Ulcerative colitis affects millions of people worldwide, and acute severe ulcerative colitis (ASUC) remains one of its most urgent presentations because delayed recognition of steroid non-response can expose patients to colectomy, postoperative complications, and prolonged hospitalization. The Truelove and Witts (T&W) criteria, first published in 1955, remain historically important because they provide a simple bedside definition of severe disease and continue to inform admission thresholds in contemporary practice. This opinion article argues that the T&W criteria should be retained as an entry definition for classic ASUC but should no longer be used as a standalone framework for dynamic risk stratification or treatment escalation. Modern guidelines and consensus statements increasingly supplement clinical toxicity with C-reactive protein (CRP), albumin, fecal calprotectin, validated endoscopic scores, intestinal ultrasound, and early prognostic indices. These tools do not replace bedside assessment; rather, they help clinicians identify steroid non-response and inflammatory burden before systemic toxicity alone becomes decisive. A balanced interpretation is therefore required: the T&W criteria remain useful because they are simple, familiar, and globally applicable, but they are insufficient by themselves for treat-to-target decision-making. Future ASUC severity classifications should integrate traditional clinical assessment with objective biomarkers, endoscopic findings, imaging, and prospective validation across both resource-rich and resource-limited settings.
Background and Objectives: This study aimed to characterize physicians’ knowledge and practice patterns regarding the use of probiotics in the management of irritable bowel syndrome (IBS). By examining clinical experiences and barriers to adoption, this research sought to identify critical gaps in practice and establish a foundation for evidence-based improvements in patient care. Materials and Methods: The survey was conducted in accordance with the CROSS (Consensus-based Checklist for Reporting of Survey Studies) guidelines. Attendees of a medical congress, specifically general practitioners, gastroenterologists, surgeons, and internists with an interest in the clinical significance and therapeutic modulation of the human microbiome, were invited to participate. Participants completed a 38-item, paper-based questionnaire. The instrument assessed respondents’ self-perceived knowledge of probiotics, their understanding of probiotic definitions and specific strains, and their current clinical practice patterns—particularly regarding the management of irritable bowel syndrome (IBS). Additionally, the survey explored information sources, the frequency of self-prescription, and the perceived need for further education, with a specific focus on safety profiles and clinical concerns. Results: Of the 70 invited attendees, 68 completed the survey, yielding a response rate of 97.1%. The respondent cohort included 40 general practitioners (GPs), 20 gastroenterologists (GEs), four surgeons (SSs), and four internists (SIMs). More than half of the respondents were female (n = 37, 54.4%), with a median age of 43 years (range: 28–70). Exactly half of the respondents (n = 34, 50.0%) agreed that probiotics always have a role in the management of irritable bowel syndrome (IBS); however, only 44.1% (n = 30) reported familiarity with the relevant scientific literature on probiotics. Furthermore, respondents more frequently recognized bacterial species associated with single-strain probiotic formulations compared to those in multi-strain mixtures. The primary concern regarding the administration of probiotics for IBS was this lack of familiarity with the scientific literature, cited by 23.5% of respondents. Notably, 100% of the surveyed cohort expressed a need for further education on the topic. Conclusions: The emergence of scientific and clinical evidence results in a clinical practice characterized by high prescribing habits, despite the lack of formal approval. These findings highlight evidence showing the effectiveness of certain probiotic strains in managing IBS symptoms, suggesting the need for standardized guidelines. Given the demonstrated need for further education among the surveyed cohort, integrating probiotic-specific training into both undergraduate medical curricula and continuing professional development programs could significantly enhance the clinical knowledge and awareness of both current and future practitioners.
