Aims:The impact of teaching patients with irritable bowel syndrome (IBS) a FODMAP diet on eating behaviors is unknown. We aimed to ascertain disordered eating behaviors and their relationships to current dietary intake and clinical status many years after FODMAP education. Methods and Results:Patients with IBS educated on a FODMAP diet by a gastrointestinal dietitian mean 7.1 (range 2.5-13.4) years prior were cross-sectionally evaluated for current eating behaviors utilizing multiple risk tools, mental health (Depression Anxiety Stress Scales), gastrointestinal symptoms (IBS-SSS), overall, food-related quality of life and dietary intake (Complete Nutritional Assessment Questionnaire), and retrospective analysis of documented mental health conditions. Of 74 participants (84% women, median age 59 (IQR 47-67) years), disordered eating behaviors were identified in 38% by the risk tools comprising Eating Attitudes Test (EAT)-26 in 7%, Nine Item ARFID screen (NIAS) in 24%, ORTO-7 for orthorexia in 21%. While these behaviors were associated with reduced overall and food-related quality of life, multivariable regression analyses identified only psychological distress and symptom severity as independent predictors of ARFID and orthorexia risk. Self-perceived eating pattern (strict low-FODMAP, personalized-FODMAP or habitual diets), level of measured FODMAP intake, or time since dietary education were not related to disordered eating behaviors. No new diagnoses or exacerbation of eating disorders were observed since dietary education. Conclusion:Disordered eating behaviors are commonly present in long-term follow-up of patients with IBS after FODMAP dietary education, but these are related to psychological distress and symptom burden, not to specific dietary effects associated with such education.
This narrative review provides an overview of progress in the development of obesity medications, including a synthesis of data describing the efficacy and safety of currently available agents and emerging therapeutic options. Historically, many obesity medications have been withdrawn from the market due to safety concerns. However, expansion in scientific knowledge of the mechanisms regulating appetite and energy balance has led to the development of medications with greater safety and efficacy. The current generation of injectable incretin analogs, semaglutide and tirzepatide, is associated with mean weight loss in the range of 15%-20% over approximately 12-18 months. These agents confer additional substantial cardiometabolic benefits, including reductions in adverse cardiovascular and kidney outcomes, and improvements in glycaemia, blood pressure, lipid profile and steatohepatitis. As therapeutic options continue to expand, obesity medications are poised to play a critical role in the management of cardiometabolic disease.
Objective:To investigate whether the neutrophil percentage-to-albumin ratio (NPAR) predicts 28- and 365-day mortality in ICU patients with acute pancreatitis (AP) and improves the performance of existing ICU scoring systems. Methods:We extracted data on 437 ICU AP patients from the MIMIC-IV 3.0 database. Selection bias was assessed by comparing included and excluded patients. The optimal NPAR cutoff was determined by maximally selected rank statistics. Kaplan-Meier and Cox regression assessed the NPAR-mortality association, with 200-iteration bootstrap resampling for internal validation. Time-dependent AUC, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated whether adding NPAR to SAPS II, SOFA, and SIRS improved prediction. Results:The optimal NPAR cutoff was 34.6. Included patients had more severe disease than excluded patients (SOFA 6.75 vs. 5.32; 28-day mortality 17.4% vs. 11.8%). High NPAR (≥ 34.6) was significantly associated with lower survival (log-rank p < 0.001) and independently predicted 28-day mortality (HR = 2.043, 95% CI 1.235-3.380, p = 0.005) and 365-day mortality (HR = 1.749, 95% CI 1.174-2.606, p = 0.006). After bootstrap validation, optimism-corrected HRs were 1.820 and 1.560, with corrected AUCs of 0.765 and 0.695, respectively. Adding NPAR to SIRS significantly improved AUC (28-day: 0.613 vs. 0.529, p = 0.011; 365-day: 0.580 vs. 0.507, p = 0.004), NRI, and IDI (all p < 0.05), whereas adding NPAR to SAPS II or SOFA yielded no significant improvement (all p > 0.05). Conclusion:NPAR ≥ 34.6 is an independent predictor of 28- and 365-day mortality in ICU AP patients, with robust internal validation. Combining NPAR with SIRS significantly enhances mortality prediction.
