INTRODUCTION:Helicobacter pylori is a major global health challenge, causing significant gastrointestinal diseases and contributing to gastric cancer risk. This study evaluated the safety and efficacy of esomeprazole-containing regimens for H. pylori eradication in treatment-naïve and previously treated patients. METHODS:This retrospective multicenter cohort study included 2,530 patients diagnosed with H. pylori infection. Patients received one of five esomeprazole-containing regimens for 14 days. Eradication was assessed 4-6 weeks post-treatment using stool antigen tests, urea breath tests, or histopathology. Analyses included intention to treat (ITT) and per protocol (PP). Demographics, socioeconomic status, prior treatment history, adverse events, and eradication rates were analyzed. RESULTS:Of 2,530 enrolled, 2,489 were analyzed per protocol. The overall eradication rate was 87.3% (ITT) and 88.7% (PP). Treatment-naïve patients achieved higher eradication rates (89.7%) compared with previously treated patients (85.2%, p = 0.003). Bismuth subcitrate-based (96.5% PP in naïve; 86.7% in experienced) and doxycycline-based regimens (92.3% PP in naïve; 84.3% in experienced) demonstrated the highest efficacy. Adverse events occurred in 34.9% of patients, with no severe events. Socioeconomic status influenced outcomes, with eradication rates of 90.8% in high, 89.4% in middle, and 80.0% in low SES groups (p = 0.0001). CONCLUSIONS:Esomeprazole-containing regimens are effective and well tolerated for H. pylori eradication. Bismuth- and doxycycline-based quadruple therapies achieved the highest eradication rates, particularly in treatment-naïve patients. Tailored strategies incorporating bismuth or quadruple therapy may benefit patients with prior treatment failures or from lower socioeconomic backgrounds. Further research should consider regional resistance patterns and prospective designs.

BACKGROUND:Helicobacter pylori infection is highly prevalent in Egypt and plays a central role in peptic ulcer disease, gastric cancer, and several extra-gastrointestinal disorders. Growing antibiotic resistance and emerging treatment options necessitate an updated national consensus to guide diagnosis and management strategies. AIM:To develop updated, evidence-based consensus recommendations for the management of H. pylori infection in Egypt, reflecting current international guidelines and regional clinical realities. METHODS:A multidisciplinary expert panel reviewed studies on H. pylori published since 2018, including Egyptian data and updated global guidelines. Statements were developed across five domains: epidemiology, diagnosis, treatment, gastric cancer, and extra-gastroduodenal associations. Each statement was discussed and voted upon; consensus was defined as ≥70% agreement. CONCLUSION:This 2026 Egyptian consensus provides practical guidance on optimizing H. pylori diagnosis and eradication. Key updates include support for high-dose PPIs and vonoprazan-based therapy, expanded use of bismuth regimens, and validation of high-dose dual therapy as an effective option. Adoption of these recommendations aims to improve eradication success, reduce complications, and guide future public health strategies in Egypt.

Background: Chronic diarrhea presents a diagnostic challenge due to its wide range of potential etiologies. Accurate diagnosis requires a comprehensive clinical evaluation, including history, physical examination, and targeted investigations.Methods: This cross-sectional analysis was carried out at the Gastroenterology and Hepatology Department of Kobbry El Kobba Medical Military Complex from September 2022 to June 2023. A total of 177 individuals with chronic diarrhea who underwent colonoscopy were enrolled. Clinical, demographic, laboratory, endoscopic, and histopathological data were collected and analyzed.Results: Out of 177 patients, 81.4% were male, with a mean age of 47.6±18.3 years. Colonoscopy revealed normal mucosal findings in 54.8% of participants. Histopathological evaluation showed that non-specific colitis/ileitis was the most prevalent diagnosis (40.7%), while adenocarcinoma was the least common (10.7%).Conclusions: Over half of the patients exhibited normal colonoscopic findings, yet 14.1% of these were found to have microscopic colitis on histology. This underscores the diagnostic value of routine mucosal biopsies even in the absence of visible abnormalities.

