Objective The aim of this systematic review was to explore the characteristics of men who have sex with men (MSM) diagnosed with anorectal lymphogranuloma venereum (LGV) Method Four bibliographical databases (Medline, Embase, CINAHL, Web of Science) were searched in September 2025 for publications written in English, exploring at least one characteristic in MSM with anorectal LGV. Two authors independently reviewed full-text publications, assessed the risk of bias (Joanna Briggs Institute toolkit) and performed a narrative synthesis to generate thematic data. Results 64 manuscripts published between 2004 and 2025, which included 9417 MSM with anorectal LGV. The manuscripts were case series (n=39), cross-sectional studies (n=20), case-control studies (n=4) and one cohort study. This review highlighted demographic (living with HIV, age >30 years, HIV-negative MSM using HIV pre-exposure prophylaxis (HIV-PrEP), ethnicity), co-infection (concurrent/previous non-LGV Chlamydia trachomatis , Neisseria gonorrhoeae , Treponema pallidum , anogenital herpes simplex virus, anogenital human papillomavirus, hepatitis B, hepatitis C, acute/new HIV, antimicrobial-resistant shigellosis, Giardia duodenalis , cytomegalovirus colitis), behavioural (multiple sexual partners, group sex, attending sex-on-premises venues and sex parties, oral sex, condomless anal sex, other anal sexual behaviours (penile-anal sex, oro-anal sex (rimming), sex toys, fisting, enemas/douching), recreational drug use, chemsex, injecting drug use, travel and sex) and other (diagnosed / treated erroneously for inflammatory bowel disease / lymphoma / squamous cell carcinoma, unnecessary interventions, delayed treatment) characteristics described in MSM with anorectal LGV. Conclusion Clinical guidelines should recommend that MSM with anorectal LGV require comprehensive sexually transmitted infection / HIV testing, sexual health interventions (eg, HIV-PrEP) and robust multidisciplinary clinical pathways to reduce misdiagnosis, unnecessary interventions and diagnostic delays. PROSPERO registration number CRD420251125095.
Objective Repeated surveys have demonstrated that senior gastroenterology trainees lack confidence and experience in managing acute upper gastrointestinal (UGI) bleeds. Whilst no current formalised sign-off exists, this is an area of interest and development among stakeholders. We developed a course to address this gap in training and our aim was to evaluate its impact on delegate knowledge and perceived confidence. Method A 1-day course was developed comprising case-based discussions and small group hands-on training stations. A variety of complex real-life bleed cases were discussed through interactive expert-guided discussion. Delegates completed a pre-course and post-course multiple choice assessment using haemostasis scenarios. The primary outcome was to assess both confidence and knowledge before and after our intervention. Secondary outcomes included perceived acceptability, benefit of case-based multidisciplinary team (MDT) discussions and effectiveness of hands-on stations. Results A total of 58 delegates took part across two cycles of the course a year apart. The median knowledge score for the pre-course quiz was 58.33% (CI=3.45), rising to 75% (CI=4.33) post-course (p<0.05). The median confidence score prior to the course was 6.42/10, rising to 8.58/10 after (p<0.05). All delegates felt the course met their requirements. The perceived effectiveness of MDT discussions was 4.87/5, and all hands-on stations received positive feedback, averaging 4.62/5. Conclusions Our educational intervention proved beneficial in increasing delegates’ confidence and knowledge in managing UGI bleeds. We believe that a UGI haemostasis course could be embedded in training programmes to improve UGI bleeding management competence.
Disorders of gut-brain interaction (DGBI) are common chronic gastrointestinal conditions diagnosed using the Rome V criteria. They account for a substantial proportion of gastroenterology workload, with many patients identifying specific foods as symptom triggers. Dietary management is therefore a frequent focus of care, and an emerging evidence base supports a broad range of dietary interventions that can provide meaningful symptom improvement when matched to patients symptom profile. However, readiness for dietary change and psychosocial contexts must be considered to facilitate optimal outcomes. This is important as, for a subset of patients, dietary therapies may exacerbate avoidant or disordered eating, highlighting the rationale for screening for these risks before implementing restrictive modalities, such as the low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet. This review presents a pragmatic framework for gastroenterologists, highlighting clinical considerations when implementing first-line dietary advice or referring to a dietitian for more complex dietary modalities. It summarises the spectrum of evidence-based dietary approaches for DGBI and provides practical resources to assist in safe and effective clinical use.
