Crohn’s disease (CD) is often refractory to standard therapies, and patients are sometimes reluctant to initiate immunosuppressive therapy, prompting interest in novel treatments such as low-dose naltrexone (LDN). To evaluate the efficacy of LDN for induction of remission in patients with mild-to-moderate active CD. We conducted a multicenter, double-blind, placebo-controlled trial in 7 hospitals in the Netherlands. Adults with active CD (defined by mucosal ulcers on endoscopy and Simple endoscopic score for CD 3–15) were randomized 1:1 to LDN 4.5 mg once daily or placebo for 12 weeks. The primary endpoint was endoscopic remission at week 12. Secondary endpoints included clinical and endoscopic response, safety and patient-reported outcome measures. The trial was stopped early due to futility. Forty-one patients were randomized. After 12 weeks, endoscopic remission occurred in 1 (5.6
Small-bowel vascular lesions are a major cause of bleeding. The Yano–Yamamoto classification defines angioectasia and Dieulafoy lesions as Types 1 and 2, respectively. To investigate clinical differences between the above lesion types and their associations with systemic arteriosclerosis. We retrospectively analyzed 145 patients with small-bowel vascular lesions (125 Type 1; 20 Type 2) diagnosed using double-balloon enteroscopy. Clinical characteristics, comorbidities, updated Charlson Comorbidity Index, and Ohmiya index were compared. Arteriosclerosis was assessed using computed tomography-based arterial calcification and modified Agatston score. Rebleeding rates were analyzed using the Kaplan–Meier method. Type 2 lesions were significantly associated with overt bleeding (85 vs. 55
Children with type 1 diabetes (T1DM) and positive celiac serology but normal duodenal mucosa (potential celiac disease–CeD) often have spontaneous normalization of serology despite a gluten-containing diet. This results in either repeated biopsies or an upfront advice for gluten-free diet (GFD) if TTG is >10ULN. To find the predictors of villous atrophy in children with T1DM and potential CeD. Ambispective observational study: Children with T1DM and potential CeD on a gluten-containing diet were included. Clinical, serological, histological, and immunohistochemical parameters at baseline and follow-up biopsy were evaluated. Of the 110 children with T1DM and positive celiac serology, 66 (60
Pediatric polypectomy is routine, yet no prior study has directly compared cold forceps (CFP), hot forceps (HFP), cold snare (CSP), and hot snare polypectomy (HSP). This study evaluated techniques, polyp characteristics, and outcomes. We retrospectively reviewed patients aged 0–20 years who underwent polypectomy at Riley Hospital for Children from 2/2012–7/2025. Demographic, morphologic, histologic, and outcome data were analyzed at procedure and polyp levels. Across 320 procedures, 2,000 polyps were removed from 203 patients (mean age, 9.5 ± 5.2 years). Polyps were predominantly colorectal, with gastric lesions the most common upper gastrointestinal location. HSP was most common (67.2
To systematically evaluate the efficacy and safety of intermittent pneumatic compression (IPC) in preventing lower extremity deep vein thrombosis (DVT) in patients with severe acute pancreatitis (SAP). Randomized controlled trials (RCTs) and non-randomized controlled trials on IPC for DVT prevention in SAP patients were retrieved from PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature Database from inception to 30 April 2026. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias. Meta-analyses were performed using R software (version 4.2.2). Subgroup analyses were conducted based on study design and treatment frequency. This review is registered in PROSPERO (CRD420261379348). A total of 10 studies (7 RCTs and 3 non-RCTs) involving 970 patients (484 in the intervention group and 486 in the control group) were included. Meta-analysis showed that IPC significantly reduced the incidence of DVT (RR = 0.22, 95
MASLD is the most prevalent chronic liver disease worldwide, with pooled global prevalence estimates of approximately 30
Inpatient chemical dependency programs for alcohol use disorder (AUD) primarily focus on treating the use disorder, with limited attention to alcohol-related medical complications. We implemented a hepatology provider-led educational intervention focused on alcohol-related liver disease (ARLD) within an inpatient alcohol treatment program and evaluated the intervention’s impact on return to alcohol use and subsequent healthcare utilization. Data were collected between 1/2023 and 12/2024. Patients were categorized into historical and educational groups based on admission before or after implementation of the intervention. Data on return to alcohol use were collected through manual chart review. Demographics, ICD codes for AUD/ARLD, laboratory values, AUD medication use, return to alcohol and subsequent AUD/ARLD healthcare utilization, and mortality were also evaluated. Patients completed a voluntary survey asking for feedback regarding this intervention. Bivariate analyses assessed associations between patient characteristics and clinical outcomes. Kaplan–Meier methods estimated alcohol-free survival, and Cox proportional hazards regression estimated adjusted hazard ratios (HRs) for return to alcohol use. 465 patients (n=233 historical, n=232 educational) were included. Most patients were white (71.6
GI symptoms are frequently non-specific and common across many disorders. Fecal burden on CT imaging is a finding commonly reported on, but with an undefined relationship to GI symptoms. A study was performed to assess the association between fecal burden and GI function and symptoms. A single-center cross-sectional study was performed assessing the relationship between fecal burden using the Starreveld scoring method for patients undergoing CT Abdomen/Pelvis for any indication, and GI function and symptoms using a survey tool with a validated GI symptom scale. 205 patients completed surveys on the day of CT exam. Interobserver reliability for fecal burden assessment yielded kappa of 0.6. Spearman correlation showed a negative correlation between total colon fecal burden and stool frequency (rho = − .21, p = .002), liquid bowel movements (rho = − .23, p < .001), and bloating (rho = − .16, p = .02). Positive correlation was identified with difficult stool evacuation (rho = .18; p = .009). No correlation was found for symptoms of hard stools, urgency, fullness, satiety, abdominal discomfort, abdominal pain, or nausea. Logistic regression analysis demonstrated total colon fecal burden distinguished symptom frequency for symptoms of difficulty evacuating (OR 1.12, p = .05) and liquid bowel movements (OR 0.8, p < .001) only. Fecal burden on CT imaging is weakly associated with metrics of bowel function and poorly associated with GI symptoms other than difficulty evacuating. This study challenges the practice of attributing GI symptoms to fecal burden beyond those for which there is any identified association.
