Necator americanus infection is now rare in developed countries but remains an important cause of iron-deficiency anemia and abdominal symptoms in individuals with relevant epidemiological backgrounds. A 59-year-old Filipino man with long-standing unexplained iron-deficiency anemia was admitted to our hospital for epigastric pain associated with choledocholithiasis. Although biliary enzymes improved after endoscopic treatment, his abdominal pain persisted. Subsequent gastrointestinal investigations, including upper gastrointestinal endoscopy, colonoscopy, and small-bowel capsule endoscopy, revealed multiple parasites distributed throughout the gastrointestinal tract. Image-enhanced endoscopy using narrow-band imaging clearly improved visualization of the parasites compared with conventional white-light imaging, facilitating their identification and endoscopic removal. Genetic analysis of the extracted worms confirmed N. americanus infection. The patient was treated with pyrantel pamoate, which resulted in the resolution of abdominal symptoms and improvement of iron-deficiency anemia. Follow-up stool examination confirmed eradication of the parasite. This case highlights the importance of considering hookworm infection in patients with persistent iron-deficiency anemia and abdominal pain, even in developed countries. In addition, image-enhanced endoscopy and capsule endoscopy are valuable diagnostic tools for detecting hookworms and assessing their distribution within the gastrointestinal tract.

BACKGROUND Proton pump inhibitors (PPIs) affect hepatic drug metabolism via cytochrome P450 (CYP) enzymes, but the impact of potassium-competitive acid blockers (P-CABs), such as vonoprazan (VPZ), is not fully understood. This study aimed to evaluate whether maintenance-dose VPZ influences hepatic CYP activity using the 13C-aminopyrine breath test (13C-ABT). MATERIAL AND METHODS Twenty healthy subjects aged 18 years or older were recruited. Each participant underwent 13C-ABT under 2 conditions: without treatment (control) and after 8 days of 10 mg VPZ once daily. After oral administration of 100 mg 13C-aminopyrine, breath samples were collected before dosing and every 15-30 minutes for 3 hours. The delta-over-baseline (DOB) ratio, reflecting ¹³CO₂/¹²CO₂, was measured using infrared spectroscopy. RESULTS Nineteen participants (median age 24 years; 10 men, 9 women) completed the study. In the control condition, DOB values increased from 15 minutes after dosing and reached a peak at 49.7±35.8 minutes. The VPZ condition showed no significant differences in the DOB curve compared to the control condition (P=0.316). The area under the DOB curve over 3 hours was comparable between conditions, with a geometric mean ratio of 1.09 (90% confidence interval 0.97-1.23). Peak values and time to peak were also similar between 2 conditions. CONCLUSIONS Administration of 10 mg of VPZ did not significantly affect hepatic CYP activity as assessed by the 13C-ABT, suggesting that VPZ at a maintenance dose has minimal effect on hepatic drug metabolism and drug-drug interactions.

ABSTRACT Aim Fecal occult blood concentration, fecal calprotectin (FC) level, serum C‐reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) are valuable biomarkers for ulcerative colitis (UC). However, their clinical utility for longitudinal disease assessment remains unclear. This retrospective, observational study assessed correlations between biomarker changes and endoscopic activity scores in UC. Methods Spearman's rank correlation coefficient analysis was applied to examine the relationship between longitudinal variations in endoscopic activity scores, including the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity (UCEIS), and sum of Mayo endoscopic subscores (S‐MES), and corresponding biomarker changes in patients with UC. Results The study included 97 patients, contributing to 145 observation intervals (48 contributed two intervals each and 49 contributed one each). All endoscopic scores and biomarkers were significantly correlated with disease activity, with corresponding increases or decreases (p < 0.05). Changes in MES and S‐MES correlated most strongly with FC level changes (r = 0.62 and 0.66, respectively). Changes in the UCEIS exhibited the strongest correlation with fecal occult blood concentration changes (r = 0.67). Changes in fecal occult blood and FC (r = 0.55) and in serum CRP and ESR (r = 0.58) were strongly correlated. Conclusions All four biomarkers reflected endoscopic activity in UC. Changes in fecal occult blood concentration and FC level had stronger correlations with endoscopic score changes than blood biomarker concentration changes. FC assessment is valuable for monitoring inflammatory activity during remission maintenance, whereas fecal occult blood concentration reflects mucosal bleeding. Serum CRP level and ESR are useful adjunctive biomarkers, particularly in cases of increased disease activity.