Hepatobiliary disorders during pregnancy represent a significant cause of maternal and fetal morbidity, requiring careful differentiation between physiological adaptations of pregnancy and true hepatic pathology. This narrative review provides a comprehensive overview of three major hepatobiliary conditions encountered during pregnancy: gallstone disease, intrahepatic cholestasis of pregnancy (ICP), and viral hepatitis (HAV, HBV, HCV, HDV, and HEV). Pregnancy-induced hormonal and immunological changes influence disease pathogenesis, clinical presentation, diagnostic interpretation, and therapeutic decision-making. Gallstone disease remains the most common non-obstetric surgical condition in pregnancy, with contemporary evidence supporting timely laparoscopic intervention when indicated. ICP is characterized by pruritus and elevated serum bile acids and is associated with increased risks of preterm birth, fetal distress, and stillbirth, necessitating close surveillance and individualized delivery planning. Viral hepatitis poses unique challenges because of the potential for vertical transmission, maternal complications, and adverse neonatal outcomes. Universal antenatal screening for hepatitis B and C is increasingly recognized as a cornerstone of care. For HBV, maternal antiviral prophylaxis combined with neonatal immunoprophylaxis has reduced mother-to-child transmission to below 1%, whereas the role of direct-acting antivirals for HCV during pregnancy continues to evolve. HEV remains the most severe viral hepatitis in pregnancy, carrying disproportionately high maternal mortality in endemic regions. Across all conditions, multidisciplinary management involving hepatologists, gastroenterologists, obstetricians, maternal–fetal medicine specialists, surgeons, and neonatologists is essential to optimize outcomes. This review synthesizes current evidence, highlights pregnancy-specific diagnostic and therapeutic considerations, and identifies emerging areas of research that may further improve maternal and neonatal outcomes.
Background: The intake of mineral water for therapeutic purposes (crenotherapy) in digestive system disorders is a long-established practice, even though there are still few controlled clinical studies confirming the effect of natural mineral water rich in bicarbonate. Objective: To verify whether the daily intake of Aqua 3 bicarbonate natural mineral water is able to improve digestion in a population of patients with functional dyspepsia and gastroesophageal reflux disease symptoms. Methods: Patients had a diagnosis of functional dyspepsia formulated in accordance with the Rome IV criteria and were subjected to three periods of 2 weeks: tap water (wash-out), bicarbonate natural mineral water, and oligomineral water. The mineral water bottles had their labels removed. Primary efficacy endpoint: improvement in the PAGI-SYM total. Secondary endpoints: improvements in the PAGI-SYM subscales, in the use of antacids, and in the self-assessment of efficacy on digestion. Results: The PAGI-SYM total score and the six subscales significantly decreased after bicarbonate mineral water intake, while they significantly increased after oligomineral water supplementation. The antacid use was significantly different comparing the decrease after oligomineral water versus the increase after oligomineral water. In addition, the score of the subjective assessment of effectiveness of the patient’s digestion was significantly better after the intake of bicarbonate than after oligomineral water. Conclusions: In line with the evidence reported in the literature, the findings of this study provide additional support for recommending natural bicarbonate mineral water as a symptomatic treatment for functional dyspepsia and gastroesophageal reflux disease. The intake of Aqua 3 bicarbonate mineral water proved to be a simple, safe, and natural intervention capable of improving digestive symptoms in patients with functional dyspepsia and reflux-related disorders, while promoting the digestive process.
Background: Colorectal cancer (CRC) remains a significant global health challenge, particularly because of its associated complications. Among these, tumor perforation is a critical event linked to increased postoperative morbidity and mortality. This study aimed to evaluate and compare the surgical outcomes of patients with perforated colon cancer versus those with non-perforated colon cancer. Methods: A retrospective comparative study was conducted in the visceral surgery departments of Hassan II University Hospital in Fes, Morocco, including 198 patients who underwent surgical treatment for colon cancer between January 2014 and December 2022. Statistical analyses included descriptive assessments and comparative tests using the Chi-square and Student’s t-tests, with a p-value < 0.05 considered statistically significant. Results: Of the 198 patients, 22 (11%) presented with perforated colon cancer. Laparotomy was the predominant surgical approach in the perforated group (86.4%), whereas laparoscopy was more frequently used in non-perforated cases (56.2%, p = 0.001). Stoma creation was significantly more common in perforated cases (72.7% vs. 4%, p < 0.001), with a notably higher rate of stoma closure failure in the perforated group (37.5% vs. 0%, p < 0.001). Postoperative complications were also more frequent in the perforated group (36.4% vs. 13.6%, p = 0.006), with higher rates of R2 resections (27.3% vs. 0.6%, p < 0.001) and tumor recurrence (27.3% vs. 4.5%, p < 0.001). The mean hospital stay was significantly longer in patients with perforated cancer (11 days vs. 5 days, p < 0.001). Conclusions: This comparative study demonstrates that patients with perforated colon cancer are more likely to require a Hartmann’s procedure, to have prolonged intensive care unit stays, to experience higher rates of postoperative complications, to undergo R2 resections, and to have a greater incidence of tumor recurrence. A non-significant trend toward higher 30-day mortality was also observed.