Background:Pseudoachalasia closely mimics idiopathic achalasia in both symptoms and high-resolution manometry (HRM) findings, making accurate diagnosis difficult. This study aimed to clarify the clinical characteristics of pseudoachalasia encountered at our institution and identify novel manometric findings specific to this condition. Methods:This single-center retrospective study compared the clinical characteristics and HRM findings of patients diagnosed with pseudoachalasia (pseudoachalasia group) with those diagnosed with idiopathic achalasia or esophagogastric junction outflow obstruction (EGJOO), collectively defined as the idiopathic achalasia group, between April 2015 and March 2024. Pseudoachalasia was defined as cases with no mucosal abnormalities on the initial endoscopic examination, and with clinical symptoms, esophagographic findings, and HRM results consistent with achalasia. Results:Five patients were diagnosed with pseudoachalasia. Two cases were classified as Type 2 achalasia and three as EGJOO according to the Chicago Classification. Compared with the idiopathic achalasia group, the pseudoachalasia group was older, had a shorter symptom-to-diagnosis interval, and exhibited higher Eckardt scores. HRM demonstrated significantly higher integrated relaxation pressure (IRP) in the pseudoachalasia group. Loss of Respiratory Variation in LES Pressure (LRV-LES) was observed in all patients in the pseudoachalasia group, whereas it was present in 8.3% of patients in the idiopathic achalasia group. Conclusion:Pseudoachalasia was characterized by an older age at onset, a shorter interval from symptom onset to diagnosis, and higher Eckardt scores. HRM demonstrated elevated IRP, and LRV-LES was observed in all cases. LRV-LES may represent a novel manometric finding that can aid in the diagnosis of pseudoachalasia.
Background:Despite limited extent, patients with ulcerative proctitis (UP) can suffer from debilitating symptoms, complications, and risk of disease extension. The aim was to provide a contemporary real-world insight into the management and outcomes of UP. Methods:A retrospective cohort study was conducted of UP patients attending three tertiary hospitals in Adelaide, South Australia, between 2015 and 2024. Demographic, treatment, and disease-related data were captured. Treatment success was defined as clinical response at last follow up. The primary outcome was the development of disease-related complications. Results:Of 185 patients with UP, 60.5% were female, mean age at diagnosis was 41.1 years (±14.2) and median duration of follow up was 4.18 years (IQR 2.0-7.3 years). Most patients (n = 114, 62.3%) achieved treatment success with 5-ASA therapy, but one third (n = 56, 30.3%) developed refractory UP. For those with refractory UP, treatment success was achieved in 45% of patients using systemic immunomodulators (n = 40) and in 59% using advanced therapies (n = 27). Topical tacrolimus was used in 10 patients, of whom three achieved treatment success. Overall, 34 patients (18.4%) developed either proximal disease extension (n = 22, 11.9%) or traditional UC related complications including hospitalization (n = 15, 8.1%) and colectomy (n = 1, 0.05%). The presence of refractory UP was associated with development of traditional UC related complications (p < 0.0001). Conclusion:Despite a short segment of inflammation, UP remains a clinical conundrum as many patients develop refractory disease, disease extension, and complications. Further prospective studies are required to define optimal therapeutic strategies for this under-recognized cohort.
With the consumption of protein consumption increasing globally, there are gaps in our understanding of the differences in protein sources, particularly between animal and plant proteins and their recommendations for patients with Inflammatory Bowel Disease (IBD). This narrative review synthesizes current evidence of how animal and plant proteins differentially exert physiological effects, influence IBD risk, and outcomes. First, protein sources vary in their amino acid profiles, co-existence with other nutrients and consumption within a dietary pattern, factors that influence their physiological effects. Second, observational data showed possible associations between higher intake of animal protein and risk of Ulcerative Colitis (UC); however, this association is less consistent with Crohn's Disease (CD). High intake of meat, specifically red meat, is also associated with a greater risk for a UC relapse. Third, specific animal proteins are utilized as part of efficacious strategies for the induction and maintenance of CD. In conclusion, the available data suggest that recommendations for the IBD patient should move beyond animal versus plant protein advice but consider individual protein sources and the wider dietary pattern.
