Antimicrobial peptides (AMPs) are small, cationic effectors of innate immunity that are central to gastrointestinal homeostasis and increasingly attractive as therapeutics for infection, inflammation, and malignancy. Produced by intestinal epithelial and immune cells, AMPs such as defensins and cathelicidins act as frontline regulators, responding to microbial cues through pattern-recognition receptors, shaping microbiota composition, reinforcing the mucosal barrier, and tuning the balance between pro-inflammatory and anti-inflammatory signalling. This review frames AMP biology around a central duality: The same peptides that defend the gut can, when dysregulated in concentration, location, or context, contribute to pathology, from the α-defensin deficiency that initiates ileal Crohn's disease to the concentration-dependent switch by which LL-37 turns from a wound-healing mediator into a tumour-promoting one. This duality dictates therapeutic strategy, favouring restoration where disease arises from deficiency and restraint where it arises from aberrant signalling. We examine the mechanistic basis of AMP action (membrane disruption, intracellular targeting, and receptor-mediated immunomodulation) and evaluate preclinical and clinical evidence across inflammatory bowel disease, enteric infection, and gastrointestinal cancers, drawing the recurring lesson that microbiological success rarely guarantees clinical benefit. Persistent barriers of proteolytic instability, narrow therapeutic windows, and manufacturing cost are increasingly addressed through convergent advances in artificial intelligence-guided peptide design, sequence stabilisation, gut-targeted and stimulus-responsive delivery, and engineered live biotherapeutics that produce peptides in situ. Together, these developments are transforming AMPs from endogenous immune mediators into next-generation precision therapeutics for gut disease-agents designed to be not merely potent, but deliverable, selective, and stable where needed most.
Small intestinal bacterial overgrowth (SIBO) has emerged as a potential contributor to gastrointestinal dysfunction and systemic inflammation in acute pancreatitis (AP). The recent study by Kumbar et al provides important prospective evidence demonstrating a substantially higher prevalence of SIBO among patients with AP than healthy controls and identifies several clinical variables associated with bacterial overgrowth. Rather than reiterating the methodological limitations acknowledged by the authors, we discuss how these findings fit within the evolving understanding of the gut-pancreas axis and highlight emerging opportunities for precision microbiome research in AP. Particular attention is given to intestinal methanogen overgrowth, a biologically distinct entity that may influence intestinal motility, disease phenotype, and therapeutic response. We further outline future research priorities, including longitudinal microbiome profiling, integration of microbial biomarkers with clinical severity indices, and phenotype-directed therapeutic strategies. These perspectives extend the clinical implications of the index study and underscore the need to move beyond prevalence estimates toward mechanistic and translational investigations that clarify the causal role of microbial dysbiosis in AP.
In this issue recently published in the World Journal of Gastrointestinal Pharmacology and Therapeutics, Leung et al present data that challenge a long-standing recommendation in microscopic colitis (MC): Routine bilateral colonic biopsies. In a large cohort of treatment-naïve patients, right-sided biopsies demonstrated a diagnostic yield of 100%, whereas left-sided biopsies were less sensitive (92%) and never independently diagnostic in this cohort when right-sided samples were available. These findings invite reconsideration of established biopsy protocols, particularly in light of value-based care and green endoscopy principles. This article examines the evidentiary basis of current guidelines, explores the implications for efficiency and sustainability, and calls for evidence-guided refinement of MC biopsy recommendations.