Background: The Warburg effect is a metabolic phenomenon observed in cancer cells that is characterized by aerobic glycolysis instead of mitochondrial oxidative phosphorylation as the primary mechanism of cellular energy generation. The exact benefit of such a metabolic switch is poorly understood, as aerobic glycolysis is thermodynamically more inefficient than mitochondrial oxidative phosphorylation. Case Presentation: Here, we present a case of a middle-aged individual with advanced stage 4 hepatocellular carcinoma with chronically low glucose levels measured in the 20 s to 40 s and completely asymptomatic. Upon examination, findings of sympathetic hyperactivity in the setting of hypoglycemia were absent, and mentation was completely intact. This occurred in the absence of any states or medications known to induce hypoglycemia; concurrently, the patient demonstrated hyperphagia, suggesting increased metabolic demand in the setting of an immense, overwhelming tumor burden. During these hypoglycemic intervals, the patient’s coagulation profile, including PT and international normalized ratio, remained within normal limits, suggesting sufficient residual hepatic parenchyma and glucogenic capacity. The patient’s glucose remained extremely low, refractory to correction with multiple dextrose, D5, and D10 administrations. This suggests chronic systemic habituation to malignant cell consumption of serum glucose leading to adaptations to this hypoglycemia in highly metabolically active organs, such as the brain, heart, liver, and kidneys. Discussion and Conclusions: This report highlights the clinical utility of recognizing this metabolic state in the setting of advanced-stage malignancy with significant tumor burden and how it affects hospital glucose management. Its early recognition will lead to improvements in meeting the patient’s metabolic demands while avoiding paradoxical exacerbation of lactic acidosis when providing guideline-directed oncological treatment. This metabolic state holds the potential to function as a surrogate marker, in conjunction with serum markers and imaging studies, for clinical identification of otherwise clinically silent advanced stage malignancies and for treatment escalation.
Background/Objectives: The global adoption of minimally invasive surgery has generated extensive video repositories, creating new opportunities for data-driven surgical education and quality assessment. Automated surgical phase recognition enables objective trainee evaluation, standardized competency assessment, and systematic procedural documentation. However, class imbalance in surgical workflows, where certain phases comprise 30–35% of frames while others represent only 5–10%, remains a significant challenge. This imbalance causes models to underperform on underrepresented yet clinically important phases. Methods: A retrospective analysis of laparoscopic cholecystectomy videos is performed with the implementation of a frame—based deep learning framework to develop and validate a surgical phase recognition pipeline based on ResNet-50 architecture with transfer learning. The model was designed to extract features from surgical video frames and classify them into seven distinct phases, without incorporating temporal context. We used the Cholec80 dataset and applied class balancing techniques to address inherent class imbalance. Results: The model achieved a mean balanced accuracy of 91.80% across five folds with consistent performance across all surgical phases. Per-phase F1-scores ranged from 0.89 to 0.95, demonstrating balanced classification without significant performance degradation on underrepresented phases. The confusion matrix revealed prediction errors primarily among adjacent or visually similar phases, reflecting the inherent ambiguity of surgical phase transitions. In practical terms, the model correctly identified the surgical phase in more than 9 out of 10 frames, enabling reliable automated segmentation of the operative workflow. Conclusions: This study demonstrates that artificial intelligence can reliably analyze surgical video data, achieving consistent and accurate phase recognition in laparoscopic cholecystectomy.
