Gastric antral vascular ectasia (GAVE) is a rare vascular lesion of the stomach with an overall prevalence of approximately 0.09%, accounting for up to 4% of severe acute gastrointestinal bleeding and 4–6% of non-variceal bleeding in cirrhotic patients. GAVE predominantly affects older adults, with the majority of patients diagnosed at age 60 years or older, and is strongly associated with liver cirrhosis, autoimmune conditions such as systemic sclerosis, and, as increasingly recognized, metabolic syndrome. Three interrelated pathogenic mechanisms have been proposed: mechanical injury from gastric dysmotility, hormonal and vasoactive mediator dysregulation involving hypergastrinemia and prostaglandin E2, and microvascular injury with compensatory neoangiogenesis. Clinically, GAVE most commonly presents as chronic iron deficiency anemia from occult blood loss rather than overt hemorrhage. Endoscopic phenotypes include the classic linear striped “watermelon stomach,” a diffuse punctate or “honeycomb” pattern more commonly seen in cirrhotic patients, and a nodular variant. Distinguishing GAVE from portal hypertensive gastropathy is critical, as their management strategies differ substantially. The histologic triad of vascular ectasia, fibromuscular hyperplasia, and intravascular fibrin thrombi is central to pathologic diagnosis. Intravascular fibrin thrombi, when present, are highly specific for GAVE; CD61 immunohistochemistry serves as a highly useful adjunct in equivocal cases, though its sensitivity is limited by the focal nature of thrombosis and biopsy sampling. Endoscopic therapy remains first-line, with argon plasma coagulation as the most extensively studied modality and radiofrequency ablation demonstrating promising efficacy with potentially lower recurrence rates in preliminary comparative studies. Pharmacologic therapies lack robust evidence, and antrectomy is reserved for refractory cases. This review synthesizes the current understanding of GAVE across its epidemiology, pathogenesis, clinical and endoscopic features, histopathology, differential diagnosis, and management.
Background: Biologic and small-molecule therapies have transformed inflammatory bowel disease (IBD) management, yet real-world evidence from the Gulf region remains limited. This study evaluated 12-month clinical, biochemical, and endoscopic outcomes among adults with moderate-to-severe Crohn’s disease (CD) or ulcerative colitis (UC) receiving advanced therapy in Bahrain. Material and Methods: This retrospective observational cohort included 122 patients who remained on the same biologic or small-molecule therapy for 12 months and underwent baseline and follow-up endoscopy. The primary outcome was clinical remission; secondary outcomes included corticosteroid-free status, endoscopic outcomes, IBD-related hospitalization and surgery, and biochemical changes. Results: Of the 122 patients, 95 (77.9%) had CD and 27 (22.1%) had UC. At 12 months, 49.2% achieved clinical remission, 60.7% were corticosteroid-free, and endoscopic response and remission were achieved in 62.3% and 49.2%, respectively. Significant improvements were observed in C-reactive protein, serum albumin, and fecal calprotectin (all p < 0.001). In exploratory, unadjusted analyses, clinical remission and corticosteroid-free status were more frequent with anti-TNF than with non-anti-TNF therapy, whereas endoscopic outcomes did not differ significantly. IBD-related hospitalization (40.2%) and surgery (28.7%) remained substantial. Conclusions: Among patients with moderate-to-severe IBD who remained on biologic or small-molecule therapy for 12 months, treatment was associated with meaningful clinical, biochemical, and endoscopic improvement. However, hospitalization and surgery remained substantial, and the treatment-completer design may have overestimated effectiveness relative to the broader population initiating therapy. These findings add real-world evidence from Bahrain and support larger prospective, multicenter studies with standardized outcomes and longer follow-up.
Mucinous adenocarcinoma (MAC) is a distinct colorectal cancer subtype characterized by specific clinicopathological and molecular features and a propensity for peritoneal dissemination. However, whether mucinous histology primarily represents a prognostic phenotype or independently modifies response to anticancer treatment remains uncertain. This critical narrative review evaluated the therapeutic significance of mucinous histology across localized and metastatic colon cancer. A structured PubMed/MEDLINE search was conducted from database inception through 14 September 2026 using MeSH terms and title/abstract keywords related to mucinous histology, colon or colorectal adenocarcinoma, and treatment-related outcomes. The primary search identified 2896 records and was supplemented by targeted searches and reference-list screening. Evidence was interpreted using a four-level framework distinguishing prognostic association, treatment-response association, differential treatment effect, and validated predictive biomarkers. In localized disease, available evidence supports a clinically meaningful benefit from adjuvant chemotherapy in stage III MAC, whereas evidence in stage II disease does not support treatment modification based on histology alone. In metastatic disease, historical cohorts report lower objective response to cytotoxic chemotherapy, but current evidence does not establish intrinsic MAC-specific chemotherapy resistance. Retrospective anti-VEGF and anti-EGFR studies provide treatment-response signals without demonstrating validated histology-specific predictive effects. In dMMR/MSI-H disease, immune-checkpoint blockade remains guided by molecular status rather than mucinous morphology. Peritoneal-predominant dissemination further complicates response assessment and interpretation of locoregional treatment outcomes. Current evidence does not support mucinous histology as a stand-alone predictive biomarker for treatment selection. MAC should instead be interpreted as a contextual clinicopathological modifier alongside disease stage, resectability, metastatic distribution, and validated molecular biomarkers.