Objective The aim of this systematic review was to explore the characteristics of men who have sex with men (MSM) with anorectal Treponema pallidum (syphilis). Method Four bibliographical databases (Medline, Embase, CINAHL, Web of Science) were searched in September 2025 for publications written in English exploring at least one characteristic in MSM with symptomatic anorectal syphilis. Two authors independently reviewed full-text publications, assessed the risk of bias (Joanna Briggs Institute toolkit) and performed a narrative synthesis to generate thematic data. Results 37 manuscripts were included in this analysis published between 1966 and 2025 from Europe (n=13), Asia (n=11), the USA (n=11), Israel (n=1) and Peru (n=1) and were case reports (n=29) and case series (n=8) that included 67 MSM. This review highlighted demographic (living with HIV, being a sex worker, living with a vulnerability (intellectual disability, being a victim of sexual violence/exploitation, being a migrant)), behavioural (condomless receptive anal sex, oral-anal sex (rimming), having multiple non-regular sexual partners, travel and sex), co-infection (new HIV diagnosis, Neisseria gonorrhoeae, Chlamydia trachomatis including lymphogranuloma venereum, herpes simplex virus, human papillomavirus, acute hepatitis B, Entamoeba histolytica ), symptom (rectal pain, rectal bleeding, tenesmus, anorectal ulcers, change in bowel habit, ulcerated/mass lesion, fever) and clinical (erroneously investigated, hospitalised, diagnosed and treated for other anal-rectal conditions (neoplasia, inflammatory bowel disease), having a syphilis rash, transaminitis and the Jarisch-Herxheimer reaction) characteristics seen in MSM with anorectal syphilis. Conclusion This review provides important demographic, co-infection, behavioural and clinical pathway data to inform future clinical guidelines, public health strategies and research in anorectal syphilis in MSM. PROSPERO registration number CRD420251107692.
Objective Endoscopic mucosal resection (EMR) for large colorectal polyps is supported by a growing body of randomised evidence, yet the extent of outcome heterogeneity, definition variability and adherence to trial design standards has not been characterised. We assessed outcome selection, definitions, trial design and transparency across all published EMR randomised trials. Design/method This systematic review identified EMR randomised controlled trials (RCTs) published 2015–2024 through MEDLINE, Web of Science and Cochrane Library. Two reviewers independently extracted data into a REDCap database on primary outcome categories, definitions for delayed bleeding and adenoma recurrence, trial registration, protocol availability, outcome discrepancies, use of patient-reported outcome measures (PROMs) and stakeholder input. Diversity indices quantified outcome heterogeneity. Results 46 RCTs were included. Four primary outcome categories were identified (en bloc resection 32.6%, safety 30.4%, efficacy 28.3%, technical success 8.7%) with a Simpson’s Diversity Index of 0.714 and no single published primary outcome exceeding 30.4% of trials. Among 43 trials reporting delayed bleeding, 30.2% did not define criteria. Among those that did, 20 unique definition combinations were identified. Only 52.2% of trials were preregistered, 26.1% had publicly available protocols, and 24.3% changed their primary outcome between registry and publication. Safety outcomes were systematically under-registered (perforation: 8 registrations, 35 publications). PROMs were used in 13.0%, and no trial documented patient input into outcome selection. Conclusions EMR RCTs exhibit substantial outcome heterogeneity at every level, from which outcomes are chosen, to how they are defined, to whether they are reported as planned. These findings provide the empirical foundation for developing core outcome sets in this field.
Objective Subjectively reported sleep disturbance is common in irritable bowel syndrome (IBS). Studies have examined subjective and objective sleep quality in IBS. We aimed to explore the characteristics of people with IBS according to the quality of their sleep.Design/method Participants were recruited from the National Institute for Health and Care Research (NIHR) research register ContactME-IBS. We collected data on demographics, gastrointestinal symptoms, psychological health and quality of life using validated questionnaires among adults with Rome IV IBS. We dichotomised the cohort according to whether they were good or poor sleepers, with poor sleepers defined by a Pittsburgh Sleep Index Score >5, as recommended. We compared the characteristics of the two groups and explored factors associated independently with poor sleep using logistic regression.Results Of 341 respondents with Rome IV IBS, 287 (84.2%) were poor sleepers. Poor sleepers were older (50.4 years vs 44.2 years, p=0.007), had more severe IBS symptoms (mean total IBS severity scoring system 295.9 vs 239.7, p<0.001), had a longer duration of IBS (82.2% IBS for >= 5 years vs 66.7%, p=0.009) and had higher levels of anxiety, depression and more somatoform symptom-reporting as well as worse IBS-specific health-related quality of life (p<0.001 for all analyses). After logistic regression, older age and having higher levels of somatoform symptom-reporting were independently associated with poor sleep.Conclusion Poor sleep in IBS is independently associated with age and somatoform symptom-reporting. Better understanding of the associations between sleep and IBS could help personalise management of IBS.