Abstract Background Esophageal varices can lead to morbidity and mortality in patients with chronic liver diseases. There is a debate about the frequency of endoscopic variceal band ligation sessions needed for the eradication of esophageal varices. We aimed to explore the optimal interval for endoscopic variceal band ligation sessions needed to obliterate esophageal varices. Methods This study enrolled 374 patients with liver cirrhosis indicated for endoscopic variceal band ligation. After the first variceal band ligation, patients were randomly assigned to one of four groups regarding the interval of subsequent band ligation sessions: group 1 (subsequent band ligation every week), group 2 (subsequent band ligation every 2 weeks), group 3 (subsequent band ligation every 3 weeks), and group 4 (subsequent band ligation every 4 weeks). Patients were followed until esophageal varices were eradicated, with complications reported as bleeding or post-banding ulcers. Results The studied groups showed insignificant differences in the mean number of sessions required to eradicate varices completely and the mean number of subsequent band ligation sessions. Post-banding ulcers were highly incident in group 1 (52.9%), followed by group 2 (22.8%), group 3 (8.0%), and group 4 (2.7%), with a statistically significant difference between the studied groups (p < 0.001). Bleeding after the first band ligation session was reported in only group 2 (1.3%). Conclusion A 4-week interval of elective variceal band ligation sessions achieved complete eradication with a lower rate of complications, particularly post-banding ulcers.

Background: One of the most prevalent acute abdominal surgical complications is acute cholangitis, which has a death rate of over 50% according to previous reports. The pathophysiology of acute cholangitis includes cholangiovenous reflux, bacterial buildup, and partial or total biliary blockage. Aim: To evaluate serum lipocalin-2 for its diagnostic utility in predicting the severity of acute cholangitis in patients hospitalized for endoscopic retrograde cholangio-pancreaticography. Subjects and methods: This study was conducted on 70 patients selected from the inpatient and outpatient clinics of Sayed Galal University Hospital, Cairo, Egypt, from May 2023 to June 2025. The studied patients were divided into two groups: group 1: 35 patients with acute cholangitis: calculous (1a) and non-calculous (1b); group 2: 35 patients without cholangitis: calculous (2a) and non-calculous (2b). Results: Significantly elevated LCN-2 levels in patients with cholangitis (348.71±109.49ng/L) compared to those without cholangitis. Conclusion: Elevated serum lipocalin-2 level in patients with acute cholangitis. The greater the degree of biliary tract inflammation and sepsis, the higher the serum lipocalin-2. Lipocalin-2 activity plays a potential role in biliary tract inflammation and disease progression, and has an accurate diagnosis for acute cholangitis (high sensitivity and specificity).

Background and aim Prophylactic pancreatic stent placement (PPSP) is recommended in high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis (PEP). Only a few societies, including the European Society of Gastrointestinal Endoscopy (ESGE), provide guidance on stent management, recommending assessment of spontaneous passage within 5-10 days and endoscopic removal, if retained. However, evidence on real-life adherence to these recommendations remains limited. The primary aim was to assess clinical practices related to PPS removal, methods, timing, and adherence to current guidelines. Methods An online 13-item survey was distributed via professional networks and social media between November 2024 and February 2025 to assess current PPSP and removal practices. Results In all, 322 valid responses were collected (Europe = 285; non-EU = 32; not disclosed = 5). Centers were stratified by annual ERCP volume (procedures/years): <300 (28.3%), 300-500 (31.7%), and >500 (40.1%). Approximately 40% of respondents did routinely place a PPS in high-risk situations. PPSP was most often inserted after >2 pancreatic duct cannulations (83.5%) or papillectomy (58.7%). Straight 5 Fr, 5 cm stents predominated (54% and 85.4%, respectively). Removal practices varied: 62.7% performed endoscopic retrieval, 47% within one week and 41.6% within four weeks; 55% had no fixed follow-up schedule. Complications of nonremoval were reported by 22.7% of the centers-mainly pancreatitis (63%)-yet 96% considered these rare. Overall, 31.7% followed ESGE or internal guidance, while 23.6% reported following no guidance. Conclusions The PIRATE survey reveals that most centers apply heterogenous follow-up removal practices despite presence of guidelines.

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.