ABSTRACT Aims To examine how nursing‐led support may influence engagement, continuity, adherence, retention, and protocol enactment across the standard care–clinical trial–standard care pathway in individuals with inflammatory bowel disease (IBD). Methods and Results This focused narrative review used selected realist‐informed interpretive principles as a conceptual lens to synthesize heterogeneous literature related to IBD clinical trials, specialist and clinical research nursing, placebo and nocebo processes, health literacy, teach‐back, telemonitoring, continuity of care, transitions, implementation, and intervention fidelity. Rather than conducting a formal realist review, realist concepts were used to inform the interpretation of how contextual factors, participant reasoning, and implementation conditions may influence nursing‐led support across the clinical trial pathway. Literature was identified through iterative searches in PubMed/MEDLINE, Scopus, and Google Scholar, complemented by backward and forward citation tracking. Five interrelated supportive functions emerged across the reviewed literature: expectation‐shaping during screening and enrolment; literacy‐sensitive education and teach‐back; structured hybrid contact and continuity support; transition‐sensitive assistance during trial entry, amendment, and exit phases; and governance strategies promoting role clarity, safety, and equity. Nursing‐led support appeared most relevant when it helped participants interpret uncertainty, understand protocol expectations, maintain continuity, and navigate vulnerable transitions. These functions may contribute to engagement, adherence, retention, and timely symptom reporting by strengthening trust, self‐efficacy, relational continuity, and adherence to practical protocols. Conclusion Nursing‐led support may represent a potential mechanism‐bearing component of IBD clinical trial participation rather than a purely administrative activity. Transition‐sensitive, literacy‐aware, and continuity‐oriented nursing strategies may support safer, more equitable, and more sustainable engagement across increasingly complex clinical trial pathways.
ABSTRACT Background Calcineurin inhibitors such as tacrolimus are established rescue therapies for steroid‐refractory ulcerative colitis (UC). However, their efficacy and safety as bridging or combination therapy following failure of both anti‐tumor necrosis factor (anti‐TNF) and Janus kinase (JAK) inhibitor therapy remain uncertain. Methods We conducted a retrospective, single‐center case series at a tertiary referral center between January 2020 and December 2025. Adult patients with treatment‐refractory UC who received tacrolimus after documented failure of infliximab and a JAK inhibitor were included. Demographic, disease, treatment, and outcome data were collected. Results Seven patients were included (median age, 37.1 years; median disease duration, 6 years), of whom three presented with acute severe UC. Tacrolimus was used as bridging therapy to ustekinumab ( n = 4), ozanimod ( n = 1), or upadacitinib ( n = 1), and as combination therapy with upadacitinib ( n = 1). Median tacrolimus treatment duration was 3 months, and median follow‐up was 31 months. Six of seven patients achieved a clinical response, including four who achieved clinical remission. Three patients ultimately required colectomy. No serious adverse events were observed; one patient developed tremor and one experienced mild COVID‐19 infection. Conclusion Tacrolimus may be a useful bridging or combination therapy in carefully selected patients with UC refractory to both infliximab and JAK inhibitors. Nevertheless, the substantial colectomy rate underscores the severity of disease in this population and highlights the importance of close monitoring and shared decision‐making. Larger prospective studies are needed to better define the optimal role, duration, and safety of tacrolimus in this treatment setting.
Background:Terminal ileitis is a common radiological finding in patients with abdominal pain and altered bowel habits. Although often associated with Crohn's disease (CD), it has a broad differential diagnosis including infectious, surgical, and malignant conditions. Prior studies suggest 20%-45% of terminal ileitis accounts for CD. This study aimed to evaluate the proportion of patients with computed tomography-detected (CT) terminal ileitis diagnosed with CD and to assess clinical and biochemical predictors. Methods:A retrospective cohort study was conducted at a single tertiary hospital between 2014 and 2024. Adult patients with CT findings of terminal ileitis were included. Data were collected on demographics, laboratory values, stool testing, and endoscopic evaluation. Multivariable logistic regression was used to identify predictors of CD. Results:Of 128 patients, 16 (12.5%) were diagnosed with CD. Infectious (27.7%) and surgical (17.9%) etiologies were the most common causes of non-CD terminal ileitis. Stool testing within 72 h was performed for 48.4% of patients, with 35.5% positive for pathogens. Endoscopic evaluation was performed in 59 patients (46%), and histopathological inflammation identified in 43.5% of biopsied cases. Lower albumin levels trended toward association with CD and were independently associated with CD on multivariable analysis (OR 0.82, 95% CI 0.72-0.94, p = 0.004). Conclusions:After evaluation, a small minority (12.5%) of patients with CT-detected terminal ileitis were diagnosed with CD. Hypoalbuminemia was a significant predictor of CD, whereas routine inflammatory markers had limited diagnostic value. Larger prospective studies are needed to further refine the diagnostic algorithms for detection of CD in patients with terminal ileitis.