Objective Immune checkpoint inhibitor (ICI) colitis is a common side effect of cancer treatment using ICIs that causes morbidity and mortality. Guidelines recommend initial management with high-dose systemic corticosteroids. Second-line management is with selective immunosuppressive therapy (SIT) such as infliximab and vedolizumab. The aim of our study was to assess for factors predicting need for treatment with second-line SIT in patients with ICI colitis. Design/method Two-centre retrospective analysis of adult patients admitted to hospital with ICI colitis between July 2018 and March 2023. Patient baseline characteristics and variables including ICI, histological inflammation, Mayo Endoscopic Score (MES), albumin, C reactive protein and calprotectin were reviewed. Univariable analysis was carried out to identify factors that predicted non-response to steroids. Results 82 patients were included in the analysis, 51 (62.2%) male, median age 71 (IQR 20 years). 28 (34.1%) required SIT. On univariable analysis, calprotectin emerged as a predictor of non-response to steroid therapy and the need to escalate to management with SIT. Receiver operating characteristic analysis identified an optimal cut-off of 620 mu g/g to identify those who required second-line SIT (sensitivity 75% (57.6%-92.7%), specificity 77.8% (52.4%-93.6%), accuracy 76.5%, positive predictive value 75% (47.6%-92.7%), negative predictive value 77.8% (52.4%-93.6)). Conclusions Faecal calprotectin can be used as a biomarker to identify patients with ICI colitis who are unlikely to have a successful or sustained response to systemic corticosteroids and require escalation to management with SIT. We have identified an optimal threshold of >620 mu g/g. This highlights the possibility of non-invasive testing to assist with guiding therapeutic management.
Hepatic encephalopathy (HE) represents a common and debilitating complication of cirrhosis, with a heterogeneous range of symptoms, severity, time course and impact on both patients and caregivers alike. HE represents a transitional point in the natural history of chronic liver disease and is associated with a substantial decline in quality of life, alongside increased healthcare resource utilisation and mortality. Treatment goals for HE centre on improvement in quality of life, prevention of episodes of both overt HE and other acute decompensating events associated with cirrhosis and portal hypertension. Multidisciplinary teams, including specialists in hepatology, nutrition, nursing, physiotherapy, social workers and, where appropriate, palliative medicine, help to provide comprehensive and holistic care and are important in securing the best patient outcomes. Part 3 of this review series focuses on the outpatient management of HE in addition to considering distinct clinical presentations and specific challenges posed by HE. We outline approaches to assessing the severity of HE and response to treatment. We discuss patient and carer education and highlight its importance for empowering community management, optimising medical treatment and reducing hospital admissions and resource utilisation. We outline a stepwise algorithm for the treatment of symptomatic HE, including non-absorbable disaccharides, rifaximin-α and L-Ornithine L-Aspartate and discuss when to refer for transplant assessment. Furthermore, we highlight challenges in therapeutic drug development in this field and propose a framework for consideration of trial endpoints in patients with either covert or a history of overt HE, recognising the need for modern trial designs in delivering translational therapeutics.
Serrated polyposis syndrome (SPS) is the most common colorectal polyposis syndrome, characterised by multiple serrated lesions in the colon and carries an elevated risk of colorectal cancer (CRC). Serrated lesions can be categorised into hyperplastic polyps, sessile serrated polyps (SSLs) and traditional serrated adenomas (TSAs)—with SSLs and TSAs recognised as pre-malignant lesions and contributing up to a third of sporadic CRCs via the serrated neoplasia pathway. SPS remains underdiagnosed due to the subtle endoscopic appearance and historical misclassification of these lesions. Advancements in colonoscopy, including high-definition imaging and chromoendoscopy, as well as extended withdrawal times and polyp classification systems, have significantly improved the detection of these challenging lesions. Cold snare polypectomy is the recommended technique for most non-dysplastic serrated lesions <10 mm due to its safety and efficacy. For larger or dysplastic lesions, endoscopic mucosal resection is the preferred technique and may be performed cold, hot or underwater. However, evidence regarding optimal resection techniques specific to serrated lesions remains limited. SPS and post-polypectomy surveillance strategies vary internationally and are largely based on expert opinion. All guidelines recommend annual surveillance in SPS patients following polyp clearance, although recent data suggest that biennial colonoscopy may be sufficient, thereby potentially reducing patient and procedural burden. This review highlights the ongoing challenges in diagnosing and managing SPS and serrated lesions and underscores the need for further research to guide best practices in detection, resection and surveillance, with the ultimate goal of reducing CRC incidence.