Background: Clostridioides difficile infection (CDI) remains a leading cause of hospital-acquired infection. Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and has been associated with increased infectious susceptibility. However, whether non-cirrhotic MASLD independently worsens inpatient CDI outcomes and whether this differs across the MASLD spectrum remain unclear. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) 2017–2023, identifying adult hospitalizations with a principal diagnosis of CDI. Patients with cirrhosis and alcoholic liver disease were excluded. Propensity score matching (1:1) was performed for the primary MASLD vs. non-MASLD comparison in the principal-diagnosis CDI cohort. To evaluate whether outcomes differ across the MASLD spectrum, survey-weighted multivariable logistic regression was used to compare K76.0-coded (MASLD without steatohepatitis) and K75.81-coded (MASH) hospitalizations against non-MASLD/MASH hospitalizations within the principal-diagnosis CDI cohort. The primary outcome was in-hospital mortality; secondary outcomes included complications, healthcare utilization, and discharge disposition. Results: The principal-diagnosis CDI cohort comprised 76,103 discharges (weighted ~380,515). MASLD prevalence among non-cirrhotic CDI hospitalizations nearly doubled from 1.98% in 2017 to 3.74% in 2023 (OR per year 1.089; p < 0.001). After propensity score matching (1756 pairs), MASLD was not associated with significantly higher in-hospital mortality (OR 1.252; p = 0.574) or most adverse outcomes, but was associated with lower odds of non-routine discharge (OR 0.794; p = 0.003). In the matched utilization analysis, length of stay and total charges were not significantly different, although the adjusted pre-match analysis showed higher charges among MASLD hospitalizations (+$4431; p = 0.001). Within the same principal-diagnosis cohort, K76.0-coded MASLD (n = 1988) was associated with lower odds of acute kidney injury (aOR 0.821; p = 0.004) and non-routine discharge (aOR 0.805; p = 0.001). K75.81-coded MASH (n = 197) was independently associated with higher in-hospital mortality (aOR 2.840, 95% CI 1.154–6.985; p = 0.023) and peritonitis (aOR 4.136, 95% CI 1.543–11.082; p = 0.005), although confidence intervals were wide and the number of MASH-coded hospitalizations was modest. Conclusions: The prevalence of MASLD among CDI hospitalizations is rising. Non-cirrhotic MASLD without steatohepatitis does not independently worsen inpatient CDI outcomes after adjustment, whereas K75.81-coded MASH may identify a higher-risk subgroup with increased mortality and peritonitis, pending confirmation in larger cohorts. These findings suggest that hepatic inflammatory activity, rather than steatosis alone, may drive adverse CDI outcomes and support further investigation of MASLD phenotyping in CDI risk stratification.
Colonoscopy is the gold standard for diagnosing and monitoring gastrointestinal diseases. However, bowel preparation, rather than the procedure itself, appears to be the main driver of transient gut microbiota disruption. Available evidence suggests that microbiota alterations after bowel preparation and colonoscopy may persist for days to weeks and may be associated with changes in barrier function, microbial metabolism, and symptom burden in susceptible individuals. This review summarizes current knowledge on the mechanisms underlying microbial disruption induced by bowel preparation, including loss of diversity, shifts in key taxa, impairment of metabolic pathways, and alterations in immunomodulatory metabolites. It also discusses potential clinical consequences and highlights nutritional strategies that may support microbiota recovery, including dietary fiber, polyphenols, and microbiota-targeted approaches. This review also highlights current research gaps and the need for well-designed clinical studies in this field.
Background/Objectives: The study aimed to determine the demographic and clinical characteristics of patients with acute variceal bleeding and identify predictive factors associated with treatment outcomes. Methods: The retrospective study included 91 adults hospitalised for oesophageal and/or gastric variceal bleeding at the Department of Gastroenterology, University Hospital of Split. Data were collected on patients’ demographics, clinical characteristics and laboratory findings, as well as treatment outcomes, including length of hospital stay, need for repeat endoscopy, rebleeding, infection incidence, and six-week mortality. Results: Of the 91 patients included, 85.7% were male, and the mean age was 61 ± 9 years. Liver cirrhosis was present in 94.5% of patients, with alcoholic aetiology in 76.7% of cases. The median MELD-Na score was 15 (IQR 11–21), and more than 40% of patients were classified as Child–Pugh B. The median length of hospital stay was 8 days (IQR 5–10.5). Diagnostic EGD was performed in 94.5% of patients, with 80.2% undergoing the procedure within 12 h of admission. Vasoactive therapy was administered to 65.9% of patients, while antibiotic prophylaxis was given in 82.4%. In-hospital mortality was 16.5%, and the cumulative six-week mortality was 25.3%. The severity of liver disease (expressed by MELD-Na and Child–Pugh scores) was associated with a higher risk of in-hospital mortality (p = 0.0045 and p = 0.009, respectively). Early endoscopic intervention did not result in a statistically significant reduction in in-hospital mortality (8.7% vs. 23.5%; p = 0.104). The use of antibiotic prophylaxis, vasoactive drugs, and endoscopic ligation was not associated with lower rates of infections, repeated endoscopies, or mortality. Conclusions: There was a positive correlation between the severity of decompensated liver cirrhosis and in-hospital mortality. Early endoscopic intervention (within 12 h of admission) was not statistically significant in reducing mortality. The use of antibiotic prophylaxis was not associated with reduced mortality or lower incidence of infections. Vasoactive therapy did not significantly reduce the need for repeat endoscopic intervention. Endoscopic ligation did not decrease the likelihood of rebleeding during hospitalisation, in-hospital mortality, or the length of hospital stay.
