Digestion[JOURNAL]
Sun
200 papers
A Novel Endoscopic Finding of Achalasia: "Endoscopic Vertebrae Sign".
Ochiai Y, Suzuki Y, Nomura K … +3 more , Odagiri H, Kikuchi D, Hoteya S
Digestion · 2025 Dec · PMID 41433207 · Full text
INTRODUCTION: Achalasia is an esophageal motility disorder that significantly impairs quality of life. Recently, peroral endoscopic myotomy has yielded satisfactory treatment outcomes. Although the current gold standard...
INTRODUCTION: Achalasia is an esophageal motility disorder that significantly impairs quality of life. Recently, peroral endoscopic myotomy has yielded satisfactory treatment outcomes. Although the current gold standard is esophageal high-resolution manometry (HRM), early endoscopic detection is essential for accurate diagnosis. Dilatation of the esophageal lumen during endoscopy is subjective and has not been fully evaluated. We focused on the extramural compression of the vertebrae in the esophagus, which may reflect dilatation of the esophageal lumen, named the endoscopic vertebrae sign (EVS), and examined the possibility of the EVS as a novel endoscopic finding of achalasia. METHODS: Forty-three patients were diagnosed with achalasia using HRM between July 2013 and November 2022. Five who underwent surgical treatment and one for whom esophagogram was unavailable were excluded, resulting in 37 patients in the achalasia group. Among those who underwent comprehensive medical checkups and esophagogastroduodenoscopy screening at our hospital during the same period, all age- and sex-matched individuals were randomly extracted and 74 were set as controls. The rates of EVS, endoscopic esophageal dilatation at the endoscopist's discretion, and number of visible vertebrae in a single endoscopic view were retrospectively analyzed. RESULTS: In the achalasia group, the proportion with EVS was 86.5%, with endoscopic esophageal dilatation at the endoscopist's discretion 76%, and the number of visible vertebrae in patients with EVS was 3.2 ± 0.9. These findings differed significantly in controls: 9.5%, 0%, and 1.4 ± 0.4, respectively (p < 0.001). CONCLUSION: EVS may be one of the endoscopic findings associated with esophageal dilatation and suggestive of achalasia.
The Risk of Gastric Cancer in Asian Patients with Gastric Intestinal Metaplasia.
Tan GJ, Mahadeva S
Digestion · 2025 Dec · PMID 41428613 · Publisher ↗
BACKGROUND: Gastric cancer (GC) has a significant impact in Asia. Delay in diagnosis and treatment leads to increased mortality and morbidity. The detection of gastric intestinal metaplasia (GIM) has the potential to be...
BACKGROUND: Gastric cancer (GC) has a significant impact in Asia. Delay in diagnosis and treatment leads to increased mortality and morbidity. The detection of gastric intestinal metaplasia (GIM) has the potential to be an early sign of GC, but there are controversies. Differences in GC and pre-cancerous lesions between Asians and non-Asians have also contributed to this controversy. SUMMARY: GIM is a risk factor for developing GC in Asian adults, with more recent meta-analyses demonstrating a 3-4 risk in such patients. Certain GIM subtypes are more likely to develop GC, with Asian patients appearing to have more severe, diffuse, and high-risk subtypes of GIM compared to non-Asians. As a result, most international guidelines recommend endoscopic surveillance in adults with GIM, but this review article suggests it should be targeted towards those with high-risk features. This review also highlights other factors, apart from gastric histology, which are relevant in the development of GC. Factors such as Helicobacter pylori virulence, molecular and genetic mechanisms, gut microbiota, specific dietary components, and social habits as risk factors for GC are discussed. KEY MESSAGES: GIM is a risk factor for GC in the Asian population. Surveillance in a targeted population is beneficial.
Impact of Direct-Acting Antivirals on the Hemodynamics of the Portal Circulation in Cirrhotic Patients Infected with Hepatitis C Virus.
Hassnine AA, Elsayed AM, Higazi MM … +5 more , Saied M, Abbas A, Mamdouh M, Ahmed E, Soliman W
Digestion · 2025 Dec · PMID 41396882 · Publisher ↗
INTRODUCTION: The most frequent cause of portal hypertension is liver cirrhosis (LC). Chronic hepatitis C virus (HCV) is a major cause of death and morbidity globally because of the consequences of LC, hepatocellular car...