Primary inflammatory myofibroblastic tumor (IMT) of the small intestine is rare, and its endoscopic characteristics remain poorly defined. We report a case of anaplastic lymphoma kinase (ALK)-positive small bowel IMT detected by capsule endoscopy (CE). A 24-year-old woman presented with epigastric pain. Contrast-enhanced computed tomography revealed a 2-cm mass in the small intestine. Double-balloon endoscopy was attempted but failed to reach the lesion. CE demonstrated a submucosal tumor-like protrusion with mild surface erythema and conspicuous whitish villous changes. Laparoscopy-assisted partial resection of the small intestine was performed, and histopathological examination with immunohistochemistry confirmed ALK-positive IMT. The postoperative course was uneventful, and no recurrence was observed during 8 months of follow-up. This case indicates that CE can provide clinically useful information for the evaluation of small bowel submucosal lesions beyond the reach of conventional endoscopy. IMT should be considered in the differential diagnosis of erythematous small bowel tumors in young patients.

Background/Objectives: Artificial intelligence (AI)-assisted endoscopy has shown high sensitivity for early gastric cancer detection; however, false-positive diagnoses remain a clinical challenge. This study aimed to evaluate the real-world diagnostic performance of a commercially available AI system and to identify factors associated with false-positive diagnoses, focusing on repeated AI evaluations and confidence stratification. Methods: This single-center retrospective study included 47 patients with 89 localized gastric lesions evaluated between March 2024 and March 2025. Endoscopic examinations were performed under white-light, non-magnified observation with repeated AI assessments of each lesion. The rates of "Consider biopsy" (B) judgments were calculated. Lesions with a B judgment rate of ≥50% were defined as AI-positive and classified into four AI confidence categories. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Factors associated with false-positive diagnoses were analyzed using penalized logistic regression. Results: The AI system demonstrated a sensitivity of 97.6% and an NPV of 95.7%, with a specificity of 45.8%. Pathology-positive rates decreased stepwise across the four AI confidence categories (p < 0.001). Among AI-positive lesions, low regional reproducibility, lesion size ≥ 30 mm, scar, and erosion were independently associated with false-positive diagnoses. In analyses restricted to non-neoplastic lesions, lesion size ≥ 30 mm remained significantly associated with false-positive diagnosis. Conclusions: In real-world clinical practice, a commercially available AI system provides high sensitivity for early gastric cancer detection. Incorporating confidence stratification and regional reproducibility into clinical decision-making may enhance the effective use of AI-assisted endoscopic diagnosis beyond binary interpretations.

Endoscopic submucosal dissection is the standard treatment for superficial esophageal squamous cell carcinoma. However, esophageal preservation following this procedure increases the risk of metachronous multiple cancers. Lugol-voiding lesion grade and alcohol-related genetic polymorphisms have been identified as risk factors, but the role of nonspecific mediastinal lymphadenopathy remains unclear. We retrospectively analyzed the data of 154 patients who underwent curative endoscopic submucosal dissection for esophageal squamous cell carcinoma at Hamamatsu University Hospital between 2015 and 2024. Pretreatment computed tomography was used to evaluate the Lugol-voiding lesion grade and nonspecific mediastinal lymphadenopathy. Associations with pathological findings and the development of metachronous multiple esophageal squamous cell carcinoma were assessed using Kaplan–Meier and Cox regression analyses. Nonspecific mediastinal lymphadenopathy was identified in 68 patients (59.6