Introduction: Clostridioides difficile (C. difficile) is a major cause of antibiotic-associated diarrhea and healthcare-associated infections, with rising global incidence and severity due to the emergence of hypervirulent strains. Methods: This review synthesizes recent literature on the epidemiology, pathogenesis, diagnostic approaches, and therapeutic strategies related to C. difficile infection (CDI). Sources were selected from peer-reviewed journals, clinical guidelines, and emerging research between 2020 and 2025. Results: Advances in molecular diagnostics have improved the accuracy and speed of CDI detection. New therapeutic options such as fidaxomicin offer narrower-spectrum antibiotic activity with reduced recurrence rates. Fecal microbiota transplantation (FMT) has emerged as a highly effective option for recurrent CDI. Preventive efforts, including antibiotic stewardship programs and early-phase vaccine trials, show potential in reducing infection rates. Discussion: The management of CDI is evolving rapidly with the integration of precision diagnostics, targeted therapies, and microbiome-based interventions. Preventive strategies are critical, particularly in healthcare settings where C. difficile persists in the environment. Continued research and coordinated public health efforts are essential to reduce disease burden, improve outcomes, and limit transmission. Conclusions: Clostridioides difficile infections remain a major healthcare challenge with rising incidence and recurrent cases. Fidaxomicin has become the preferred first-line therapy. Microbiota-based therapies (like FMT, Rebyota, and Vowst) and Lipopolysaccharide Binding Protein (LBP) are highly effective for recurrent CDI prevention. Diagnostic strategies have improved with multi-step testing, enhancing accuracy and reducing overtreatment. Future focus lies in vaccines, targeted antimicrobials, and stricter prevention through antibiotic stewardship and hygiene.
Background: The distance and angle between the superior mesenteric artery (SMA) and abdominal aorta play a role in the etiology of SMA syndrome. Retroperitoneal fat has been reported to affect both the distance and angle. Very few studies have reported the normal range of these measurements. The present study aimed to evaluate the reference values of the aortomesenteric angle (AMA) and aortomesenteric distance (AMD) in asymptomatic patients, as well as to determine the influence of age, sex, and anthropometric variables on these values. Methods: A retrospective cross-sectional study was conducted at Sultan Qaboos University Hospital. Computed tomography angiography scans of the abdomen from 141 Omani adult patients (aged ≥18 years) were included in the study. The morphometric data of the AMA and AMD were measured at the third part of the duodenum using sagittal and axial multiplanar reconstruction of CTA images. Patient data, including age, sex, height, weight, and BMI, were collected from the medical records. Statistical analyses included the Mann–Whitney U, Kruskal–Wallis H and Jonckheere–Terpstra J-T tests with significance set at p < 0.05. Results: The mean AMA was 57.16 ± 22.06°, and the mean AMD was 21.35 ± 10.25 mm. The AMD varied significantly across age groups (H = 17.29, p < 0.001) and showed a positive trend with increasing age (p = 0.001). Both AMA (p = 0.001) and AMD (p < 0.001) differed significantly across BMI categories, with significant increasing trends (p = 0.033 and p ≤ 0.001, respectively). No statistically significant differences were observed between sexes and study parameters (p > 0.05). Conclusions: The present study demonstrates that the reference values of the AMA and AMD are within the range of those reported in other populations. The variations in these values with BMI and age underscore the importance of individualized imaging interpretation and preoperative planning. The reported baseline data may enhance diagnostic accuracy and assist with surgical planning and radiological evaluation of suspected SMA syndrome.