INTRODUCTION: The most frequent cause of portal hypertension is liver cirrhosis (LC). Chronic hepatitis C virus (HCV) is a major cause of death and morbidity globally because of the consequences of LC, hepatocellular carcinoma, and portal hypertension, oral direct-acting antivirals (DAAs) are the effective treatment for HCV, offering a high cure rate. A virological response is also anticipated to improve portal hypertension. The aim of the study was to assess how DAA medication affects the hemodynamics of the portal circulation in patients with cirrhosis who have been infected with HCV. METHODS: A total of 120 patients with LC linked to chronic HCV were included in this study. They received treatment using regimens based on sofosbuvir combined with daclatasvir and either ribavirin or neither. Prior to beginning therapy and 2 years later, all patients underwent the following tests: complete blood count, PCR for HCV RNA, liver and renal function, abdominal ultrasonography, and colored duplex for assessment of portal hypertension. RESULTS: When compared to Doppler parameters prior to treatment, there is a notable improvement in Doppler metrics following DAA therapy (p = 0.006), including portal vein (PV) diameter, portal congestive index, PV cross-sectional area, splenic vein diameter, and span. Only roughly 69 patients (or 57% of the total) showed an improvement in portal pressure, whereas the percentage of sustained virological response is 95%. Numerous characteristics, such as the existence of splenomegaly and varices, a history of bilharzias, a high degree of fibrosis, and a low platelet count prior to treatment, are linked to non-changes in portal hypertension. CONCLUSION: We infer that sustained virological response in HCV related cirrhotic patients following DAAs may lead to decrease in portal hypertension after an extended period of time, as adopted from portal congestion index Doppler parameters.
Retraction Statement.
Digestion · 2026 · PMID 41385486 · Publisher ↗
The article "DYRK2 regulates epithelial-mesenchymal transition restriction in pancreatic cancer liver metastasis by inhibiting Twist" [Digestion 2024; https://doi.org/10.1159/000541039] by Hang Pan, Yin Liu, Kejiu Bao, Y...
The article "DYRK2 regulates epithelial-mesenchymal transition restriction in pancreatic cancer liver metastasis by inhibiting Twist" [Digestion 2024; https://doi.org/10.1159/000541039] by Hang Pan, Yin Liu, Kejiu Bao, Yulin Wang, Yuping Zhang and Lina Zhou has been retracted by the Publisher and the Editor.After peer review, the accepted, unedited manuscript was published online as Early View. The authors did not respond to our requests and communication regarding the production process of their article despite extensive attempts at contact. As the article has not been approved by the authors for publication, we cannot publish the final version. To avoid confusion for readers we are retracting the Early View accepted, unedited manuscript.The authors did not respond to correspondence about the retraction.
Integrin Inhibitors for Ulcerative Colitis Treatment.
Tanaka T, Tominaga K, Kojimahara S … +4 more , Kanazawa M, Yamamiya A, Sugaya T, Irisawa A
Digestion · 2025 Dec · PMID 41379729 · Publisher ↗
BACKGROUND: Ulcerative colitis is a diffuse, non-specific inflammatory bowel disease of unknown etiology with recurrent relapse and remission. The mechanisms of immune-mediated inflammation as a pathogenesis of ulcerativ...
BACKGROUND: Ulcerative colitis is a diffuse, non-specific inflammatory bowel disease of unknown etiology with recurrent relapse and remission. The mechanisms of immune-mediated inflammation as a pathogenesis of ulcerative colitis have been increasingly elucidated, leading to development of biological agents and low-molecular-weight agents that target specific molecules or disease processes. SUMMARY: Integrin inhibitors impede ulcerative colitis pathogenesis by selectively inhibiting integrin, an adhesion molecule expressed on leukocytes, thereby suppressing lymphocyte infiltration into gastrointestinal tissues and controlling excessive immune responses at the inflammation site: the intestinal tract. KEY MESSAGE: This article describes the mechanism of integrin inhibitors' action, the usefulness, and positioning of vedolizumab and carotegrast methyl, which are currently available for clinical use to treat ulcerative colitis, and the status of integrin inhibitor development.
Diagnostic Value of White-Light Endoscopy, Narrow-Band Imaging, and Chromoendoscopy in Detecting Esophageal Involvement in Oral Lichen Planus and Oral Lichen Planus-Based Squamous Cell Carcinoma.
Pohl M, Riphaus A, Steckstor M … +5 more , Canbay D, Tannapfel A, Canbay A, Kunkel M, Weninger J
Digestion · 2025 Dec · PMID 41370210 · Publisher ↗
INTRODUCTION: Oral lichen planus (OLP) is a chronic inflammatory condition and a precancerous lesion of OLP-based oral squamous cell carcinoma (OSCC), with possible esophageal involvement (esophageal lichen planus [ELP])...