BACKGROUND AND AIMS:A recent Delphi statement proposed an adapted term from metabolic dysfunction-associated fatty liver disease (MAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD), substituting "fatty" with "steatotic", as the former was claimed to be stigmatizing. In this cross-sectional study, we aimed to investigate this and understand stigma and awareness among fatty liver disease patients. METHODS:A semi-structured interview consisting of questions was carried out with patients to get an understanding of their knowledge of fatty liver disease and their opinions on the terminology used for its diagnosis. RESULTS:Surveys were completed by 222 fatty liver disease patients in a written questionnaire. Out of the participants, only 84 (37.8%) and 37 (16.7%) of patients believed that cirrhosis or hepatocellular carcinoma might result from fatty liver disease, while 82 (36.9%), 87 (39.2%), and 52 (23.4%) of patients thought fatty liver was connected to diabetes or cardiovascular disease. 189 individuals (85.1%) said that including the word "alcohol" in the name of a condition carries a stigma. Conversely, 177 (79.7%) of participants said that they do not consider the term "fatty" to be stigmatizing. Additionally, the degree of awareness of the disease's consequences seems very low. 159 (71.9%) and 180 (81.1%) participant expressed their lack of knowledge on how the disease can be diagnosed or treated, respectively, and 146 (65.8%) of the participants showed a desire to acquire knowledge about the impact of fatty liver disease on their well-being and health. CONCLUSIONS:A part of our concern about fatty liver disease awareness without trivialization. The use of the word "fat" in the nomenclature of fatty liver disease linked with metabolic dysfunction is not perceived to be stigmatizing. The suggested change to MASLD does not seem warranted, at least if the stigma is the main concern.

Background: Telemedicine is a newly emerging way in the Egyptian healthcare system, especially after the COVID-19 epidemic; however, understanding its practice and improving its use is critical for sustainability. Objectives: The present study aimed to assess the current situation of telemedicine practice among physicians working in different Egyptian healthcare facilities and its potential for improvement.Methods: A cross-sectional study was conducted among physicians of different specialties working in various Egyptian healthcare facilities using a constructed questionnaire.Results: Sixty-two percent of the physicians were telemedicine users, and 39.71% used telemedicine for the first time after COVID-19. Nearly 44% of the physicians reported that it was easy to learn and use telemedicine, and 32.25% revealed that it was easy to interact with the patient while using telemedicine. 33.66% of the physicians reported being satisfied with the telemedicine experience. Nearly three-quarters of the physicians reported many benefits of telemedicine use. The most perceived barriers to telemedicine use were increased liability for medical errors (62.1%), ethical barriers (58.6%), and cultural barriers (55.9%). Concerning the use of telemedicine among different specialties, 66.1%, 58.7 %, and 55.7% of telemedicine users were from the internal medicine specialty, surgical specialty, and other specialties, respectively. Regarding gender, 68.1% of telemedicine users were males (p-value <0.05). In addition, 72.2% of telemedicine users worked in the private health sector (p-value <0.05).Conclusion: The current situation of telemedicine adoption among Egyptian physicians indicates a significant adoption after COVID-19. Reported barriers to expanding the adoption of telemedicine services included increased liability for medical errors, ethical barriers, and cultural barriers.

Background:Given the limited understanding of individuals' positive gains, this study aimed to identify these gains that could be leveraged by policymakers to enhance future health and societal resilience. Methods:We used a global qualitative approach to survey adults over 18 from 30 countries across six World Health Organization (WHO) regions, who detailed up to three personal positive gains from COVID-19 pandemic via an open-ended question. Inductive thematic analysis was employed to identify main themes, and quantitative methods were used for demographic and regional comparisons based on the percentage of responses for each theme. Results:From 35 911 valid responses provided by 13 853 participants, six main themes (one negative theme), 39 subthemes, and 673 codes were identified. Five positive gain themes emerged, ordered by response frequency: 1) improved health awareness and practices; 2) strengthened social bonds and trust; 3) multi-dimensional personal growth; 4) resilience and preparedness building; 5) accelerated digital transformation. The percentage of responses under these themes consistently appeared in the same order across various demographic groups and economic development levels. However, there were variations in the predominant theme across WHO regions and countries, with either Theme 1, Theme 2, or Theme 3 having the highest percentage of responses. Although our study primarily focused on positive gains, unexpectedly, 12% of responses (4304) revealed 'negative gains', leading to an unforeseen theme: 'Distrust and emerging vulnerabilities.' While this deviates from our main topic, we retained it as it provides valuable insights. Notably, these 'negative gains' had a higher percentage of responses in areas like Burundi (94.1%), Rwanda (31.8%), Canada (26.9%), and in the African Region (37.7%) and low-income (43.9%) countries, as well as among non-binary individuals, those with lower education, and those facing employment challenges. Conclusions:Globally, the identified diverse positive gains guide the domains in which health policies and practices can transform these transient benefits into enduring improvements for a healthier, more resilient society. However, variations in thematic responses across demographics, countries, and regions highlights need for tailored health strategies.