Background/Objectives: Hepatocellular carcinoma (HCC) is the sixth most diagnosed cancer worldwide and a leading cause of cancer-related mortality. The majority of cases arise in the setting of chronic liver disease, where immune checkpoint inhibitors (ICIs) have emerged as a cornerstone of systemic therapy for advanced disease. However, durable clinical benefit remains limited to a minority of patients, and reproducible biomarkers of ICI response are lacking. The gut–liver axis—encompassing bidirectional exchange of microbial products, metabolites, bile acids, and immune signals—has emerged as a biologically plausible determinant of both hepatocarcinogenesis and immunotherapy response. This narrative review synthesises current evidence on the role of the gut–liver axis in HCC and ICI response and proposes a unifying conceptual framework to resolve discrepancies in the existing literature. Methods: A narrative review was conducted through systematic searches of PubMed/MEDLINE, Embase, and Web of Science. Studies were selected based on relevance to the biological mechanisms, clinical associations, and experimental models underpinning gut–liver–immune interactions in HCC, with particular emphasis on studies providing mechanistic insight, addressing immunotherapy outcomes, or highlighting temporal and context-dependent effects. Results: Observational studies consistently associate higher microbial diversity and enrichment of homeostasis-promoting taxa—including Akkermansia, Bifidobacterium, and short-chain fatty acid-producing Ruminococcaceae—with ICI responsiveness in HCC. Functional microbial outputs, particularly short-chain fatty acids and secondary bile acids, exert mechanistically grounded effects on hepatic immune tone and T cell activity that are biologically proximate to ICI effector pathways. Therapeutic modulation of the gut–liver axis through probiotics, dietary interventions, faecal microbiota transplantation, and antibiotic exposure demonstrates context-dependent effects on immune activation and ICI outcomes, with timing and disease severity emerging as critical determinants. The limited reproducibility of microbiome-immunotherapy associations across cohorts is attributable primarily to the dynamic and treatment-sensitive nature of the gut–liver axis rather than a fundamental lack of mechanistic coupling. Conclusions: The gut–liver axis in HCC is best understood as a dynamic, treatment-sensitive system rather than a static baseline trait. This reframing shifts emphasis from single-timepoint taxonomic signatures toward functional and longitudinal readouts and provides a coherent rationale for the heterogeneity observed across existing studies. Longitudinal clinical studies incorporating mechanistic endpoints and functional biomarker assessment are needed to translate this framework into clinically actionable strategies for patient stratification and microbiota-targeted intervention in HCC immunotherapy.
Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy. The identification and management of precursor lesions, particularly the increasingly common intraductal papillary mucinous neoplasms (IPMNs), pose a significant challenge, creating a profound clinical dilemma between intercepting pancreatic ductal adenocarcinoma and avoiding surgical overtreatment. This literature review aims to synthesize the latest evidence to facilitate a transition from purely morphology-based surveillance toward a biologically informed risk stratification paradigm. This approach could provide a personalized risk-stratification algorithm that optimizes therapeutic management and enables timely intervention for pancreatic cancer. By using PubMed, Embase, Scopus, and Web of Science, we analyzed and summarized key findings from recent literature (2020–2025), including cohort studies, mechanistic analyses, evidence-based guidelines, and systematic reviews on cyst fluid biomarkers (CEA panels, DNA/RNA sequencing), and emerging AI applications. Prospective and multicenter studies consistently report that NOD is independently associated with high-risk stigmata, cyst progression, and malignant transformation. Mechanistic research suggests a bidirectional interplay between the evolving neoplasia and pancreatic endocrine dysfunction. Updated guidelines underscore the need for more precise diagnostic algorithms. Recent work demonstrates that advanced cyst fluid markers—CEA panels, DNA/RNA sequencing, and multi-omic signatures—significantly improve diagnostic accuracy. Furthermore, explainable AI models show encouraging performance in predicting malignancy and assisting patient triage. Risk stratification in PCLs is shifting from morphology-based assessment toward integrated, multimodal approaches combining clinical, endocrine, imaging, molecular, and computational data. Recent evidence positions new-onset diabetes as a clinically accessible and biologically plausible marker of high-risk IPMNs. Similarly, molecular assays and AI-enhanced analytics provide an additional layer of diagnostic precision. The development of personalized risk prediction algorithms could improve early detection of malignancy while reducing unnecessary surgical resections.