INTRODUCTION: Oral lichen planus (OLP) is a chronic inflammatory condition and a precancerous lesion of OLP-based oral squamous cell carcinoma (OSCC), with possible esophageal involvement (esophageal lichen planus [ELP]), though the latter prevalence and clinical significance remain uncertain. This study aimed to determine ELP prevalence in OLP/OSCC patients, assess the diagnostic performance of white-light endoscopy (WLE), narrow-band imaging (NBI), and Lugol's iodine staining-based chromoendoscopy, and evaluate histologic findings for potential prognostic implications. METHODS: In this prospective single-center study (2011-2020), 81 adults with confirmed OLP and about 50% history of OSCC underwent esophagogastroduodenoscopy (EGD) using WLE, NBI, and chromoendoscopy. Biopsies were taken from visually suspicious areas and from normal-appearing mucosa throughout the esophagus, stomach, and duodenum. RESULTS: ELP was identified in only 4 patients (4.9%), all of whom were asymptomatic or had minimal symptoms. In 3 cases, ELP was detected only via random biopsies despite normal endoscopic appearance. The sensitivity of WLE, NBI, and chromoendoscopy was low, with Lugol's staining yielding false positives due to benign changes like glycogen acanthosis. No dysplasia or carcinoma was observed. CONCLUSION: Even in one of the largest prospective studies, ELP remained a rare finding, often clinically silent, and frequently undetectable on endoscopy. Step biopsies are essential for diagnosis. EGD screening in OLP may be considered as a one-time index endoscopy, supplemented by symptom-based evaluation in selected cases. ELP does not appear to increase short-term malignancy risk, and management should focus on symptom control and avoiding complications.
Diagnostic Performance of Fecal Biomarkers and Their Correlation with Endoscopic Severity in Immune Checkpoint Inhibitor-Related Colitis.
Morikawa R, Fujii T, Tamura A … +9 more , Kawamoto A, Hibiya S, Takenaka K, Shimizu H, Kano Y, Suenaga M, Hamamoto Y, Ohtsuka K, Okamoto R
Digestion · 2025 Dec · PMID 41351856 · Publisher ↗
INTRODUCTION: Immune-related adverse events (irAEs), which occur due to loss of immune tolerance, represent a significant challenge when using immune checkpoint inhibitors (ICIs). As the indications for ICIs continue to...
INTRODUCTION: Immune-related adverse events (irAEs), which occur due to loss of immune tolerance, represent a significant challenge when using immune checkpoint inhibitors (ICIs). As the indications for ICIs continue to expand, the incidence of irAEs has been increasing. Immune-mediated diarrhea and colitis (IMDC) is one of the most frequent irAEs. Although important for the management of IMDCs, colonoscopy is highly invasive for patients with cancer, and development of noninvasive alternatives is needed. METHODS: We prospectively enrolled patients diagnosed with IMDC between May 2019 and May 2025, and a total of 34 patients were included in the final analysis. Blood and stool samples were collected, and biomarker levels were measured. Endoscopic activity was defined as a Mayo Endoscopic Subscore of ≥2, as evaluated during colonoscopy. The relationship of each biomarker with endoscopic activity was examined using Spearman's rank correlation and receiver operating characteristic curve analysis. RESULTS: Fecal calprotectin (FC), fecal lactoferrin (FL), and fecal immunochemical test (FIT) were significantly correlated with the Mayo Endoscopic Subscore, with correlation coefficients of 0.50, 0.51, and 0.74, respectively. These biomarkers effectively detected endoscopic activity, with high area under the curve values of 0.79, 0.81, and 0.94, respectively. Furthermore, certain combinations of fecal biomarkers enhanced accuracy, as demonstrated by FC (+) or FIT (+), which achieved a sensitivity of 95.5% and a specificity of 75.0%. CONCLUSION: Fecal biomarkers were correlated with endoscopic activity and effectively identified patients with endoscopically active IMDC. Our findings suggest that these biomarkers may be valuable tools for the diagnosis and assessment of treatment response in IMDC.
EndoTrac-Assisted vs. Conventional ESD in Superficial Gastric Neoplasms: A Multicenter Randomized Controlled Trial.
Ishida R, Sako T, Yamamoto Y … +21 more , Takao T, Kawara F, Ose T, Kitamura Y, Ikeda A, Ariyoshi R, Morita Y, Ishida T, Ikegawa T, Morisawa T, Katayama N, Nisikawa M, Wada T, Hara K, Yoshie T, Anami T, Abe H, Yoshizaki T, Sakaguchi H, Toyonaga T, Kodama Y
Digestion · 2025 Dec · PMID 41335541 · Publisher ↗
INTRODUCTION: Endoscopic submucosal dissection (ESD) is a technically demanding curative treatment for early gastric cancer. The EndoTrac traction device was designed to enhance maneuverability during ESD. This study eva...
INTRODUCTION: Endoscopic submucosal dissection (ESD) is a technically demanding curative treatment for early gastric cancer. The EndoTrac traction device was designed to enhance maneuverability during ESD. This study evaluated whether EndoTrac-assisted ESD (ET-ESD) improves outcomes versus conventional ESD (C-ESD) in patients with superficial gastric neoplasms. METHODS: In this multicenter, single-blind, randomized controlled trial, 142 patients from 11 Japanese centers were assigned to undergo ET-ESD (n = 72) or C-ESD (n = 70). The primary endpoint was ESD procedure time. Secondary endpoints included efficacy, safety, and device-related outcomes. Operator experience, lesion characteristics, knife type, and institutional ESD volume were recorded and analyzed. RESULTS: Median procedure times were 53.5 min for ET-ESD and 57.0 for C-ESD (p = 0.56). Among trainees, ET-ESD was associated with a shorter procedure time than C-ESD (59.0 vs. 85.5 min; p = 0.02). In subgroup analyses of trainee cases, shorter times with ET-ESD were associated with several scenarios (e.g., lesions ≤20 mm, upper/middle third of the lesser curvature, needle-type knife, and low-volume centers). In a multivariable analysis among trainees, ET-ESD remained independently associated with shorter procedure time (B = -24.8 min; 95% CI: -43.8 to -5.8; p = 0.012). In the overall cohort, en bloc and R0 resection rates, adverse events, and device-related complications were similar between groups. CONCLUSION: ET-ESD did not significantly shorten procedure time in the overall cohort. Nonetheless, exploratory subgroup analyses suggested potential benefits among trainees, small lesions, technically challenging locations, and low-volume centers.