ABSTRACT Aims This study aimed to assess current dietary patterns in adults with inflammatory bowel disease (IBD) in New Zealand and to evaluate associations with current self‐reported disease activity and well‐being. Methods A prospective online survey was conducted using validated dietary data collection instruments. Dietary patterns were derived using principal component analysis. Self‐reported current disease activity and health‐related quality of life (HRQoL) scores were ascertained. Relationships between diet patterns and other variables were assessed. Results The responses of 205 participants were included in the analysis: mean age 43.0 (±14.0) years, and a mean disease duration of 31.5 (±14.0) years. There were 107 (52%) people with Crohn's disease (CD) and 98 (48%) with ulcerative colitis/IBD‐unclassified (UC/IBDU). Six dietary patterns were identified among the cohort data: Western, vegetarian, pescatarian, semi‐vegetarian, semi‐pescatarian, and low‐carbohydrate. Consuming a Western dietary pattern was associated with active CD (adjusted odds ratio [AOR] = 4.55, 95% CI [1.27, 7.26], p = 0.02) or active UC/IBDU (AOR = 3.50, 95% CI [1.07, 5.40], p = 0.04). In contrast, people with CD following a vegetarian diet pattern were less likely to report active disease (AOR = 0.32, 95% CI [0.11, 0.98], p = 0.04). Adherence to a Western or semi‐pescatarian dietary pattern was predictive of worse HRQoL. Conclusions In this group of adults with IBD, vegetarian dietary patterns were associated with lower current CD activity but not UC/IBDU, while the Western dietary pattern was associated with higher disease activity and impaired HRQoL.
ABSTRACT Background This study evaluated the diagnostic performance of Golgi protein 73 (GP73), laminin‐γ2 monomer (LG2m), and the GLAS score in detecting advanced fibrosis in patients with metabolic dysfunction‐associated steatotic liver disease (MASLD). Methods This study included patients with MASLD who underwent liver biopsy. The performance of serum levels of GP73 and LG2m and the GLAS score to diagnose advanced fibrosis was evaluated using area under receiver operating characteristic curves (AUROC). Results The data for 209 patients with MASLD were analyzed [median age 52 (42–58) years, 53.1% men, 71.3% had steatohepatitis, 18.1% had advanced fibrosis]. The serum levels of GP73 and LG2m and the GLAS score were significantly higher in patients with advanced fibrosis compared to patients without advanced fibrosis [GP73: 83 ± 50 ng/mL vs. 61 ± 35 ng/mL, p = 0.013; LG2m: 31 (14–48) pg/mL vs. 17 (12–23) pg/mL, p < 0.001; GLAS score: 0.89 (0.49–0.97) vs. 0.47 (0.15–0.78), p < 0.001]. The AUROC of serum levels of GP73 and LG2m and GLAS for diagnosing advanced fibrosis was 0.63 (0.52–0.74), 0.73 (0.62–0.83), and 0.72 (0.61–0.82), respectively. Using the optimal cut‐off of 27 pg/mL, the sensitivity, specificity, positive predictive value, and negative predictive value of LG2m for diagnosing advanced fibrosis were 60.5%, 86.0%, 48.9%, and 90.7%, respectively. Using the optimal cut‐off of 0.75, the corresponding values for the GLAS score were 65.8%, 73.7%, 35.7%, and 90.6%, respectively. Conclusion Serum LG2m level and the GLAS score have fair accuracy for the diagnosis of advanced fibrosis in patients with MASLD.