Crohn’s disease (CD) is a chronic immune-mediated inflammatory disorder characterized by transmural inflammation and a progressive course that frequently leads to structural complications such as intestinal fibrosis. Fibrostenosing disease represents a major clinical challenge, affecting up to 50% of patients over time and often requiring surgical intervention. Despite advances in anti-inflammatory therapies, no effective treatments currently exist to prevent or reverse established fibrosis. Intestinal fibrosis arises from a dysregulated tissue remodeling process driven by excessive extracellular matrix deposition and persistent activation of mesenchymal cells, particularly fibroblasts and myofibroblasts. This process is orchestrated through complex interactions between immune and non-immune cells and mediated by key signaling pathways, including transforming growth factor beta (TGF-β1) and the TL1A/DR3 axis. Genetic susceptibility, notably variants in NOD2 and other fibrosis-related genes, contributes not only to disease risk but also to phenotype progression. Epigenetic mechanisms, particularly microRNAs such as the miR-29 and miR-200 families, further modulate fibrogenesis and represent promising non-invasive biomarkers. Additionally, intestinal dysbiosis and specific microbial signatures, including reduced short-chain fatty acid-producing bacteria and the presence of adherent-invasive Escherichia coli, play a critical role in promoting fibrotic pathways. Mesenteric adipose tissue, especially creeping fat, also contributes to fibrosis through immune and metabolic signaling. Emerging biomarkers related to collagen metabolism and advances in molecular profiling are improving early detection strategies. Novel therapeutic approaches targeting fibrogenic pathways, including anti-TL1A agents, show promising preliminary results. A deeper understanding of these mechanisms is essential to develop effective antifibrotic therapies and improve long-term outcomes in CD.
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging intervention that provides a minimally invasive approach to drainage of the gallbladder, showing promising results in treating acute cholecystitis (AC) and malignant biliary obstruction (MBO). This review summarizes the current applications of EUS-GBD and compares its clinical effectiveness with traditional methods such as percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic transpapillary gallbladder drainage (ET-GBD). Available evidence suggests that EUS-GBD may offer potential advantages in terms of success rates and complication profiles, particularly in patients who are not candidates for surgery or those at high surgical risk. The method is effective in reducing inflammation, alleviating symptoms from obstruction, and improving patient quality of life. This article also discusses the technical evolution of EUS-GBD, its indications, complications, and its comparative advantages over other drainage techniques. These observations suggest that EUS-GBD may represent a valuable addition to the therapeutic armamentarium for selected high-risk patients.
Background: Fecal calprotectin (FC) is a well-established, non-invasive biomarker of intestinal inflammation and is widely used to differentiate inflammatory bowel disease (IBD) from functional gastrointestinal disorders. Although enzyme-linked immunosorbent assays (ELISA) remain the reference method, rapid immunochromatographic tests (ICTs) offer important operational advantages for point-of-care (POC) diagnostics. However, variability in analytical performance among available ICTs remains a concern. Objective: This study aimed to evaluate the diagnostic accuracy of the CerTest Calprotectin one-step card (CerTest Biotec S.L., Zaragoza, Spain) in comparison with the Actim (R) Calprotectin lateral flow assay and the reference Calprest (R) ELISA (Eurospital Diagnostics, Italy). Methods: A total of 128 fresh stool samples from patients clinically suspected of IBD were analyzed in parallel using all three assays. For the reference ELISA (Calprest (R)), a cutoff value of >40 & micro;g/g was applied according to the manufacturer's instructions. For discrepant results between assays, a cutoff of 200 ng/mL (equivalent to 200 & micro;g hCp/g stool) was employed for ELISA Calprest (R) to resolve inconsistencies. The results of the lateral flow assays (CerTest (R) Calprotectin ICT and Actim (R) Calprotectin) were interpreted using their respective manufacturer-recommended thresholds. Diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ELISA as the reference standard. Agreement between methods was assessed using Cohen's kappa coefficient. Results: Using ELISA, 47 of 128 samples (36.7%) exceeded the 40 & micro;g/g cutoff. Compared with the Actim (R) assay, the CerTest card demonstrated a sensitivity of 88.0% (95% CI: 75.7-95.5), a specificity of 100.0% (95% CI: 95.4-100), and a strong agreement (kappa = 0.90). When compared with ELISA, the CerTest assay showed a sensitivity of 87.2% (95% CI: 74.3-95.2), a specificity of 96.3% (95% CI: 89.6-99.2), a PPV of 93.2%, an NPV of 93.2%, and a strong agreement (kappa = 0.85). Conclusions: The CerTest Calprotectin one-step card provides a rapid and reliable detection of fecal calprotectin, demonstrating a high sensitivity and specificity that are comparable to both other lateral flow assays and the ELISA reference method. These findings support the use of rapid immunochromatographic testing as a valuable tool for preliminary screening and clinical decision-making in patients suspected of IBD, while acknowledging that histology remains the gold standard for definitive diagnosis.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of global chronic liver disease, with a prevalence of approximately 30%. This review outlines the diagnostic transition from the exclusionary non-alcoholic fatty liver disease (NAFLD) framework to the affirmative MASLD nomenclature, which mandates the presence of at least one of five specific cardiometabolic risk factors (CMRFs) to prioritize active pathophysiology. Beyond hepatic complications, MASLD drives systemic metabolic failure, significantly elevating risks for type 2 diabetes, hepatocellular carcinoma, and cardiovascular disease, the primary cause of mortality in this cohort. Clinical management relies on a standardized, two-tier risk-stratification pathway for advanced fibrosis. Primary care triage utilizes the Fibrosis–4 (FIB–4) index; a score < 1.3 excludes advanced disease via a high negative predictive value, whereas indeterminate or high scores require secondary validation via vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) test to guide specialist referral. Although lifestyle modifications, principally a 7–10% weight reduction and Mediterranean diet adherence, remain foundational, management has transitioned toward disease-modifying pharmacotherapies. A pivotal breakthrough occurred with the 2024 FDA approval of resmetirom, a selective thyroid hormone receptor-beta (THR-β) agonist, for non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced fibrosis. Concurrently, the emergence of GLP-1 receptor agonists and multi-incretin mimetics offers a personalized, multi-target approach simultaneously addressing hepatic inflammation, glycemic control, and adiposity.