Gastric squamous metaplasia is a rare condition whose clinical significance and malignant potential remain unclear. Most reported cases are located in the cardia and are continuous with the esophageal squamous epithelium. Ectopic gastric squamous metaplasia, defined as lesions discontinuous from the esophagus, is exceedingly rare, and its association with gastric neoplasms has not been well characterized. An 81-year-old woman with a history of Helicobacter pylori eradication underwent esophagogastroduodenoscopy for gastric cancer screening. A 20-mm discolored, slightly depressed lesion was identified on the greater curvature of the upper gastric body. The lesion was discontinuous from the esophageal mucosa and appeared as an iodine-unstained area. Magnifying endoscopy with narrow-band imaging revealed intrapapillary capillary loop–like vascular dilation with background coloration. Biopsy specimens suggested squamous metaplasia with reactive atypia, and en bloc resection was performed by endoscopic submucosal dissection. Postoperative histopathological examination identified mature stratified squamous epithelium consistent with gastric squamous metaplasia, and incidentally identified a well-differentiated adenocarcinoma confined to the mucosa adjacent to the metaplastic lesion without lymphovascular invasion. Immunohistochemical analysis revealed a linear arrangement of p63-positive cells along the basal layer of the metaplastic epithelium with a subset of Ki-67–positive cells indicating proliferative activity at the basal layer. p53 expression showed a wild-type pattern. We report an extremely rare case of ectopic gastric squamous metaplasia associated with well-differentiated adenocarcinoma. Although a direct histogenetic relationship between the two lesions remains uncertain, their coexistence raises important considerations regarding the pathogenesis of gastric squamous metaplasia and its potential clinical significance. The immunohistochemical findings may support a possible role of competitive epithelial replacement in the development of gastric squamous metaplasia. Careful endoscopic and histopathological evaluation is warranted when this rare lesion is encountered.

In real-world clinical settings, the clinical efficacy of vedolizumab (VDZ) in patients with ulcerative colitis (UC) remains unclear. In this study, we aimed to evaluate the efficacy of prednisolone (PSL)–VDZ combination therapy in patients with UC. Changes in the clinical activity index (CAI), blood test results, and the factors affecting VDZ rate and continuity were investigated. Patients who received at least 20 mg PSL within 1 week of VDZ induction were included in the VDZ + rapid PSL induction (VDZ + rPSL) group, and the remaining were assigned to the non-VDZ + rPSL group. Failure and non-failure in both groups were compared. We conducted a comparative analysis of 38 patients with UC treated with VDZ (VDZ + rPSL, n = 14; non-VDZ + rPSL, n = 24). The CAI in both groups improved significantly from week 2 to 24 compared with the pretreatment values (P < 0.01). Clinical remission and response at week 8 were significantly higher in the VDZ + rPSL group than in the non-VDZ + rPSL group (85.7

Purpose: Fecal calprotectin (FC) is a Crohn's disease (CD) biomarker, although the impact of disease duration on its accuracy remains unclear. This study was aimed at investigating the effects of CD disease duration on FC. Methods: In this prospective, single-center, cross-sectional study, we performed 113 endoscopies and biomarker measurements. Endoscopy results were assessed using the simple endoscopic score for Crohn's disease (SES-CD), with an SES-CD ≤ 2 defined as endoscopic remission (ER). Cohort 1 was divided into short-term and long-term disease groups. The associations of the SES-CD with C-reactive protein and FC were analyzed. Results: The correlation coefficient of FC and the SES-CD was 0.670 for all cases. In Cohort 1, the correlation coefficient of FC and the SES-CD was > 0.670 for all subgroups of the short-term disease group (≤ 20 years). The correlation coefficient of FC and CD was < 0.670 for all subgroups of the long-term disease group (> 20 years). In Cohort 2, the correlation coefficients were > 0.670 (0.808) for the 0-4-year disease group and < 0.670 for the 5-14- and 15-40-year disease groups. The receiver-operating characteristic analysis performed to predict ER of all cases resulted in an area under the curve (AUC) of 0.8443, with large AUCs of 0.907, 0.816, and 0.770 observed for the 0-4-, 5-14-, and 15-40-year disease groups, respectively. Conclusions: FC was affected by CD duration, and it may be a useful biomarker of CD, especially in patients with a short disease duration.