Characteristics and Long-Term Prognosis of Celiac Disease: Comparisons between Patients Diagnosed either in Childhood or Adulthood.
Koskimaa S, Nurminen S, Salmi T … +4 more , Huhtala H, Kaukinen K, Kurppa K, Kivelä L
Digestion · 2025 Dec · PMID 41329627 · Full text
INTRODUCTION: It is plausible but not yet proven that early celiac disease diagnosis prevents long-term complications of untreated disease. Our aim was to compare phenotype and health outcomes in currently adult celiac d...
INTRODUCTION: It is plausible but not yet proven that early celiac disease diagnosis prevents long-term complications of untreated disease. Our aim was to compare phenotype and health outcomes in currently adult celiac disease patients diagnosed either in childhood (<18 years) or adulthood. METHODS: Data on 1,059 patients were collected from medical records at diagnosis and with questionnaires and structured interviews after long-term follow-up. Associations between timing of diagnosis and long-term health were studied with regression models. RESULTS: Patients diagnosed in childhood (n = 239) were more often males (32% vs. 23%, p = 0.004), currently younger (27 vs. 54 years, p < 0.001), more often screen-detected (20% vs. 14%, p < 0.001), and reported lower adherence to gluten-free diet in adulthood (92% vs. 97%, p < 0.001) than those diagnosed in adulthood (n = 820). After adjusting for clinico-demographic variables and dietary adherence, patients diagnosed in childhood had fewer miscarriages (odds ratio 0.41 [95% confidence interval: 0.21-0.80]) but more allergies (1.75 [1.11-2.76]), dermatological diseases excluding dermatitis herpetiformis (1.99 [1.11-3.58]), asthma (2.28 [1.16-4.48]), and depression (2.84 [1.24-6.50]) in adulthood. The groups were comparable in other comorbidities including type 1 diabetes and autoimmune thyroidal diseases, persistent symptoms, and quality of life. CONCLUSION: Diagnosis in childhood compared to adulthood was associated with disease phenotype and its effects on long-term comorbidities are complex.
Efficacy of Image-Enhanced Endoscopy Using a Novel Double-Balloon Enteroscope for Visibility of Small-Bowel Lesions.
Shigenobu S, Tsuboi A, Sugata S … +11 more , Matsubara Y, Hirata I, Takasago T, Tanaka H, Yamashita K, Hiyama Y, Kishida Y, Takigawa H, Urabe Y, Kuwai T, Oka S
Digestion · 2025 Dec · PMID 41329623 · Publisher ↗
INTRODUCTION: The novel double-balloon enteroscope (DBE), EN-840T, is the first DBE system to incorporate image-enhanced endoscopy (IEE) technologies, such as blue laser imaging (BLI) and linked-color imaging (LCI). This...
INTRODUCTION: The novel double-balloon enteroscope (DBE), EN-840T, is the first DBE system to incorporate image-enhanced endoscopy (IEE) technologies, such as blue laser imaging (BLI) and linked-color imaging (LCI). This study aimed to evaluate the efficacy of IEE in improving the visibility of small-bowel lesions using EN-840T. METHODS: We conducted a retrospective analysis of 49 patients with 120 lesions who underwent double-balloon enteroscopy using EN-840T between March and June 2024. Lesion visibility and color differences were compared among BLI, LCI, and white light imaging (WLI). Five physicians assessed lesion visibility by assigning scores. Additionally, color differences between normal mucosa and the patchy reddish lesions <5 mm in diameter, including angioectasia and erythema, were calculated for each IEE and WLI image. The primary and secondary outcomes were the visibility of small-bowel lesions on IEE and the color differences in these lesions, respectively. RESULT: Lesions were classified as inflammatory (n = 71), tumorous (n = 39), and vascular (n = 10). LCI improved lesion visibility by 75% (53/71) for inflammatory lesions, 72% (28/39) for tumorous lesions, and 80% (8/10) for vascular lesions compared with WLI. Furthermore, the mean color difference (mean ± SD) of reddish lesions was significantly greater in LCI than in WLI for both angioectasia (25.2 ± 1.83 vs. 20.6 ± 2.14 [p < 0.001]) and erythema (25.3 ± 2.25 vs. 19.8 ± 1.82 [p < 0.001]). CONCLUSIONS: IEE using EN-840T enhanced the visibility of small-bowel lesions. Specifically, LCI improved lesion visibility and may contribute to detecting small lesions.