Background/Objectives: Non-steroidal anti-inflammatory drug (NSAID)-induced small bowel (SB) injuries have a variable clinical and endoscopic presentation. Limited data exists regarding their long-term outcomes, natural course, and discerning factors and differentiation from Crohn’s disease (CD). This study aims to evaluate the spectrum of presentation at capsule endoscopy (CE) and outcome in patients with documented NSAID use. Methods: We retrospectively evaluated all CEs performed at our hospital from 2014 to July 2023 in patients with documented NSAID use and with SB injury on CE. Patients’ demographics, clinical and endoscopic data, CE findings and outcome were recorded. Results: A total of 52 patients (33 females; median age 54 years, IQR 41–65) with documented NSAID use who underwent CE were included. The most prominent findings were erosions (56%) and superficial (46%) and deep ulcers (21%). Median follow-up time was 16 months (IQR 4–57). A total of 26 (50%) patients underwent repeat CE after a median interval of 12 months (IQR 10–15). In 77% (n = 20) of patients, SB injury was still present, with the majority (80%) having a Lewis score of < 790. Overall, compared to the previous CE, there were no changes in 35% of cases, worse appearance in 35%, and an improvement in 30%. SB CD was diagnosed in 7 out of 26 patients on follow-up. There were no statistically significant clinical or endoscopic differences between those with NSAID enteropathy and those diagnosed with CD. Conclusions: NSAID enteropathy presents with a wide spectrum of SB injuries, which cannot be differentiated on CE images alone. This highlights the importance of the clinical picture in the diagnostic process of these patients. Furthermore, our study demonstrated that a percentage of patients still exhibit some degree of SB damage despite cessation of NSAIDs for several months.
Objectives: This study aimed to investigate the impact of TDs on the survival of patients with locally advanced rectal cancer (LARC). Additionally, we propose a novel staging method that combines TDs and lymph node metastases (LNMs) to enhance prognostic accuracy. Methods: Patients with LARC were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database and a Sun Yat-sen University (SYSU) cohort. Propensity score matching (PSM) was utilized to minimize selection bias when evaluating TDs. We quantitatively stratified TDs counts and integrated them with regional LNMs to formulate a novel tumor node metastasis (TNM) staging system. Furthermore, a prognostic nomogram incorporating TDs was constructed and validated to predict survival. Results: Overall, 19,991 patients were included in the SEER database, with 2667 (13.3%) TDs-positive and 17,324 (86.7%) TDs-negative tumors. After PSM, multivariate Cox analysis reveals that TDs are an independent adverse prognostic factor (HR = 1.521, 95% CI: 1.366–1.693, p < 0.001). Patients with high-risk group (TDs > 4) at any TNM stage exhibit OS comparable to or worse than that of stage IIIC disease. For patients staged as T4N2M0, the high-risk group (TDs > 4) demonstrates OS equivalent to stage IV disease. The nomogram achieved C-indices of 0.713 (training cohort, n = 8586) and 0.789 (external validation cohort, n = 304), with AUCs of 0.774 (3-year) and 0.710 (5-year). Conclusions: The presence of TDs is associated with poorer OS, and integrating TDs with LNMs improves the accuracy of TNM staging. The nomogram (C-index = 0.789) provides enhanced prognostic stratification and survival prediction.