Background and study aims:Olympus's new endoscopic system, EVIS X1, features five-LED illumination and a novel complementary metal-oxide-semiconductor (CMOS) image sensor distinct from conventional charge-coupled devices (CCDs), potentially improving colorectal adenoma detection rates (ADRs). This study compared ADR and related indicators between the EVIS X1 system and the conventional EVIS LUCERA ELITE, a xenon-light system. Patients and methods:Of 4,915 colonoscopies performed between September 2020 and April 2023, 814 EVIS X1 and 953 LUCERA cases met inclusion criteria. After propensity score matching to balance baseline characteristics, 660 patients per group were analyzed. Outcomes included ADR, polyp detection rate (PDR), adenomas per colonoscopy (APC), and polyps per colonoscopy (PPC). Subgroup analysis assessed the impact of CMOS-equipped scopes within the X1 group. Results:ADR was slightly higher in the X1 group (36.1%) than the LUCERA group (32.1%), although not statistically significant ( P = 0.147). APC (0.77 vs. 0.61, P = 0.034) and PPC (0.95 vs. 0.75, P = 0.023) were significantly higher with X1. Within the X1 group, scopes with CMOS sensors achieved a significantly higher ADR (41.9%) compared with those without. Mean size of polyps detected was smaller with CMOS than with CCD scopes. Multivariate analysis identified age > 60 years, male sex, positive fecal occult blood test, and use of the X1 system with CMOS scopes as independent predictors of higher ADR. Conclusions:The EVIS X1 system may have the potential to improve adenoma detection, particularly when used with CMOS sensor-equipped scopes. These findings suggest potential benefits for colorectal cancer screening, although further large-scale studies are warranted for validation.

GOALS:This study aimed to investigate whether sepsis markers act as biomarkers of ulcerative colitis (UC) and Crohn's disease (CD). BACKGROUND:The identification of noninvasive biomarkers for inflammatory bowel disease (IBD) is advantageous. This prospective observational study investigated whether the sepsis markers, interleukin-6 (IL-6), presepsin (PSEP), procalcitonin (PCT), and pentraxin 3 (PTX3), act as biomarkers of UC and CD. STUDY:Patients with UC or CD underwent endoscopy and assessment of the abovementioned sepsis markers, C-reactive protein (CRP), and leucine-rich alpha 2 glycoprotein (LRG). We prospectively examined the association of these markers with clinical activity and endoscopic scores, including the Mayo endoscopic subscore (MES) and simple endoscopic score for Crohn's disease (SES-CD). RESULTS:Eighty-eight patients with UC and 49 patients with CD were enrolled. MES significantly correlated with LRG, CRP, IL-6, PSEP, and PTX3 in patients with UC. SES-CD significantly correlated with LRG, CRP, IL-6, and PTX3 in patients with CD. In UC, MES to 3 groups showed significantly higher LRG, CRP, and IL-6 levels than the MES 0 to 1 groups. The LRG, CRP, IL-6, PSEP, and PTX3 levels were significantly higher in the SES-CD ≥3 group than in the SES-CD ≤2 group. CONCLUSIONS:IL-6 in UC and IL-6, PSEP, and PTX3 in CD are potential biomarkers. Overall, our findings could promote better management of IBD.

The diagnostic performance and clinical utility of fecal calprotectin (FC), fecal immunochemical occult blood test (FIT), leucine-rich alpha-2 glycoprotein (LRG), C-reactive protein (CRP), and prostaglandin E-major urinary metabolite (PGE-MUM) as established biomarkers for ulcerative colitis (UC) were evaluated. Significant correlations were observed between the clinical activity index, Mayo endoscopic subscore (MES), and each biomarker. Among MES groups, fecal biomarkers demonstrated significant differences, except between MES 2 and MES 3. CRP and LRG showed significant differences, except between MES 1 and MES 2. PGE-MUM exhibited significant differences across all MES groups. Areas under the curve (AUCs) for receiver operating characteristic (ROC) analysis in predicting MES 0 or 1 were as follows: FC, 0.891; FIT, 0.853; LRG, 0.723; CRP, 0.747; PGE-MUM, 0.795. For predicting MES 0 alone, AUCs were as follows: FC, 0.885; FIT, 0.845; LRG, 0.708; CRP, 0.691; PGE-MUM, 0.732. In distinguishing between each MES group, fecal biomarkers exhibited the highest AUC and accuracy in differentiating MES 0 from MES 1, whereas LRG, CRP, and PGE-MUM were most effective in differentiating MES 2 from MES 3. In summary, in UC, fecal biomarkers effectively detect mucosal healing, whereas LRG, CRP, and PGE-MUM are valuable for assessing mucosal healing and active inflammation.

