIVE: To investigate the effects of a structured early rehabilitation nursing (ERN) program on short-term and long-term clinical outcomes, including length of stay, functional recovery, and survival, in patients with severe acute pancreatitis (SAP) admitted to the intensive care unit (ICU). METHODS: This single-center, prospective, randomized controlled trial was conducted from June 2019 to June 2024. A total of 400 eligible SAP patients admitted to the intensive care unit (ICU) were randomized (1:1) to either the ERN group (n = 200), receiving a protocolized, multidisciplinary rehabilitation program, or the control group (n = 200), receiving usual care. The primary outcome was hospital length of stay (LOS). Key secondary outcomes included ICU LOS, systemic inflammatory markers (CRP, IL-6), muscle strength (MRC sum score), activities of daily living (ADL), quality of life (WHOQOL-BREF), and 1-year all-cause mortality. Assessments were performed at baseline, discharge, and at 3, 6, and 12 months post-discharge. RESULTS: The ERN group had significantly shorter hospital LOS (11.5 ± 2.5 vs. 14.8 ± 3.1 days, P < 0.001) and ICU LOS (7.2 ± 2.1 vs. 10.5 ± 2.8 days, P < 0.001). At day 7, the ERN group showed lower levels of CRP (48.5 ± 15.2 vs. 95.3 ± 25.4 mg/L, P < 0.001) and IL-6 (55.2 ± 18.3 vs. 110.6 ± 30.1 pg/mL, P < 0.001). At discharge, the ERN group demonstrated superior muscle strength (MRC score: 52.4 ± 4.9 vs. 46.1 ± 5.8, P < 0.001) and functional independence (ADL score: 75.8 ± 8.1 vs. 62.5 ± 9.3, P < 0.001). These functional and quality of life benefits were sustained through the 12-month follow-up. Kaplan-Meier analysis revealed a significantly higher 1-year survival rate in the ERN group (95.0% vs. 87.5%; log-rank P = 0.012). The incidence of ICU-acquired complications was also lower in the ERN group (5.5% vs. 26.0%, P < 0.001). CONCLUSION: A structured, early rehabilitation nursing program for SAP patients effectively attenuates systemic inflammation, accelerates physical recovery, reduces length of stay, and improves long-term functional outcomes, quality of life, and 1-year survival. These findings support the integration of ERN as a standard of care in the management of critically ill SAP patients.
Abu Sneineh A, Haj Ali S, Mazzawi T
… +9 more, Mohtaseb MS, Ali R, Abu Farsakh N, Senan F, Hodali S, Agraib L, Khatib O, Khatib L, Sablaban I
BMC Gastroenterol
· 2026 May · PMID 42192311
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BACKGROUND AND AIMS: Crohn's disease is a chronic inflammatory condition often requiring surgical intervention, which can significantly impact a patient's quality of life and mental health. This study aimed to evaluate t...BACKGROUND AND AIMS: Crohn's disease is a chronic inflammatory condition often requiring surgical intervention, which can significantly impact a patient's quality of life and mental health. This study aimed to evaluate the prevalence of anxiety and depressive symptoms in surgically treated patients with Crohn's disease. METHODS: A comparative cross-sectional study at a tertiary center included surgically and non-surgically treated patients with Crohn's disease. Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9. Disease activity was assessed using Harvey Bradshaw index and endoscopic recurrence was evaluated using the Rutgeerts score. RESULTS: A total of 97 patients with Crohn's disease (54 surgical, 43 non-surgical controls) were included. The prevalence of anxiety and depressive symptoms were comparable between groups (57.4% surgical vs. 60.5% controls, p = 0.330) and (70.4% vs. 79.1%, p = 0.761), respectively. Surgical group had significantly better depression severity outcomes, with lower median Patient Health Questionnaire-9 scores (6.0 vs. 9.0, p = 0.007) and no cases of severe depression (0% vs. 14%, p = 0.025). Active disease was significantly associated with anxiety and depressive symptoms, whereas a lower body mass index was significantly associated with symptoms of depression. CONCLUSION: Previous surgery was not associated with lower prevalence of symptoms of anxiety or depression but was associated with significantly milder depression severity. The strong association of active disease and anxiety symptoms, and of active disease and lower body mass index with depressive symptoms, highlights the need for comprehensive care models that target both physical and psychological symptoms.