Metabolic dysfunction-associated fatty liver disease (MAFLD) now affects roughly one-quarter of the world's population, reflecting the global spread of obesity and insulin resistance. Reframing non-alcoholic fatty liver disease as MAFLD emphasizes its metabolic roots and spotlights the gut-liver axis, where intestinal dysbiosis acts as a key driver of hepatic injury. Altered microbial communities disrupt epithelial integrity, promote bacterial translocation, and trigger endotoxin-mediated inflammation that accelerates steatosis, lipotoxicity, and fibrogenesis. Concurrent shifts in bile acid signaling and short-chain fatty acid profiles further impair glucose and lipid homeostasis, amplifying cardiometabolic risk. Epidemiological studies reveal pervasive dysbiosis in MAFLD cohorts, linked to diet quality, sedentary behavior, adiposity, and host genetics. Newly developed microbiome-derived biomarkers, advanced elastography, and integrated multi-omics panels hold promise for non-invasive diagnosis and stratification, although external validation remains limited. In early trials, interventions that re-engineer the microbiota including tailored pre-/pro-/synbiotics, rational diet patterns, next-generation fecal microbiota transplantation, and bile-acid-modulating drugs show encouraging histological and metabolic gains. Optimal care will likely couple these tools with weight-centered lifestyle programmes in a precision-medicine framework. Key challenges include inter-ethnic variability in microbiome signatures, the absence of consensus treatment algorithms, and regulatory barriers to live biotherapeutics. Rigorous longitudinal studies are required to translate mechanistic insight into durable clinical benefit and improve patient-centered outcome measures.

Background We aimed to identify the central lifestyle, the most impactful among lifestyle factor clusters; the central health outcome, the most impactful among health outcome clusters; and the bridge lifestyle, the most strongly connected to health outcome clusters, across 29 countries to optimise resource allocation for local holistic health improvements. Methods From July 2020 to August 2021, we surveyed 16 461 adults across 29 countries who self-reported changes in 18 lifestyle factors and 13 health outcomes due to the pandemic. Three networks were generated by network analysis for each country: lifestyle, health outcome, and bridge networks. We identified the variables with the highest bridge expected influence as central or bridge variables. Network validation included nonparametric and case-dropping subset bootstrapping, and centrality difference tests confirmed that the central or bridge variables had significantly higher expected influence than other variables within the same network. Results Among 87 networks, 75 were validated with correlation-stability coefficients above 0.25. Nine central lifestyle types were identified in 28 countries: cooking at home (in 11 countries), food types in daily meals (in one country), less smoking tobacco (in two countries), less alcohol consumption (in two countries), less duration of sitting (in three countries), less consumption of snacks (in five countries), less sugary drinks (in five countries), having a meal at home (in two countries), taking alternative medicine or natural health products (in one country). Six central health outcomes were noted among 28 countries: social support received (in three countries), physical health (in one country), sleep quality (in four countries), quality of life (in seven countries), less mental burden (in three countries), less emotional distress (in 13 countries). Three bridge lifestyles were identified in 19 countries: food types in daily meals (in one country), cooking at home (in one country), overall amount of exercise (in 17 countries). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P< 0.05). Conclusions In 29 countries, cooking at home, less emotional distress, and overall amount of exercise emerged as common central lifestyle, health outcome, and bridge lifestyle factors, respectively. However, notable regional variations necessitate tailored interventions and resource allocations to effectively address unique local key variables and promote holistic health in each locale. The study's cross-sectional design and self-reported data may limit generalisability, emphasising the need for cautious interpretation and further longitudinal research.