This study aimed to investigate whether sepsis markers act as biomarkers of ulcerative colitis (UC) and Crohn’s disease (CD). The identification of noninvasive biomarkers for inflammatory bowel disease (IBD) is advantageous. This prospective observational study investigated whether the sepsis markers, interleukin-6 (IL-6), presepsin (PSEP), procalcitonin (PCT), and pentraxin 3 (PTX3), act as biomarkers of UC and CD. Patients with UC or CD underwent endoscopy and assessment of the abovementioned sepsis markers, C-reactive protein (CRP), and leucine-rich alpha 2 glycoprotein (LRG). We prospectively examined the association of these markers with clinical activity and endoscopic scores, including the Mayo endoscopic subscore (MES) and simple endoscopic score for Crohn’s disease (SES-CD). Eighty-eight patients with UC and 49 patients with CD were enrolled. MES significantly correlated with LRG, CRP, IL-6, PSEP, and PTX3 in patients with UC. SES-CD significantly correlated with LRG, CRP, IL-6, and PTX3 in patients with CD. In UC, MES to 3 groups showed significantly higher LRG, CRP, and IL-6 levels than the MES 0 to 1 groups. The LRG, CRP, IL-6, PSEP, and PTX3 levels were significantly higher in the SES-CD ≥3 group than in the SES-CD ≤2 group. IL-6 in UC and IL-6, PSEP, and PTX3 in CD are potential biomarkers. Overall, our findings could promote better management of IBD.

Aims:Inflammatory bowel disease is characterized by various cytokine patterns. In this study, we aimed to investigate the markers that can distinguish Th1/Th2 cytokines in patients with inflammatory bowel disease. Methods and Results:In patients with inflammatory bowel disease treated at our hospital, the Th1/Th2 ratio (interferon-γ/interleukin-4 ratio), serum immunoglobulin E level, leucine-rich alpha 2 glycoprotein level, serum amyloid A level, and leukocyte fraction were measured simultaneously, and the relationship between them was examined. We enrolled 108 patients with Crohn's disease and 153 patients with ulcerative colitis. No significant difference was observed in the Th1/Th2 ratio between the ulcerative colitis and Crohn's disease groups. In the inflammatory bowel disease and Crohn's disease groups, the lymphocyte fraction was significantly correlated with the Th1/Th2 ratio (r = 0.154, p = 0.013 and r = 0.204, p = 0.0346, respectively). In ulcerative colitis, lymphocyte fraction and Th1/Th2 ratio were significantly correlated in the group without steroid treatment; however, no significant correlation was observed in the steroid-treated group. Serum immunoglobulin E, leucine-rich alpha 2 glycoproteins, and serum amyloid A levels did not significantly correlate with the Th1/Th2 ratio. Conclusions:The lymphocyte fraction may serve as a marker of Th1/Th2 cytokines and could be particularly useful in non-steroid-treated patients.