The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual gut hormone therapies has revolutionised obesity treatment, with implications across all surgical specialties. These medications achieve clinically significant weight loss of 15–22.5% total body weight and demonstrate multisystemic benefits including cardiovascular risk reduction, improved renal outcomes and treatment of metabolic-dysfunction-associated steatohepatitis. For surgeons, GLP-1 RAs are increasingly relevant across the entire care pathway: as alternatives or adjuncts to metabolic and bariatric surgery, tools for perioperative optimisation in elective procedures and potential interventions throughout cancer treatment pathways from prevention to survivorship. This narrative review synthesises current evidence on GLP-1 RA use relevant to surgical practice, important for both clinical and research settings. We examine their integration with bariatric surgery as both preoperative bridges and postoperative adjuncts for recurrent weight regain. In elective surgery, we evaluate perioperative safety data, aspiration risk and potential roles in prehabilitation programmes. Within oncology, we explore emerging evidence for cancer prevention, treatment optimisation and tertiary prevention in survivors. Critical considerations include management of gastrointestinal side effects, gallstone formation, pancreatitis risk, nutritional deficiencies and rare complications including mental health and ophthalmic effects. Understanding these medications is essential for contemporary surgical practice. Surgeons must recognise both therapeutic opportunities and potential complications, ensuring safe perioperative management whilst optimising patient outcomes. As evidence matures, GLP-1 RAs should be positioned not as competitors to metabolic bariatric surgery, but as complementary tools within multidisciplinary obesity and metabolic care pathways.
Objective Gallstone carriers have elevated cardiovascular disease (CVD) risk. Shared lifestyle risk factors only partly explain the observed association. Gallstone-driven inflammation may contribute to CVD with cholecystectomy offering protection. A triangulation study using observational, genetic and interventional data was undertaken.Design Cox proportional hazards analysis of UK Biobank data assessed 10-year CVD risk in gallstone cases versus healthy controls and gallstone carriers versus post-cholecystectomy individuals. Data were meta-analysed with other published cohorts. Gallstone state was additionally modelled as a time-varying covariate with states: gallstone-free, gallstone-carrier, gallstone-related inflammation and post cholecystectomy. Finally, Mendelian randomisation (MR) analyses were undertaken using 41 gallstone-promoting single nucleotide polymorphisms (SNPs) to assess causal effects of gallstones on CVD.Results In UK Biobank (gallstones=32,528, controls=424,520) and meta-analysis (gallstones=202,055, controls=1,256,861), gallstones were associated with CVD (adjusted HR (aHR) 1 & centerdot;28 (1 & centerdot;20 to 1 & centerdot;36), meta-analysis aHR 1 & centerdot;23 (1 & centerdot;18 to 1 & centerdot;29)). Cholecystectomy was associated with reduced CVD risk compared with gallstone carriers (aHR 0 & centerdot;71 (0 & centerdot;62 to 0 & centerdot;82)). Time-varying analysis supported elevated CVD risk with inflammation and reduced CVD following cholecystectomy. MR analyses required handling of pleiotropic cholesterol-lowering SNPs that affect CVD risk independently of gallstones. Multivariable MR adjusting for the impact of SNPs on lipids showed no significant association of CVD and gallstones.Conclusion Gallstones are associated with elevated CVD risk, which increased with gallstone-related inflammation but diminished post cholecystectomy. The benefits of cholecystectomy indicate a potential causal pathway. However, as cholecystectomy interrupts exposure to gallstones, the effects of gallstone-promoting SNPs on CVD are likely attenuated by cholecystectomy, meaning MR analyses cannot detect an underlying causal effect.
The presence of clinically significant portal hypertension and decompensated cirrhosis heralds a significant change in a patient’s trajectory, with an associated high morbidity and mortality. Our understanding and treatment of these conditions has evolved significantly in modern times. This review aims to highlight the most important studies that have influenced our understanding and management of these complex conditions. In this manuscript, we explore the milestone studies in defining decompensation and recompensation, risk stratification, the pathophysiology and treatment of portal hypertension, ascites management, spontaneous bacterial peritonitis, hepatic encephalopathy, renal dysfunction and the potential for disease regression. While the field of hepatology is at an exciting frontier, with novel therapeutics emerging, it is important to reflect on which pivotal studies have brought us to our current standard of care.