ABSTRACT Aims This study investigated the prevalence of H elicobacter pylori infection and associated factors in children from households with members' history of successful H. pylori eradication. Methods A cross‐sectional study was conducted from February to December 2024 in Hanoi, Vietnam. Eligible households were those having lived together for at least 12 months, including at least one child under 16 years old and at least one member with successful H. pylori eradication. H. pylori infection status among family members was assessed using stool antigen testing. Data on household demographic characteristics, childcare practices, and infection status of family members were collected. Multivariable logistic regression was used to identify factors associated with infection in children. Results A total of 193 households with 877 members were included, including 338 children under 16 years old. The prevalence of H. pylori infection was 59% overall and 53% among children. Children living with both infected parents had a higher infection prevalence than those with only one infected parent (58% vs. 38.2%, p < 0.001), with a similar trend observed among infected siblings. After adjustment, parental infection status remained the strongest predictor of infection (aOR = 3.18; 95% CI: 1.83–5.52), while larger household size was inversely associated (aOR = 0.74; 95% CI: 0.58–0.93). Conclusions Children's infection risk increased according to the infection status of parents and siblings, while a higher number of family members was associated with a lower likelihood of infection, although this finding should be interpreted with caution, supporting the importance of household‐level transmission and family‐based prevention strategies in high‐prevalence settings.
ABSTRACT Background and Aims Patients with synchronous conventional adenomas and serrated polyps are at increased risk for metachronous neoplasia. We used New Hampshire Colonoscopy Registry data to examine the prevalence, pathway, and severity of synchronous lesions detected on colonoscopy after positive multi‐target‐stool DNA (mt‐sDNA) or Fecal Immunochemical Tests (FIT), compared to colonoscopies without prior stool test. Methods We estimated the risk of synchronous conventional adenomas and serrated polyps relative to no lesions, adenomas only, and serrated polyps only, across the three study cohorts using multinomial logistic regression. Results We included 1089 mt‐sDNA+ patients, 436 FIT+ patients, and 43 379 patients with screening colonoscopy only without previous stool test. Patients with mt‐sDNA+ tests had a higher risk of synchronous lesions compared to FIT+ patients (OR = 2.34; 95% CI: 1.70–3.28) and colonoscopy‐only patients (OR = 2.92; 95% CI: 2.50–3.40). Mt‐sDNA+ patients also had significantly higher risks of serrated polyps versus no polyps (RRR = 2.92; 95% CI: 2.39–3.58) and synchronous polyps versus adenomas alone (RRR = 2.00; 95% CI: 1.67–2.4) compared to colonoscopy‐only patients; no such differences were found in the FIT+/colonoscopy‐only comparison. Most mt‐sDNA+ and FIT+ patients with synchronous lesions had at least one advanced lesion, while the majority of colonoscopy‐only patients with synchronous lesions had no advanced lesion. Conclusions The yield of synchronous conventional adenomas and serrated polyps is higher in patients with positive mt‐sDNA tests compared to FIT+ or colonoscopy‐only patients, likely due in part to the higher yield of serrated polyps in mt‐sDNA+ patients, which persists even among patients with adenomas.
ABSTRACT Aims Despite the recommendation of steroid therapy for type 1 autoimmune pancreatitis (AIP), the value of steroid pulse therapy remains unclear. This study aimed to assess the efficacy and safety of steroid pulse therapy in patients with AIP. Methods and Results Of 121 patients with type 1 AIP who were identified, 116 with adequate follow‐up data were included in the analysis. Patients were classified into four groups according to the initial treatment modality—pulse therapy alone (Pulse alone group), pulse therapy followed by oral steroid therapy (Pulse + PSL group), conventional oral steroid therapy (PSL group), and observation without treatment (Observation group)—and short‐ and long‐term clinical response, relapse rates, and steroid‐associated adverse events were compared across these groups. The numbers of patients in the Pulse alone, Pulse + PSL, PSL, and Observation groups were 12, 13, 68, and 23, respectively. After 2 weeks of steroid initiation, steroid pulse groups (Pulse alone and Pulse + PSL group) showed a significantly greater reduction in serum IgG4 levels than the PSL group (p = 0.048). Pulse + PSL was associated with a significantly lower relapse rate than PSL (log‐rank test p = 0.02; multivariate Cox regression p = 0.048), with no differences in adverse events. Rates of relapse and adverse events did not differ significantly between the Pulse alone and Observation groups. Conclusions Steroid pulse therapy may serve as a useful therapeutic option when conducting a steroid trial and may help reduce relapse rate in the management of type 1 AIP.