Gut Microbiome Mediates the Effect of Inflammatory Bowel Disease on Sarcopenia: A Bidirectional Mendelian Randomization Study.
Liang Y, Lu C, Ma D … +1 more , He X
Digestion · 2025 Nov · PMID 41317335 · Publisher ↗
INTRODUCTION: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), imposes a global health burden. Observational studies suggest links between IBD and sarcopenia as well as obesit...
INTRODUCTION: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), imposes a global health burden. Observational studies suggest links between IBD and sarcopenia as well as obesity, but establishing causality is challenging due to confounding factors. METHODS: This study utilized two-sample Mendelian randomization (MR) analyses to explore bidirectional causality between obesity, sarcopenia, and IBD, using genetic instruments from summary-level data. The primary causal estimates were derived using the inverse-variance weighted method. To ensure robustness, we performed a range of sensitivity analyses, including MR-Egger regression and the weighted median method to detect and adjust for horizontal pleiotropy, and MR-PRESSO to identify and remove potential outliers. RESULTS: MR analysis revealed significant associations between obesity, sarcopenia, and IBD, especially CD. Trunk fat percentage, body fat percentage, and abdominal subcutaneous adipose tissue volume were positively associated with an increased risk of CD, whereas hand grip strength showed a negative association, highlighting the role of obesity and sarcopenia in CD risk. Conversely, CD was causally linked to lower abdominal fat, muscle mass, and strength. For UC, only visceral adipose tissue volume showed an association with disease risk. Mediation analysis indicated the gut microbiome might mediate the causal effect of CD on sarcopenia-related traits. CONCLUSION: This MR study confirms bidirectional causality between sarcopenia, obesity, and IBD, particularly CD. It highlights the complex interplay between body composition and IBD pathogenesis. Moreover, the gut microbiome may mediate the relationship between CD and sarcopenia. These findings underscore the importance of managing obesity and sarcopenia in IBD treatment and suggest potential therapeutic targets related to the gut-muscle axis.
Erratum.
Digestion · 2025 Nov · PMID 41296657 · Publisher ↗
In the article by Ruan et al. entitled "Clinical Application of Confocal Laser Endomicroscopy in the Diagnosis of Gastrointestinal Diseases" [Digestion. 2025; https://doi.org/10.1159/000548414], there is an error in the...
In the article by Ruan et al. entitled "Clinical Application of Confocal Laser Endomicroscopy in the Diagnosis of Gastrointestinal Diseases" [Digestion. 2025; https://doi.org/10.1159/000548414], there is an error in the affiliation of the first author. The correct affiliation of the first author, Wenli Ruan, is:The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China.
Clinical Features and Short-Term Disease Progression of Asymptomatic Perianal Fistulizing Crohn's Disease.
Wu T, Chen X, Bai C … +3 more , Chen H, Huang L, Cao Q
Digestion · 2025 Nov · PMID 41289219 · Full text
INTRODUCTION: Anal imaging improves the diagnosis of perianal diseases in Crohn's disease (CD) patients, especially those with no perianal symptoms. However, the clinical characteristics and outcomes of CD patients with...
INTRODUCTION: Anal imaging improves the diagnosis of perianal diseases in Crohn's disease (CD) patients, especially those with no perianal symptoms. However, the clinical characteristics and outcomes of CD patients with asymptomatic perianal fistula are unknown. This study aims to explore the prevalence and clinical course of Chinese CD patients with asymptomatic perianal fistula in a hospital-based cohort. METHODS: We performed a retrospective cohort study of consecutive hospitalized patients with newly diagnosed CD in China. Asymptomatic perianal fistula patients with CD were defined as those who exhibited fistula tracts on magnetic resonance imaging scans, absence of reported perianal symptoms, or any prior history of perianal fistula. Their clinical features and prognosis were reviewed and analyzed. RESULTS: Among 376 patients who underwent anal imaging, 93 (24.73%) had asymptomatic perianal fistula, 187 (49.73%) had symptomatic perianal fistula, and 67 patients (17.82%) showed no perianal involvement. There were significant differences among patients without perianal lesions, patients with symptomatic perianal fistula, and patients with asymptomatic perianal fistula in the proportion of male sex (49.25% vs. 84.49% vs. 64.52%, respectively; p < 0.001), age at diagnosis (median 32.00 vs. 26.00 vs. 24.00, p < 0.01), disease location (p < 0.05), and laboratory examination. Patients with asymptomatic perianal fistula had a higher cumulative incidence of abdominal surgery (p < 0.001) and intestinal obstruction (p < 0.05). CONCLUSION: Patients with asymptomatic perianal fistulas account for a certain proportion of CD patients at diagnosis, with a higher proportion of stricturing behavior and cumulative incidence of intestinal obstruction and CD-related bowel surgery.