Patients with inflammatory bowel disease (IBD) frequently modify their diet and use complementary medicine, but inconsistent evidence and persistent myths complicate clinical guidance. Our aim was to critically evaluate the evidence for dietary and complementary strategies in IBD and to clarify common misconceptions, supporting evidence-based, patient-centred management. A narrative synthesis of randomised trials, systematic reviews and international guidelines was conducted. Interventions that were evaluated included dietary strategies encompassing the Mediterranean diet, low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet, exclusive enteral nutrition, Crohn’s disease exclusion diet and the specific carbohydrate diet. Other interventions included complementary modalities such as probiotics, curcumin, herbal medicine, mind-body interventions and physical activity. The Mediterranean diet shows moderate evidence for improving quality of life and inflammatory biomarkers. A low-FODMAP diet can relieve functional symptoms but does not reduce inflammation. Exclusive enteral nutrition remains first-line induction therapy in paediatric Crohn’s disease. The Crohn’s disease exclusion diet/partial enteral nutrition shows promise in adults. Among complementary therapies, specific probiotics and curcumin demonstrate benefits in certain cases of ulcerative colitis, but evidence for their use in Crohn’s disease remains limited. Personalised, multidisciplinary supervised dietary and complementary approaches may support symptom control and quality of life in IBD patients. However, they should complement rather than replace evidence-based pharmacologic therapy, and high-quality trial and clinical studies are needed to define optimal, evidence-based nutritional strategies.
Objective The aim of this study was to explore sexually transmitted infection (STI) coinfections, antimicrobial resistance patterns and antimicrobial prescribing in men who have sex with men (MSM) with sexually transmissible shigellosis. Method We conducted a case series of MSM diagnosed with shigellosis between 2019 and 2024 presenting to the sexual health clinic in Brighton, UK. Demographics, sexual behaviour, reported recreational drug use, concurrent STI diagnoses, antimicrobial resistance and prescribed antimicrobials were collected and analysed. Results Overall, there were 62 cases of shigellosis in 61 MSM with a median age of 40 (IQR=34-54) years. 29 (47%) were living with HIV, 29/33 (88%) HIV-negative MSM were using HIV-PrEP and 14 (23%) were using proton pump inhibitors. The median number of sex partners was 4 (IQR=1-8), 24 (38%) reported recreational drug use, 13 (21%) reported group sex, seven (11%) reported attendance at sex-on-premises venues and eight (13%) reported recent travel. 25 (40%) had a concurrent STI (Neisseria gonorrhoeae (n=12), Chlamydia trachomatis (n=8), HSV (n=6), Treponema pallidum (n=6), incident HIV (n=2), Mycoplasma genitalium (n=1)). Seven (11%) had a concurrent enteric infection (Campylobacter (n=6), diarrhoeagenic Escherichia coli (n=1), Cryptosporidium (n=1), Giardia duodenalis (n=1)). Overall, 26 (42%) cases (15/18: Shigella sonnei, 11/13: Shigella flexneri) had available antimicrobial sensitivities; 23/26 (88%, 95% CI 71 to 96) had antimicrobial resistance and three (12%) had multidrug resistance. 25 (40%) were treated with antimicrobials (13 (21%) specifically for Shigella); MSM living with HIV with shigellosis were significantly older (p<0.01), had fewer sex partners (p<0.01), were more likely to use crystal meth (p=0.02) and were less likely to be treated with antimicrobials than HIV-negative MSM (28% vs 52%, p=0.04). Conclusions This study demonstrates high rates of STI coinfection, antimicrobial resistance, and antimicrobial prescribing in MSM with sexually transmissible shigellosis.
Myths and misconceptions about the evaluation and treatment of constipation persist. Many widely prevalent misconceptions about laxatives, specifically stimulant laxatives, interfere with the effective management of constipation. Although some of these myths and misconceptions have been dispelled in recent years, there is additional room for improving the awareness and understanding of the pathophysiology of constipation, the mechanisms of action and the efficacy and safety of available therapies. An evolution in our understanding of pathophysiology and the availability of new treatments requires that primary care practitioners be better positioned to treat this common disorder that reduces patients’ quality of life and negatively impacts the healthcare system. This review defines constipation and elucidates various factors that contribute to its aetiology, including lifestyle, dietary habits, medications and underlying medical conditions. This review addresses and refutes common myths and misconceptions about constipation, such as the belief that regular bowel movements must occur daily or the use of laxatives leads to dependence. This review also highlights the importance of distinguishing between normal and abnormal bowel habits and emphasises the need for individualised management approaches to address constipation effectively. Finally, the review discusses different classes of laxatives, dispelling misconceptions about their safety, efficacy and potential for misuse, with a specific focus on stimulant laxatives. In summary, this review enhances awareness and knowledge of this prevalent disorder, provides evidence-based insights into common myths and misconceptions surrounding constipation and promotes more informed decision-making regarding constipation and the use of laxatives.