ABSTRACT Introduction Colorectal cancer (CRC) is increasing in Africa, yet reports in children and adolescents are limited. We describe the epidemiology, management, and survival outcomes of CRC in African children. Methods Retrospective data of children under 19 years diagnosed with CRC between 2000 and 2023 were collected from 14 African countries. Patient and tumor characteristics and treatment data were described and survival outcomes analyzed. GLOBOCAN data were used to evaluate age‐related geographical distribution of CRC. Results Hundred‐and‐eight patients, 57.4% males, were diagnosed with a mean age of 14.9 (range 5–18) years. The mean symptom‐onset‐to‐diagnosis duration was 90 days (range 2–1200). Most common symptoms were abdominal discomfort (70.6%) and change in bowel habits (57.8%). The commonest primary site was the ascending colon (30.6%) with a mean tumor size of 64.3 mm (range 30–150 mm) and 37% presenting in stage III and 36.1% in stage IV. Most (83.3%) tumors were confirmed on histology, of which 78.7% were adenocarcinoma. Carcinoembryonic antigen was performed in 38.9% of patients. Complete resection was achieved in 55.6% of cases, while 18.5% received radiotherapy. Folinic acid, Fluorouracil, Oxaliplatin (FOLFOX) was the first line chemotherapy in 48.1% of patients. A third of patients were lost to follow‐up while 25.6% experienced disease progression. The 2‐year and 5‐year overall survival rates were 40.0% and 16.9%, respectively. Disease stage ( p = 0.07) and degree of resection ( p = 0.02) predicted outcomes. Conclusion Pediatric CRC is characterized by delayed diagnosis and advanced stage presentation, contributing to a significantly lower overall survival compared to adults. Focused research and multidisciplinary management are needed to understand pediatric CRC and improve outcomes.
ABSTRACT Aims Gastroesophageal reflux disease can progress to reflux esophagitis and Barrett's esophagus (BE), making accurate endoscopic diagnosis important. Artificial intelligence tools like ChatGPT‐5 may assist image interpretation, though data on newer large language models remains limited. This study evaluated ChatGPT‐5 for BE detection and LA esophagitis severity classification. Methods and Results Endoscopic images from the HyperKvasir dataset were analyzed, including BE, esophagitis A, esophagitis B–D, and normal Z‐line images. Four standardized prompts were assessed: (1) BE versus normal, (2) esophagitis versus normal, (3) LA‐grade severity (A vs. B–D), and (4) BE versus severe esophagitis. ChatGPT‐5 was evaluated in auto mode. Two investigators analyzed 640 unique images, yielding 1280 evaluations. Sensitivity, specificity, positive/negative predictive values (PPV/NPV), F1 scores, and accuracy were calculated. In binary tasks, sensitivity was highest for severe esophagitis (B–D) (0.774). Binary accuracy was similar across tasks (~0.64), with the highest for severe esophagitis (0.655). In three‐class analyses, severe esophagitis performed best (sensitivity 0.506, specificity 0.761, accuracy 0.438), with performance improving alongside disease severity. PPV trended higher for severe esophagitis compared with normal mucosa ( p ~ 0.03), though significance was not retained after multiple‐comparison correction. In the BE‐severe esophagitis‐normal comparison, severe esophagitis achieved the highest sensitivity (0.590), specificity (0.790), and accuracy (0.521). PPV trended higher for severe esophagitis versus normal mucosa ( p ~ 0.05), though significance was not maintained after multiplicity adjustment. NPVs exceeded PPVs across all paradigms. Conclusion ChatGPT‐5 demonstrated moderate performance for esophageal image interpretation, performing best for severe esophagitis and worst for mild esophagitis/BE. Binary prompting outperformed multiclass formats, and the model functioned better as a rule‐out tool.