BACKGROUND:A clinically relevant subset of patients with inflammatory bowel disease (IBD) remain partial responders despite multiple advanced therapies. In this setting, reflexive class switching risks forfeiting incremental mechanistic gains, whereas a deliberate "build-on-partial-response" strategy - through dose optimization, extended induction, and, in selected cases, advanced combination therapy (ACT) [an oral Janus kinase inhibitor (iJAK) plus a biologic] - may consolidate disease control. However, real-world data supporting ACT remain limited, particularly regarding phenotype-driven selection, objective reassessment, and safety considerations. CASE SUMMARY:We report nine multi-refractory IBD patients [ulcerative colitis (UC), n = 5; Crohn's disease, n = 4] managed with ACT after incomplete response to an initial advanced therapy. UC strategies included infliximab plus tofacitinib, ustekinumab plus tofacitinib, and vedolizumab combined with iJAK. Crohn's disease cases illustrate three patterns: Add-on anti-tumor necrosis factor therapy after partial iJAK response (e.g., upadacitinib plus adalimumab in two patients with stenosing or perianal phenotypes), interleukin-23 pathway intensification combined with iJAK (guselkumab plus tofacitinib), and phenotype discordance between extraintestinal and luminal disease control. Overall, 8/9 patients (89%) achieved clinical response with improvement in biochemical markers and/or endoscopic findings; among these, 6/9 (67%) achieved documented deep remission (clinical and biochemical, with endoscopic confirmation in 5/6). One patient with severe refractory UC failed ustekinumab plus tofacitinib and infliximab rescue and proceeded to colectomy with ileal pouch construction (11%). Patients did not present any adverse event associated with therapy, only secondary to uncontrolled disease. CONCLUSION:In multi-refractory IBD, add-on ACT may convert partial response into deep remission, averting surgery in selected patients.
The development of colonoscopy technology aims to enhance diagnostic accuracy while speeding up procedures, improving patient comfort, and addressing the technical limitations of standard endoscopy. The latest technological advancements include robotic and manually assistive systems, which provide better navigation, real-time feedback, and automated capabilities. This review compares the current status of manual and robotic assistive devices in colonoscopy, including their underlying mechanisms, clinical performance, and adoption status. A narrative review of the literature was conducted, examining commercially available and investigational devices that enhance colonoscope navigation, reduce patient discomfort, and automate endoluminal procedures. The devices were classified into two groups: Manual assistive systems (ScopeGuide, Third Eye Retroscope, NaviAid) and robotic platforms (Endotics, NeoGuide, Invendoscope, Aer-O-Scope). The clinical performance was evaluated by cecal intubation rates (CIR), adenoma detection rates (ADR), procedural times, and complication profiles. Manual assistive systems showed gradual improvements in loop reduction, retroflexion, and positional feedback with CIRs ranging from 93% to 100% and variable ADR outcomes depending on operator training and use patterns. The robotic colonoscopes showed CIRs ranging from 82% to 98%, and some platforms (Endotics and Aer-O-Scope) achieved reduced patient discomfort and minimal sedation use. Several devices have received Food and Drug Administration and European Conformity clearances, but their adoption remains limited because of their high costs, technical complexity, and insufficient large-scale validation. Also, the available evidence is limited by heterogeneity and the predominance of small, early-stage studies. Overall, the integration of robotic and manually assistive devices in colonoscopy shows promise as they may provide better ergonomics, reduced pain, and potential quality metric improvements. These findings suggest potential benefits in improving colorectal cancer detection, patient comfort, and procedural accessibility. However, despite technological advances, conventional colonoscopy remains highly effective, while current robotic platforms are limited by high costs and a lack of clear superiority, contributing to their restricted clinical adoption. The future development should concentrate on real-world usability, device standardization, and head-to-head comparative trials to validate clinical value. Ultimately, widespread adoption will require clear clinical benefit and economic justification beyond current standards.
Nor-ursodeoxycholic acid (nor-UDCA) is a side-chain shortened analogue of ursodeoxycholic acid (UDCA). Because of its biochemical modification, it is resistant to amidation. Nor-UDCA undergoes cholehepatic shunt, leading to increased bicarbonate secretion. In addition, it has shown potential antifibrotic activity in the animal model of cholestasis and fibrosis. Nor-UDCA has several advantages over UDCA in its pharmacokinetic and pharmacodynamic properties. However, its safety and efficacy data on cholestatic diseases are largely extrapolated from pre-clinical animal studies. Vitamin E, resmetirom, peroxisome proliferator-activated receptor agonists, and incretin-based therapies dominate the pharmacotherapeutic armamentarium for metabolic dysfunction-associated steatotic liver disease or steatohepatitis. Recently, nor-UDCA has been evaluated in patients with metabolic dysfunction-associated steatotic liver disease with conflicting therapeutic benefits and a controversial trial endpoint. This comprehensive narrative review focuses on its novel mechanism of action, comparison with UDCA, and underscores the limited evidence of its safety and efficacy in various hepatobiliary diseases. This review also discusses future research prospects of nor-UDCA in hepato-biliary diseases, which addresses the research gap in existing literature.