Diagnostic Approach to Early Barrett's Neoplasia: Japanese Perspective.
Shibagaki K, Ishimura N, Takahashi Y … +5 more , Kotani S, Suemitsu S, Kawabata S, Niino D, Ishihara S
Digestion · 2026 · PMID 41284605 · Full text
<p>Background: The incidence of Barrett's esophagus-related neoplasia is increasing worldwide, with a growing number of cases reported in Japan. While early stage lesions are suitable for endoscopic resection, accurate e...
<p>Background: The incidence of Barrett's esophagus-related neoplasia is increasing worldwide, with a growing number of cases reported in Japan. While early stage lesions are suitable for endoscopic resection, accurate endoscopic detection, and histological assessment remain difficult, particularly in long-segment Barrett's esophagus (LSBE), where lesions often exhibit flat morphology and indistinct margins. These characteristics reduce endoscopic visibility and are associated with lower endoscopic R0 resection rates compared with short-segment Barrett's neoplasias. In Japan, image-enhanced magnifying endoscopy with targeted biopsy is the preferred diagnostic approach, whereas Western guidelines recommend random biopsies according to the Seattle protocol. This review discusses current diagnostic approaches and challenges from a Japanese perspective. Summary: Current diagnostic strategies for superficial Barrett's esophagus-related neoplasia (SBERN) incorporate high-resolution modalities such as white-light endoscopy and magnifying narrow-band imaging with or without acetic acid enhancement. The Japan Esophageal Society Barrett's Esophagus (JES-BE) classification provides a standardized framework for evaluating mucosal and vascular patterns in magnifying endoscopy, thereby improving diagnostic consistency. Nevertheless, histological interpretation, particularly for SBERNs arising in LSBE, poses major challenges due to interobserver variability in differentiating true dysplasia from inflammation-associated atypia and in grading dysplasia, even among expert gastrointestinal pathologists. In Japan, immunohistochemical markers such as p53 and Ki-67 are widely used in routine practice to support histological assessment, particularly for lesions indefinite for dysplasia. Key Messages: Given the increasing clinical burden of SBERN, further standardization of endoscopic criteria and histological assessment is expected to establish more reliable surveillance strategies tailored to segment extent of BE. </p>.
Diagnostic Approach to Early Barrett's Neoplasia: Western Perspective.
Latorre G, Kim DG, Espino A … +1 more , Bechara R
Digestion · 2026 · PMID 41284598 · Publisher ↗
BACKGROUND: Barrett's esophagus (BE) is the replacement of normal squamous epithelium in the distal esophagus by columnar epithelium. The prognosis of esophageal adenocarcinoma depends largely on the stage at diagnosis....
BACKGROUND: Barrett's esophagus (BE) is the replacement of normal squamous epithelium in the distal esophagus by columnar epithelium. The prognosis of esophageal adenocarcinoma depends largely on the stage at diagnosis. Advances in endoscopic imaging and quality standards have significantly improved the early detection of BE-associated neoplasia. This review summarizes current classification systems, sampling protocols, and adjunct tools for diagnosing early neoplasia in BE in Western practice. SUMMARY: In Western practice, the diagnosis of BE relies on consensus criteria requiring endoscopic evidence and histopathological confirmation of columnar epithelium proximal to the gastroesophageal junction. However, there are discrepancies regarding the minimum BE extent and the necessity of intestinal metaplasia for diagnosis. Detecting early neoplasia in BE is challenging due to the flat and subtle nature of dysplastic lesions. High-definition white-light endoscopy (HD-WLE) is the standard modality for BE surveillance and is used to assess for characteristic features of neoplasia, including nodularity, surface irregularity, color changes, and demarcated areas. Image-enhancing techniques - such as virtual chromoendoscopy (e.g., narrow-band imaging [NBI], texture and color enhancement imaging [TXI], blue light imaging [BLI], linked color imaging [LCI]), and acetic acid chromoendoscopy - have improved dysplasia detection when applied alongside validated classification systems. Despite technological advances, random four-quadrant biopsies (4QBs) remain the standard for dysplasia detection. Estimating lesion depth is based primarily on HD-WLE, with limited contribution from chromoendoscopy and ancillary imaging techniques (i.e., endoscopic ultrasound [EUS], confocal laser endomicroscopy, optical coherence tomography). KEY MESSAGES: Early Barrett's neoplasia is challenging to detect. HD-WLE and image-enhancing techniques improve visualization, but random 4QBs remain central to the diagnostic process. Lesion depth is primarily assessed using endoscopic features and, to a limited extent, ancillary techniques.
Gastric Cancer after <italic>Helicobacter pylori</italic> Eradication: Characteristics, Diagnosis, and Management.
Myeong S, Kim I, Kang D … +2 more , Cho YK, Park JM
Digestion · 2025 Nov · PMID 41284588 · Full text
BACKGROUND: Helicobacter pylori eradication is one of the most well-established strategies for the prevention of gastric cancer and is recommended in several countries, particularly in high-risk countries. However, gastr...