BACKGROUND:Helicobacter pylori resistance to antibiotics commonly used in eradication regimens is increasing dramatically in many locations; new strategies are needed to manage this infectious disease. OBJECTIVE:This study's aim was to collect and update information on antibiotic resistance (AR) rates in H. pylori as well as current strategies for H. pylori management, including public health issues, from a global perspective. DESIGN:An international survey was conducted in 31 countries on 6 continents to address key issues concerning the management of H. pylori-related AR. Individual aspects included the prevalence of AR for specific antibiotics, antibiotic susceptibility testing (AST) in different healthcare systems, availability of drugs, reimbursement issues and strategies for H. pylori AR surveillance. RESULTS:Resistance to the most effective antibiotics used in H. pylori eradication regimens is increasing globally, with clarithromycin and levofloxacin resistance exceeding 15% in 24/31 and 18/31 countries, respectively. Amoxicillin remains an exception, with resistance rates under 2% in 14/31 countries; though African countries have reported amoxicillin resistance rates of over 90%. Bismuth-based treatment regimens are the most effective and are recommended as first-line treatment in several countries. However, more than 1 billion inhabitants worldwide have no access to bismuth-based regimens. PCR-based tests for AR are used in 16/26 countries but are reimbursed in only 4, while next generation sequencing-based tests are available, but not reimbursed, in 3 countries. In 22/26 countries only culture-based methods are available (reimbursed in 9/26 countries). AR surveillance programmes have only been established in 4/26 countries. Therefore, in most countries, empirical therapy with the most effective local regimen available locally is practiced. CONCLUSION:The dramatic global rise in H. pylori antibiotic resistance requires an urgent revision of current management strategies. Possible solutions include AST-based selection of effective treatment regimens, identification of novel combinations of existing drugs and exploration of novel drugs.

Abstract Acute bacterial meningitis (ABM) is an emerging disease with high morbidity and mortality. It is a globally serious disease and is considered endemic in Egypt, affecting all age groups and being common in low-standard and overcrowded areas. Early and appropriate antimicrobial therapy is crucial for suspected bacterial meningitis, even before the causative pathogen is identified. This is because definitive laboratory confirmation can take several days and may not always be successful. Those who do recover, especially if there was delayed appropriate intervention, can have permanent disabilities, such as brain damage, hearing loss, and learning disabilities. Rapid intervention in such cases is mandatory, which is not easy in countries with limited income due to weak capabilities and resources. Therefore, we are in dire need of making an Egyptian consensus that suits our country as a low-resource one, in order to facilitate and speed up the process of managing such cases. This consensus-based paper is under the supervision of the Egyptian Society of Fever comprising clinicians, microbiologists, epidemiologists, and public health representatives. They convened to assess the current situation and develop a new consensus on the management of ABM, taking into consideration the human and health potential of Egypt. All the experts who participated in writing and directing this conference belong to different Egyptian universities, and their main clinical interest was infectious diseases. Others work in fever hospitals that are affiliated with the Ministry of Health. They collaborated on the statements` writing, reviewing, and voting to reach the final version. Each statement was voted as strongly, moderately, or weekly recommended. Each statement should have a predefined score of 80% agreement to be accepted and reported in this consensus. Conclusion This Egyptian consensus model offers a feasible and context-specific approach to managing ABM, aiming to improve outcomes and reduce disparities in resource-limited settings.

Background Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt.Aim We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt.Methods This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt.Results 5910 patients aged 38-63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them.Conclusion This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

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No specific treatment for COVID-19 infection is available up till now, and there is a great urge for effective treatment to reduce morbidity and mortality during this pandemic. We aimed to evaluate the effect of combining chloroquine/hydroxychloroquine (CQ/HCQ) and zinc in the treatment of COVID-19 patients. This was a randomized clinical trial conducted at three major University hospitals in Egypt. One hundred ninety-one patients with a confirmed diagnosis of COVID-19 infection were randomized into two groups: group I (96) patients received both HCQ and zinc, and group II (95) received HCQ only. The primary endpoints were the recovery within 28 days, the need for mechanical ventilation, and death. The two groups were matched for age and gender. They had no significant difference regarding any of the baseline laboratory parameters or clinical severity grading. Clinical recovery after 28 days was achieved by 79.2% in the zinc group and 77.9% in zinc-free treatment group, without any significant difference (p = 0.969). The need for mechanical ventilation and the overall mortality rates did not show any significant difference between the 2 groups either (p = 0.537 and 0.986, respectively). The age of the patient and the need for mechanical ventilation were the only risk factors associated with the patients’ mortality by the univariate regression analysis (p = 0.001 and < 0.001, respectively). Zinc supplements did not enhance the clinical efficacy of HCQ. More randomized studies are needed to evaluate the value of adding zinc to other therapies for COVID 19. ClinicalTrials.gov Identifier: NCT04447534