BACKGROUND:The goal of treatment for Crohn's disease (CD) is to achieve mucosal or transmural healing, and biomarker measurements are useful in monitoring disease activity and guiding treatment. This study aimed to investigate the utility of a new urinary biomarker, prostaglandin E-major urinary metabolite (PGE-MUM), in assessing CD activity. METHODS:The study involved 87 patients with CD who underwent endoscopic examination and measurements of 4 biomarkers: Prostaglandin E-major urinary metabolite, fecal calprotectin (FC), leucine-rich α2 glycoprotein (LRG), and C-reactive protein (CRP). Endoscopic activity was assessed by the Simple Endoscopic Score for Crohn's Disease (SES-CD). Correlations between the CD activity index (CDAI) and SES-CD with the 4 biomarkers were analyzed, and receiver-operating characteristic (ROC) analyses were performed to predict SES-CD ≧ 3. RESULTS:All 4 biomarkers showed significant correlations with both CDAI and SES-CD. The cutoff (area under the curve [AUC]) values for predicting SES-CD ≥ 3 were as follows: PGE-MUM, 25.2 µg/g Cr (0.800); FC, 257 mg/kg (0.816); LRG, 11.8 µg/mL (0.748); and CRP, 0.22 mg/dL (0.656). Subgroup analysis revealed significant correlations between PGE-MUM and SES-CD in both the L1 (small intestine only) and L2 + L3 (including large intestine) groups, with correlation coefficients of 0.654 and 0.586, respectively. In the L1 group, ROC analysis revealed that, among the 4 biomarkers, PGE-MUM had the highest AUC for predicting SES-CD ≥ 3, with a cutoff (AUC) of 33.1 µg/g Cr (0.861). CONCLUSIONS:PGE-MUM is a biomarker that can reflect endoscopic activity in patients with CD and may be particularly useful in small intestinal lesions.

Jejunoileal adenocarcinoma (JIAC) is a rare type of malignancy, the clinicopathological, genetic, and evolutionary characteristics of which have rarely been reported. In this study, 52 patients with JIAC and 182 patients with colorectal adenocarcinoma (CRAC) were recruited. Immunohistochemical analyses using 34 primary antibodies identified a novel subtype, JIAC with enteroblastic differentiation (JIAED). High MUC1 expression and low Cyclin D1 expression were identified as independent poor prognostic markers. Additionally, compared with mismatch repair deficient (dMMR)-CRAC, MSH2/MSH6 loss was more frequently observed in dMMR-JIAC. These results suggested essential molecular differences between JIAC and CRAC. To better understand these differences, we selected three dMMR-JIACs and eight mismatch repair proficient (pMMR)-JIACs and evaluated molecular evolutionary history by multi-regional whole-exome sequencing. Phylogenetic trees constructed for both pMMR-JIAC and dMMR-JIAC were more consistent with a "long trunk-short branches" structure than were those of CRAC, and the variant allele frequency peaks obtained for JIAC were higher than those of CRAC. Moreover, TP53 and ARID2 were identified as common driver gene mutations in pMMR-JIAC, arising during early tumorigenesis. Our evolutionary analysis revealed that pMMR-CRAC follows the principle of shifting from Darwinian to neutral evolution, generating intratumoral heterogeneity (ITH). In contrast, our findings on pMMR-JIAC and dMMR-JIAC demonstrate that both remain under Darwinian evolution, even in advanced stages, resulting in lower ITH. In summary, we identified a distinct pathohistological subtype of JIAC and highlighted the unique molecular evolutionary dynamics presented in JIAC, potentially lead to the better management and treatment strategies for patients with JIAC in the future.

Background Familial adenomatous polyposis (FAP) is an autosomal dominant colorectal tumour syndrome characterised by the formation of multiple adenomatous polyps throughout the colon. It is important to understand the extracolonic phenotype that characterizes FAP. Most previous case reports of patients with both FAP and intellectual disability (ID) have described deletions in all or part of chromosome 5q, including the APC locus. However, it remains unclear whether the ID phenotype in patients with FAP is due to APC disruption or another genetic defect in the deleted 5q region. Case presentation Patient of family 1 is a 32-year-old woman presented with > 500 colorectal adenomatous polyps, gastric fundic gland polyposis, several duodenal adenomas, and mild intellectual disability (ID). She had no known family history of the FAP phenotype or ID. By copy number trio analysis, a 15.4 Mb interstitial heterozygous de novo deletion including APC region was observed in 5q21.2. q22.3. The patient in family 2 was a 29-year-old man with approximately 50 colorectal adenomatous polyps, fundic gland polyposis in the stomach, non-ampullary adenomas in the duodenum, and mild ID. He had no family history of the FAP phenotype or ID. Using copy number trio analysis, a de novo 9.8 Mb heterozygous deletion was identified on 5q22.1. q23.1 which includes the APC region. Conclusions Based on previous reports and the present study, we narrowed down the 5p deletion region associated with ID in FAP. Further investigation is required to understand ID due to 5q stromal deletion.