BACKGROUND: Helicobacter pylori eradication is one of the most well-established strategies for the prevention of gastric cancer and is recommended in several countries, particularly in high-risk countries. However, gastric cancer can still develop even after successful eradication. As H. pylori eradication has become more prevalent, the characterization, surveillance, and management strategies for gastric cancers that arise following eradication have emerged as important clinical challenges. SUMMARY: Gastric cancers that develop after H. pylori eradication typically arise in the context of preexisting atrophic gastritis or intestinal metaplasia, high-risk background mucosa rather than obligate precursor lesions, reflecting a field effect that predispose gastric stem cells to malignant transformation. Although H. pylori eradication reduces the overall risk of gastric cancer, residual risk depends on the extent and severity of atrophy or intestinal metaplasia. Molecular changes, including persistent CpG island hypermethylation and aberrant miRNA expression, particularly within intestinal metaplasia, may persist after eradication. These cancers are mainly the intestinal type and frequently present as small, depressed, gastritis-like appearance or lesions covered by epithelium with low-grade atypia, making endoscopic diagnosis challenging. Risk prediction can be improved through endoscopic assessment of precancerous lesions, advanced high-resolution imaging endoscopy techniques, and molecular biomarkers. Given the persistent risk, individualized, risk-based long-term surveillance strategies are recommended, particularly for patients with extensive atrophy or intestinal metaplasia. KEY MESSAGES: (1) Despite H. pylori eradication, the risk of gastric cancer persists in patients with atrophic mucosal changes and intestinal metaplasia. (2) Gastric cancers after H. pylori eradication exhibit distinct endoscopic and pathological features compared to those without prior eradication, making early diagnosis challenging. (3) Risk stratification based on endoscopic assessment, advanced imaging, and molecular biomarkers can refine surveillance strategies, emphasizing the importance of long-term, personalized follow-up after eradication.
Decoding the Gut Microbiota: Mechanisms of Host-Microbe Interactions and Inflammatory Pathologies.
Richie T, Lee STM
Digestion · 2025 Nov · PMID 41248092 · Publisher ↗
BACKGROUND: Microbes residing in the gastrointestinal tract are intertwined with the immune development and overall health of the host throughout stages of life. It is well established that these microbes can have both p...
BACKGROUND: Microbes residing in the gastrointestinal tract are intertwined with the immune development and overall health of the host throughout stages of life. It is well established that these microbes can have both positive and negative impacts on host health. Having foundational knowledge of these interactions with the host is critical in understanding gastrointestinal health. SUMMARY: This review discusses the importance of high-resolution study of the gut microbiota, which includes potential modern approaches for analyzing the gut microbiota and considers the challenges and aspects necessary for robust investigation of the gut microbiota. Here, we highlight the complex and highly individualized relationship of microbes interacting within the host results in an ever-changing landscape in the gastrointestinal tract, whether due to host conditions or microbial conditions including microbe-microbe and microbe-host interactions. The vastness and complexity of the gut microbiota contribute to the challenge of quantifying not only a community of microbes in the gut environment, but also maintaining resolution to investigate individual microbes, capturing the network of interactions coinciding in the gastrointestinal tract. Furthermore, the review emphasizes the importance of microbial functions and products to host health outcomes in the context of inflammatory diseases. KEY MESSAGES: Consideration for microbial functions and interactions with the gut immune system is critical for developing effective treatment strategies of inflammatory disorders. Employing high-resolution microbial techniques to investigate microbes with environmental relevance and community functions are a major challenge in the microbiome field. With new techniques and improvements on existing methodologies, investigating microbes at various community levels is feasible and becoming critical in understanding the community interactions with the host influencing the immune status and overall health outcomes.
Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Patients with Irritable Bowel Syndrome.
Wei Q, Rui M, Wang Y … +2 more , Ng SC, You JHS
Digestion · 2025 Nov · PMID 41217998 · Full text
INTRODUCTION: Studies have demonstrated clinical benefits of fecal microbiota transplantation (FMT) for treatment of irritable bowel syndrome (IBS). This study aimed to evaluate the cost-effectiveness of FMT versus stand...