Inflammatory bowel disease (IBD) is a chronic immune-mediated gastrointestinal disorder with rising global incidence, especially in industrializing regions. The Global Burden of Disease Study (GBD) framework enables standardized assessment of this growing health challenge. To assess temporal trends and socio-demographic disparities in the global burden of IBD from 1990 to 2021 and to project future disease trajectories. We obtained data on IBD incidence, mortality, and disability-adjusted life years (DALYs) for 204 countries and territories from 1990 to 2021. Temporal trends were assessed using Joinpoint regression. Future burden from 2022 to 2040 was projected using Bayesian age-period-cohort modeling. Associations with the socio-demographic index (SDI) were examined via Spearman’s rank correlation test. Cross-country inequalities in IBD burden were quantified using the slope index of inequality (SII) and concentration index. Between 1990 and 2021, global age-standardized incidence rate (ASIR) of IBD increased [average annual percentage change (AAPC) = 0.16], whereas age-standardized mortality rate (ASMR) (AAPC = − 0.49) and age-standardized DALY rate (ASDR) (AAPC = − 0.57) declined. By 2040, the ASIR, ASMR, and ASDR of IBD are projected to decrease to 4.18, 0.41, and 15.06 per 100,000, respectively. The highest burden was observed in high-SDI regions, particularly Australasia, North America, and Western Europe. From 1990 to 2021, absolute inequalities in IBD incidence (SII: 4.12–6.89) and mortality (SII: 0.35–0.48) widened. IBD burden has grown unequally across socio-demographic strata. Despite mortality and DALY reductions, rising incidence and inequalities necessitate targeted prevention and early intervention strategies.
Hepatocellular carcinoma (HCC) surveillance remains suboptimal. We evaluated longitudinal trends in HCC surveillance adherence, its associated factors, and impact on HCC-related outcomes, following US LI-RADS implementation in a safety-net system. Electronic medical records and radiology database were queried from 6/1/2020 to /31/2021, with follow-up (median 51 months) through 12/31/2024. Multivariable repeated measures logistic regression assessed factors associated with full (vs. partial/none) HCC surveillance adherence. Adherence trends were analyzed using a nonparametric mean cumulative function. Cox proportional hazards models assessed the association between adherence and composite outcomes of HCC or death. Among 1083 patients, mean age was 59.3, 44
Metabolic dysfunction–associated steatotic liver disease (MASLD) is rising in parallel with obesity and metabolic syndrome among reproductive-age women. Although MASLD has been associated with adverse pregnancy outcomes, its burden and clinical impact in modern cohorts remain incompletely defined. Using 2016–2022 discharge data from the National Inpatient Sample (NIS), we identified hospitalized pregnant women ≥20 weeks gestation. Patients were stratified by the presence of MASLD, other chronic liver diseases (CLD), or no liver disease. Multivariable regression analyses compared maternal and perinatal outcomes while adjusting for demographics, comorbidities, pregnancy-related factors, and hospital characteristics. Among 24,808,697 pregnancy-related hospitalizations, 21,860 (0.09
Colorectal cancer (CRC) is largely preventable through risk-adapted screening, yet participation remains below recommended targets. Digital platforms may help bridge this gap by identifying at-risk individuals and facilitating timely preventive evaluation. We aimed to validate the accuracy of ChequeáTuColon (CTC), a digital tool designed to stratify CRC risk, detect alarm symptoms, and provide personalized guideline-based screening recommendations. We conducted a validation study using data from individuals who completed the CTC digital assessment during a CRC awareness campaign at a tertiary care center in March 2026. A random sample was selected for validation. Three expert gastroenterologists, blinded to CTC outputs, independently reviewed participant data and assigned risk categories and screening recommendations. We evaluated concordance across four domains: alarm symptom detection, risk stratification, indication for genetic evaluation, and recommended screening initiation age. Of 35758 individuals who completed the assessment, 395 were randomly selected for validation (median age 59 years; range 23–83). Overall, 50.4