Background: Pancreatic carcinomas are among the malignant tumours with the highest mortality and remain associated with an extremely poor prognosis. Early identification and surveillance of premalignant lesions, such as intraductal papillary mucinous neoplasms (IPMNs), are therefore of central importance for preventing malignant transformation. According to the revised Kyoto Guidelines, for small branch-duct IPMNs (BD-IPMNs) measuring less than 20 mm and lacking high-risk factors (“worrisome features”), regular diagnostic imaging is recommended. However, it remains unclear whether BD-IPMNs smaller than 10 mm carry a comparable risk of progression and therefore require monitoring at the same frequency. Methods: In this retrospective analysis, all patients who had undergone follow-up examinations for IPMN at St. Josef University Hospital Bochum between 1 January 2006 and 30 September 2025, were identified based on the coded ICD diagnoses K86.2 (“pancreatic cyst”) or D37.70 (“neoplasm of uncertain or unknown behaviour: pancreas”). Results: A total of 185 patients with BD-IPMN with a mean follow-up of 6.5 years and an average of 10 EUS examinations per patient were included in the final analysis. Overall, 37.8% developed at least one worrisome feature, whereas high-risk stigmata were rare (1.6%). Only one patient (0.5%) developed IPMN-associated pancreatic carcinoma during follow-up. Patients with BD-IPMNs <10 mm at initial EUS developed significantly fewer worrisome features compared with those measuring 10–20 mm (14.1% vs. 58.3%; p < 0.01). No patient in the <10 mm group developed high-risk stigmata. An initial size of 10–20 mm was associated with a 4.2-fold increased risk of developing worrisome features or high-risk stigmata compared with <10 mm lesions (adjusted OR 3.93). Surgical indications for pancreatic resection occurred significantly less frequently in patients with lesions <10 mm (8.1%) than in those with 10–20 mm (30.0%) (p < 0.01). Time to development of worrisome features was comparable between the <10 mm and 10–20 mm lesions (31.2 vs. 33.9 months). Conclusions: In summary, BD-IPMNs measuring <10 mm were associated with a markedly lower risk of developing worrisome features compared with larger lesions. Further large-scale studies are warranted to clarify whether prolonging surveillance intervals for small BD-IPMNs can be safely recommended.
Background/Objectives: Transanal irrigation (TAI) is an established bowel-emptying strategy for selected patients with bowel dysfunction, whereas evidence on Colon Hydrotherapy (CHT) in chronic gastrointestinal disorders remains limited. This pilot study characterized patients undergoing CHT within specialist gastroenterological care and prospectively evaluated gastrointestinal and extraintestinal symptoms, lifestyle modifications, concomitant treatments, and safety over 12 months. Methods: Consecutive adults with chronic gastrointestinal disorders, including Irritable Bowel Syndrome (IBS) and IBS-like disorders, underwent CHT within an individualized gastroenterological management pathway. Symptoms were assessed using a 44-item modified Gastrointestinal Symptom Rating Scale at baseline (T0), 7 days after the first CHT session (T1), and 12 months thereafter (T2). Longitudinal changes were analyzed using linear mixed-effects models. Results: Of 81 enrolled patients, 40 completed all assessments. Overall, 38/44 (86.4%) symptoms showed a significant time effect, predominantly between T0 and T1. Significant time effects were observed across gastrointestinal (14/16, 87.5%), general well-being and systemic (11/13, 84.6%), gynecological (5/6, 83.3%), and urological (8/9, 88.9%) domains. At T2, 36/44 (81.8%) symptoms remained significantly improved versus baseline. The greatest gastrointestinal improvements involved bloating, incomplete evacuation, straining, abdominal pain, hard stools, and reduced bowel movements. Fluid intake and alcohol consumption improved, while macrogol and glycerol suppositories use increased. No clinically significant CHT-related adverse events were observed or reported during the 120 documented CHT procedures performed in the 40 participants included in the longitudinal analysis. Among the remaining 41 enrolled participants, no procedure-related complications or problems were reported in routine clinical care, although a reliable total number of procedures and comparable procedure-level safety data were unavailable. Preliminary safety findings are encouraging, although available data do not allow definitive conclusions regarding the procedural safety of CHT. Conclusions: Symptom improvements were observed after 7 days and confirmed over 12 months in patients managed within an individualized, multimodal gastroenterological pathway that included CHT, pharmacological and dietary management, lifestyle modifications, and specialist follow-up. Although the uncontrolled pilot design and limited longitudinal sample preclude definitive conclusions regarding the specific contribution of CHT, the findings support further investigation of its potential role within integrated gastroenterological care. Controlled studies are warranted to confirm these preliminary observations.