Despite major advances in inflammatory bowel disease (IBD) therapeutics, secondary loss of response remains a persistent clinical challenge. Upadacitinib, a selective Janus kinase-1 inhibitor, has demonstrated efficacy in both ulcerative colitis and Crohn's disease; however, real-world patients frequently experience declining response during maintenance therapy. In this editorial, we discuss the findings of Ellington et al, who evaluated upadacitinib dose re-escalation to 45 mg daily in patients with refractory IBD and secondary loss of response. In their retrospective single-center cohort study involving 56 heavily treatment-experienced patients, dose escalation was associated with significant improvement in abdominal pain, hematochezia, urgency, and diarrhea, along with reduced corticosteroid exposure and favorable treatment durability. Objective inflammatory markers and endoscopic outcomes improved numerically but did not achieve statistical significance. These findings highlight the growing importance of individualized therapeutic optimization in IBD management while also underscoring the need for careful patient selection, long-term safety monitoring, and prospective comparative studies. Although current evidence remains preliminary, upadacitinib dose escalation may represent a pragmatic rescue strategy for selected patients with refractory disease.
BACKGROUND:Endoscopy and colonoscopy are gastrointestinal procedures which are frequently performed in diagnosing conditions like gastrointestinal inflammatory disorders, strictures, or malignancy. Sedation in these procedures is necessary for patient comfort and successful completion of the procedure, especially in elderly people. This meta-analysis compares the efficacy and safety profiles of two commonly used sedatives, propofol and remimazolam, a new agent with a potentially safer profile. AIM:To compare the efficacy and safety profiles of two commonly used sedatives in the elderly population, propofol and remimazolam, a new agent with a potentially safer profile. METHODS:PubMed, Google Scholar, and Cochrane Library databases were searched from inception until 2025 to identify studies comparing remimazolam to propofol in elderly patients undergoing gastrointestinal endoscopic procedures. Statistical analyses were performed using RevMan with a random-effects model. Heterogeneity was assessed using the I 2 test. RESULTS:Our study involved 10 randomized controlled trials with a total of 1994 patients, 997 (50.0%) of whom were in the remimazolam group and 997 (50.0%) were in the propofol group. Hypotension, the primary outcome, occurred significantly less often in patients receiving remimazolam (risk ratio = 0.48, 95% confidence interval: 0.38-0.61; P < 0.00001; I 2 = 52%). Other outcomes, including bradycardia, respiratory depression, and pain at the injection site, were also significantly lower with remimazolam. No significant difference was found between the groups in terms of nausea and vomiting and time to recovery outcome. CONCLUSION:Remimazolam appears to be a safer alternative to propofol for elderly patients undergoing gastrointestinal endoscopy. Remimazolam was associated with a lower incidence of hypotension, bradycardia, respiratory depression, and injection-site pain. The recovery time and incidence of nausea and vomiting were similar after administration of either drug. Further high-quality trials are warranted to confirm these findings.
Emerging microbial discoveries have transformed infectious-disease science, yet detection alone does not equate to pathogenicity. Human health is mediated by complex microbiomes, and dysbiosis can convert commensals into opportunists, a concept captured by the "pathobiome". Across infectious-disease literature, gaps remain in integrating ecological context, host response, longitudinal data, and one-health perspectives. Misinterpretation of culture or sequencing results drives antimicrobial misuse, resistance, and ecological harm. We propose an eight-principle framework to distinguish pathogen from non-pathogen: (1) Clinical localization; (2) Temporal host response; (3) Exclusion of alternative sources; (4) Ecological context; (5) Host susceptibility; (6) Contamination assessment; (7) Transparent reporting of methods and quantitative thresholds; and (8) Ethical use of diagnostic technology. Adoption of this framework to any specialty, including gut, promotes accurate infection identification, stewardship, and transparency. Expanding perspective from the individual microbiome to planetary health, this approach aligns discovery with ecological and ethical responsibility, transforming infectious-disease practice from reactionary treatment to preservation of microbial harmony.
Open abdomen management poses unique challenges in resource-limited settings, where costly dynamic fascial traction techniques remain inaccessible. Balhara et al's prospective randomized trial published on the World J Gastrointest Pharmacol Ther introduces serial Bogota bag tightening, a bedside, negligible-cost method using urine bags and sutures, as an effective dynamic fascial traction alternative, achieving skin-to-skin distance ≤ 5 cm in 9.94 days vs 13 days in controls (P = 0.0003) and shortening hospital stays without added morbidity. This editorial appraises the study's strengths, contextualizes it against negative pressure wound therapy/mesh systems, and advocates its scalability for low- and middle-income countries, urging multicenter validation of long-term fascial closure.
BACKGROUND:The therapeutic landscape for unresectable hepatocellular carcinoma (HCC) has evolved with the advent of combinations of immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI). However, the absence of direct comparisons in clinical trials makes it challenging to determine their relative efficacy. AIM:To explore the comparison between ICI and TKI in combination therapy and determine the relative efficacy. METHODS:We conducted a PubMed database search from inception to January 2026, selecting all first-line regimens supported by a randomized controlled trial (RCT). Overall survival (OS) was the endpoint. A series of indirect comparisons was performed across the selected regimens. To conduct our analysis, individual patient data (IPD) were reconstructed from Kaplan-Meier curves. Survival was assessed by the Cox univariate model. Hazard ratio (HR) and restricted mean survival time (RMST) were estimated. Heterogeneity between the sorafenib and lenvatinib control arms was assessed in two separate analyses. RESULTS:Based on our PubMed search, eight RCTs were included. Most combinations compared with sorafenib significantly improved OS, with camrelizumab plus rivoceranib showing the most favourable HR. This was followed by atezolizumab plus bevacizumab, tremelimumab plus durvalumab, toripalimab plus bevacizumab and anlotinib plus penpulimab. Cabozantinib plus atezolizumab did not demonstrate a clear benefit. Camrelizumab plus rivoceranib was superior to tremelimumab plus durvalumab (HR = 0.78; 95%CI: 0.61-0.99) and anlotinib plus penpulimab (HR = 0.73; 95%CI: 0.57-0.93). Compared with lenvatinib, nivolumab plus ipilimumab and pembrolizumab plus lenvatinib yielded modest improvements, with no significant difference between the two. RMST analyses suggested that nivolumab plus ipilimumab, lenvatinib and pembrolizumab plus lenvatinib produced similar results to those of camrelizumab plus rivoceranib. The choice of comparator meaningfully shapes the estimated treatment effect. CONCLUSION:Our study compared the efficacy of the main first-line treatments recommended for unresectable HCC. While we were able to rank the magnitude of efficacy across these treatments, the intrinsic limitations of our methods (primarily the reconstruction of IPD and the indirect nature of the treatment comparisons) should be borne in mind.
We read the paper published in World Journal of Gastroenterology by Yang et al on how Bifidobacterium species alleviate colitis by modulating deoxycholic acid (DCA) levels and macrophage polarization, which provides important insights into the microbiome-immune axis. However, the classic M1/M2 polarization model oversimplifies the plasticity of macrophages and fails to account for the spatial heterogeneity of the intestinal microenvironment. Therefore, we propose integrating spatial transcriptomics and spatial metabolomics to resolve the intricate correlations between DCA distribution and specific macrophage subsets. Building upon this, we further discuss the transition from broad-spectrum probiotic supplementation to mechanism-driven precision probiotic strategies, emphasizing the future need to develop engineered strains capable of spatial awareness and metabolic pathway remodeling. This spatial multiomics-guided precision intervention framework holds promise for advancing colitis treatment toward approaches with greater mechanistic depth.
BACKGROUND:Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), is a chronic relapsing condition in which surgical intervention remains a cornerstone of management despite advances in medical therapy. Surgery plays a definitive role in UC and a complication-directed, bowel-preserving role in CD. AIM:To provide a comprehensive narrative overview of contemporary surgical management in IBD, focusing on indications, operative strategies, perioperative optimization, postoperative outcomes, and future directions. METHODS:A narrative review was conducted following the principles of the PRISMA 2009 guidelines. A comprehensive literature search of PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library was performed for studies published between January 2000 and December 2024. Relevant original studies, systematic reviews, and meta-analyses addressing surgical interventions in adult IBD patients were included. Evidence was synthesized descriptively. RESULTS:Surgical indications in UC include medically refractory disease, dysplasia or malignancy, and life-threatening complications, with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) representing the standard elective procedure. In CD, surgery is primarily indicated for fibrostenotic and penetrating complications, with emphasis on bowel-sparing approaches such as limited resection and strictureplasty. Minimally invasive and robotic techniques have demonstrated favorable short-term outcomes without compromising long-term results. Perioperative optimization-including nutritional support, steroid minimization, and appropriate integration of biologic therapy-plays a critical role in reducing complications. Postoperative recurrence in CD and pouch-related disorders following IPAA remain major challenges, requiring structured surveillance and multidisciplinary care. CONCLUSION:Surgery continues to play a vital and evolving role in the management of IBD. Advances in surgical techniques, perioperative care, and integration with medical therapy have improved outcomes and quality of life. Optimal results depend on individualized decision-making within a multidisciplinary framework, with ongoing research needed to refine strategies for recurrence prevention and long-term functional preservation.
Short bowel syndrome represents a severe form of intestinal failure characterized by malabsorption and dependence on parenteral nutrition (PN). Advances in gut hormone research have positioned glucagon-like peptide-2 (GLP-2) and its analogues as key pharmacologic agents promoting intestinal adaptation and reducing PN dependence. This minireview summarizes current evidence on the mechanisms, clinical efficacy, and expanding therapeutic applications of GLP-2 analogues, with emphasis on emerging agents such as glepaglutide and their safety profiles. GLP-2, a 33-amino acid peptide secreted by enteroendocrine L cells, enhances mucosal growth, nutrient absorption, and intestinal barrier integrity through activation of cyclic adenosine monophosphate-dependent and insulin-like growth factor-1-mediated pathways. Clinical trials have demonstrated that teduglutide and newer long-acting analogues such as glepaglutide significantly increase plasma citrulline levels, reduce fecal output, and decrease PN requirements while improving hepatic function and quality of life. Additionally, preclinical and clinical data support GLP-2's anti-inflammatory effects in inflammatory bowel disease and its potential to mitigate intestinal failure-associated liver disease. Although current evidence indicates low neoplastic risk, long-term safety monitoring remains essential. GLP-2 analogues represent a paradigm shift in short bowel syndrome management, transforming care from supportive nutrition to regenerative therapy. Ongoing studies exploring novel formulations, broader indications, and precision medicine approaches will further refine their clinical integration and maximize therapeutic benefit.
Inflammatory bowel disease (IBD) is a group of chronic recurrent disorders, Crohn's disease and ulcerative colitis being its two major types. IBD patients require continuous lifetime monitoring of disease activity and effects of therapeutic interventions, achievement of stable remission being the goal of the current 'treat-to-target' strategy. This review considers a wide range of approaches applied for this purpose. Although ileocolonoscopy combined with histological evaluation and now employing modern endoscopic techniques is still regarded as the gold diagnostic standard, its inability of visualizing small intestine is a limitation. Alternative non-invasive techniques such as capsule endoscopy and, especially, cross-sectional imaging, comprising computed tomography enterography, magnetic resonance enterography, and intestinal ultrasound, are becoming increasingly popular. In addition, the use of molecular biomarkers detectable in human body fluids is a rapidly developing area, and recent rapid progress in gut microbiome research promises to add a new dimension to it. It is also anticipated that new approaches based upon multi-omics can identify new composite biomarkers useful for IBD monitoring. Artificial intelligence-driven integration of abundant information provided by various diagnostic and analytical modalities outlined in this review may help in transforming the current 'one-size-fits-all' treatment paradigm into a truly personalized model of IBD care.
BACKGROUND:Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and often coexists with obstructive sleep apnea (OSA). Emerging evidence suggests that OSA may independently accelerate liver injury in MASLD. Despite this the epidemiology and clinical significance of OSA within the population with MASLD remain incompletely understood. AIM:To estimate the prevalence of OSA among MASLD and determine the impact of OSA on hepatic complications. METHODS:This was a large, multicenter, population-based retrospective cohort study conducted using the TriNetX Global Health Research Network from 2010 to 2024. We identified adults with MASLD with International Classification of Diseases, Tenth Revision codes and propensity score matched (PSM) them 1:1 with adults without MASLD. Patients with any record of prior liver disease other than MASLD or OSA (G47.3x) before the MASLD index date were excluded from the study. RESULTS:After PSM there were 364283 pairs analyzed with balanced covariates. From 2010-2024 OSA incidence and prevalence in MASLD increased more than 400-fold (P < 0.001). MASLD was associated with 54% higher odds of OSA vs matched controls (odds ratio: 1.54), and patients with MASLD developed OSA earlier (median 189 days vs 358 days; P < 0.001). OSA markedly worsened hepatic outcomes. The odds of fibrosis were 1.78-fold higher at 1 year and 2.12-fold higher at 10 years while cirrhosis risk was 50%-55% higher at the 1-year and 10-year follow-ups (P < 0.001). Independent predictors of OSA in MASLD included male sex, obesity, older age, hypertension, and nicotine dependence. CONCLUSION:MASLD was associated with a significantly higher risk of OSA, and coexisting OSA substantially amplified long-term hepatic complications. In addition, MASLD was associated with an earlier onset of OSA, highlighting the need for integrated hepatology-sleep medicine approaches and early identification and treatment of OSA in MASLD cohort may prevent the development of complications such as hepatic fibrosis and cirrhosis.
Oesophageal squamous cell carcinoma (ESCC) remains a significant global health challenge due to its aggressive nature and poor prognosis. Recent advances in immunotherapy, particularly immune checkpoint inhibitors (ICIs), have revolutionized treatment paradigms. This review comprehensively examines the molecular pathogenesis of ESCC, highlighting key oncogenic pathways and immune evasion mechanisms. Furthermore, it explores the evolving landscape of biomarkers and predictive models for ICI response, emphasizing the critical role of precision immunotherapy in tailoring treatment strategies. A deeper understanding of these molecular and immunological underpinnings is essential for optimizing patient selection, overcoming resistance, and ultimately enhancing therapeutic efficacy in ESCC.
BACKGROUND:Stoma reversal is often considered a low-risk elective procedure; however, postoperative morbidity remains clinically significant. Evidence identifying predictors of meaningful complications, particularly from resource-limited settings, is limited. AIM:To identify risk factors associated with Clavien-Dindo grade II and above complications following stoma reversal surgery. METHODS:This prospective analytical study was conducted at a tertiary care center between February 2024 and June 2025. Adult patients undergoing elective stoma reversal were included and followed for 30 days postoperatively. Demographic, clinical, and operative variables-including age, etiology, type of index surgery, timing of reversal, type of anastomosis, and anastomosis time-were analyzed. Postoperative complications were graded using the Clavien-Dindo classification. Secondary outcomes included postoperative ileus and length of hospital stay. RESULTS:Clinically significant complications were observed in a substantial proportion of patients. Advanced age and longer anastomosis time were significantly associated with Clavien-Dindo grade ≥ II complications, postoperative ileus, and prolonged hospital stay. In contrast, type of stoma and anastomotic technique were not independent predictors of high-grade complications. CONCLUSION:Stoma reversal carries a measurable risk of morbidity and should not be regarded as a minor procedure. Patient-related factors and operative complexity play a greater role in determining outcomes than technical variations alone. Careful patient selection, preoperative optimization, and strategies to minimize anastomosis time are essential to improve postoperative outcomes.
BACKGROUND:Acute pancreatitis (AP) is associated with intestinal dysmotility, barrier dysfunction, and dysbiosis, which may increase the risk of small intestinal bacterial overgrowth (SIBO). Evidence on the prevalence of SIBO in AP and its clinical correlates is limited. AIM:To evaluate the frequency of SIBO in patients with AP and identify the clinical, laboratory, and imaging predictors of SIBO. METHODS:This hospital-based case-control study was conducted at a tertiary gastroenterology unit in New Delhi, India, from December 2022 to June 2024. Consecutive adults with AP were enrolled as cases, and age- and sex-matched healthy controls (HCs) were included. The glucose hydrogen breath test was used for the diagnosis of SIBO. The predictors of SIBO were examined. RESULTS:In total, 30 cases and 60 HC were included in the study. SIBO was detected in 12 (40.0%) cases, significantly higher than in HC (1.7%) (P < 0.001). SIBO occurred more frequently in severe AP [4 (100%)] than in moderate-severe AP [6 (75%)] and mild AP [2 (11.1%)] (P = 0.001). Predominant methane producers were more common among AP cases than among HC [12 (40.0%) vs 8 (13.3%); P = 0.004]. Univariate analysis revealed that factors such as abdominal bloating, obstipation, severe pancreatitis, ileus, systemic inflammatory response syndrome, acute necrotic collection, higher computed tomography severity index score, higher neutrophil-lymphocyte ratio, higher creatinine, and elevated high-sensitivity C-reactive protein were associated with SIBO. CONCLUSION:SIBO was frequent in AP and was strongly associated with disease severity. Larger prospective studies are required to determine whether identifying and treating SIBO can improve clinical outcomes in AP.
BACKGROUND:Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent worldwide. Experimental studies have shown that cholecystectomy (Chx) increases metabolic dysfunction-associated steatotic liver (MASL) and is associated with MASLD in large retrospective cohort studies. AIM:To prospectively evaluate the effect of Chx on MASL and fibrosis, assess the prevalence of MASLD, and identify its risk factors in this population. METHODS:There were 213 MASLD patients enrolled, with 103 being Chx and 110 being non-Chx patients. The patients were followed up for 36 months. RESULTS:Body mass index increased in the Chx group (30.15 ± 4.08 to 31.58 ± 4.64) vs (31.90 ± 4.07 to 30.03 ± 4.16) in the control group (P < 0.001). Median controlled attenuation parameter increased from 300.77 ± 47.42 to 314.17 ± 44.7 (Chx) and decreased from 325.06 ± 41.74 to 296.36 ± 56.51 (control) (P < 0.01). MASL/magnetic resonance imaging (MRI) moved from 14.22 ± 8.64 and 18.55 ± 8.57 at baseline to 15.98 ± 7.93 and 13.88 ± 8.12 at the end of the study (P < 0.001). The biological scores of MASL (fatty liver index, hepatic steatosis index, and lipid accumulation product) all progressed in the Chx group and regressed in the control group (P < 0.001). The prevalence of hepatic steatosis was 42.38% (Chx). Risk factors associated with significant hepatic steatosis were metabolic syndrome, Chx, MASL/MRI, and fatty liver index scores. Risk factors associated with advanced fibrosis are body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score, stiffness, and Chx. Stiffness, obesity, Chx, gamma-glutamyl transferase, and MASL/MRI are associated with metabolic dysfunction-associated steatohepatitis (MASH) lesions. CONCLUSION:Chx increases MASL and fibrosis. MASLD prevalence in the Chx group is higher than in the overall population.