INTRODUCTION: Studies have demonstrated clinical benefits of fecal microbiota transplantation (FMT) for treatment of irritable bowel syndrome (IBS). This study aimed to evaluate the cost-effectiveness of FMT versus standard drug treatment for patients with moderate-to-severe IBS who failed to respond to first-line therapy from the US payer's perspective. METHODS: Two 1-year Markov models were developed to examine the outcomes of FMT versus standard drug treatment in patients with constipation-predominant IBS (IBS-C) and diarrhea-predominant IBS (IBS-D). The primary model outcomes included direct medical cost and quality-adjusted life-years (QALYs) gained. Model inputs were obtained from literature and public data. Sensitivity analyses were performed to examine the robustness of model results. RESULTS: In the base-case analysis, FMT gained higher QALYs (by 0.0159 QALYs for IBS-C and 0.0166 QALYs for IBS-D) with cost savings (USD 7,835 for IBS-C and USD 9,015 for IBS-D) when compared to standard drug treatment. Key influential parameters identified by one-way sensitivity analysis were response probabilities of FMT and first-line treatment, the utility values of therapeutic response and nonresponse, and FMT cost. The probabilities of FMT to be accepted as the preferred strategy at a willingness-to-pay threshold of USD 50,000/QALY were 99.86% and 99.89% for IBS-C and IBS-D, respectively. CONCLUSION: FMT appears to be cost-effective for patients with moderate-to-severe IBS who failed to respond to first-line therapy from the US payer's perspective.
Practical Status of Endoscopic Duodenal Observation and Clinical Relevance of Systematic Photo-Documentation Protocol: A Questionnaire Survey.
Matsui T, Kozuka K, Kawanishi R … +7 more , Nakatani K, Koyama Y, Nishiyama N, Yachida T, Oryu M, Wato M, Kobara H
Digestion · 2025 Nov · PMID 41217993 · Publisher ↗
INTRODUCTION: Early detection of duodenal neoplasms is crucial because of the complications associated with their treatment and their increasing recognition. However, standardised protocols for duodenal observation durin...
INTRODUCTION: Early detection of duodenal neoplasms is crucial because of the complications associated with their treatment and their increasing recognition. However, standardised protocols for duodenal observation during screening esophagogastroduodenoscopy (EGD) have not been established. This study was performed to survey the current practical status of duodenal observation and to evaluate the clinical relevance of our systematic photo-documentation protocol, known as the Seven Pictures Rule (7 PR). METHODS: A cross-sectional survey using a web-based self-administered questionnaire was conducted among endoscopists in a regional area of Japan. The questionnaire included items on respondents' professional background, duodenal observation practices during screening EGD (observed locations, observation time, ampulla visualisation, and patient discomfort), as well as awareness, application, and perceived effects of the 7 PR, and preferences for future protocols. Data were anonymised and analysed descriptively. RESULTS: Of the 99 endoscopists included, 96.7% reported observing the duodenum based on their own individual methods. The intentional observation rates by location were highest in the following order: bulb (99%), ampulla in descending (94%), contralateral ampulla in descending (84%), superior duodenal angle (77%), contralateral superior duodenal angle (79%), and transverse duodenum (33%). However, only 14% of respondents reported successfully observing the ampulla in more than 75% of cases. While 62% were aware of the 7 PR, only one-fourth had implemented it in practice. Notably, 43% of respondents familiar with the 7 PR felt that it had led to an increased detection of duodenal neoplasms. CONCLUSIONS: Current duodenal observation practices vary among endoscopists. The establishment of a systematic photo-documentation protocol such as the 7 PR may serve as a useful strategy for improving the detection of duodenal neoplasms. Further optimisation of the protocol is warranted to support broader adoption in clinical settings.
Questionnaire Survey on the Current Status of Advanced Therapy for Inflammatory Bowel Disease in Asia.
Toya Y, Shiotani A, Ono S … +18 more , Saito Y, Sugimoto M, Naito Y, Nomura S, Handa O, Hisamatsu T, Fujishiro M, Matsuda T, Morita Y, Yahagi N, Chan FKL, Ang TL, Abdullah M, Tablante MC, Prachayakul V, Li B, Jung HY, Matsumoto T
Digestion · 2026 · PMID 41191538 · Publisher ↗
INTRODUCTION: The incidence of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is increasing rapidly worldwide. Although multiple advanced therapies are now available, select...
INTRODUCTION: The incidence of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is increasing rapidly worldwide. Although multiple advanced therapies are now available, selecting the optimal treatment remains challenging due to the expanding options and diverse healthcare systems. METHODS: We conducted a questionnaire survey among physicians in nine Asian countries prior to the 18th International Gastrointestinal Consensus Symposium (IGICS) to assess the current status of advanced therapies for IBD. The survey included questions regarding therapeutic agent selection, biomarkers, and imaging modalities for monitoring. RESULTS: Of the 210 respondents, 173 physicians treating IBD were analyzed. Anti-TNFα antibodies remain the most commonly selected advanced therapy for both UC and CD. Elderly patients with UC were more likely to receive anti-α4β7-integrin antibodies or anti-IL-12/23p40 monoclonal antibodies, reflecting safety considerations. Janus kinase inhibitors were used more frequently as a second-line option in severe cases. Comorbidities, drug costs, and lifestyle factors also influenced treatment choice. CRP is the most common biomarker used for monitoring, and endoscopy is the most frequently used imaging modality. CONCLUSION: This questionnaire survey revealed the current status of advanced therapies for IBD in nine Asian countries and regions. Region-specific evidence-based algorithms for selecting advanced therapies for IBD should be established.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe