Clinical Gastroenterology and Hepatology最新文献

{"title":"Avoidant/restrictive food intake across the gastrointestinal tract.","authors":"Karen Routhiaux, Karen Van den Houte, Lukas Balsiger, Karlien Raymenants, Cedric Van de Bruaene, Bert Broeders, Annelies Verheyden, Helen Burton-Murray, Michael P Jones, Tim Vanuytsel, Jan Tack","doi":"10.1016/j.cgh.2026.09.046","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.046","url":null,"abstract":"<p><strong>Background: </strong>Avoidant/restrictive food intake disorder (ARFID) is characterized by reduced dietary intake leading to medical and/or psychosocial impairment, independent of body image concerns. We aim to assess ARFID screening and characteristics in patients with gastrointestinal disorders versus healthy volunteers (HV), and its associations with symptom severity, extraintestinal symptoms and depression scores.</p><p><strong>Methods: </strong>We analyzed 92 HV and 467 patients from seven tertiary cohorts: irritable bowel syndrome (IBS, n=88), functional dyspepsia (FD, n=83), constipation (n=59), reflux (n=107), globus (n=45), dysphagia (n=37), and achalasia (n=48), grouped into non-esophageal (IBS, FD, constipation) and esophageal disorders (reflux, globus, dysphagia and achalasia). Assessments included Rome IV criteria, extraintestinal symptoms and depression scores (PHQ-12/9), and ARFID screening. ARFID+ was defined as NIAS+ (≥1 subscale cutoff: picky eating ≥10, appetite ≥9, fear ≥10) plus DSM-5 impairment. Odds ratios were derived from multiple logistic regression with three-level hierarchical approach adjusted for symptom severity, extra-intestinal, and depression symptoms.</p><p><strong>Results: </strong>Compared to HV, IBS (OR=15.0), FD (OR=10.6), constipation (OR=18.2), reflux (OR=5.2) and dysphagia (OR=7.0) were associated with ARFID+, whereas globus or achalasia were not. A higher prevalence of ARFID+ was observed in non-esophageal versus esophageal disorders (24% vs. 11%; OR=2.7, p<0.001), remaining significant after adjustments. Within non-esophageal disorders, depressive symptoms (OR=1.1) and food-related abdominal pain (OR=1.2) were independently associated with ARFID+, with fear-based food avoidance emerging as primary contributor to pain-related restrictive eating (β=0.3, p<0.001).</p><p><strong>Conclusion: </strong>ARFID symptoms are more prevalent across non-esophageal disorders compared to esophageal disorders. Within non-esophageal disorders, symptoms severity and food-related abdominal pain are associated with ARFID+, and mostly characterized by fear of aversive consequences.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referent Choice and Dose–Response Modeling Behind Moderate, Unsweetened Coffee","authors":"Xingyong Huang, Tao Han, Kai Zhang","doi":"10.1016/j.cgh.2026.08.040","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.08.040","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"13 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149087096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TREAT-TO-TARGET IN INFLAMMATORY BOWEL DISEASE: PROMISE, PERILS, AND THE PATH FORWARD","authors":"Siddharth Singh MD MS, Olga Maria Nardone MD PhD, Mariangela Allocca MD PhD, Yuhong Yuan MD PhD, Jakob Begun MD PhD, Jason K. Hou MD MS, Mohammad Shehab MD, Taku Kobayashi MD PhD, Vineet Ahuja MD DM, Axel Dignass, Vipul Jairath MBChB Dphil","doi":"10.1016/j.cgh.2026.09.033","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.033","url":null,"abstract":"Treat-to-target has become the organising framework for contemporary inflammatory bowel disease (IBD) management, yet its evidence base is less robust than its widespread endorsement might suggest. The approach rests on two equally essential pillars: defining the right therapeutic target, and adjusting treatment iteratively until that target is achieved. Over the past decade, the first pillar has advanced substantially: targets have deepened from symptomatic remission through endoscopic and histologic healing toward transmural and emerging molecular endpoints, supported largely by association data linking deeper remission to better long-term outcomes. The second pillar has received considerably less scrutiny. Completed randomised trials of iterative treatment adjustment have yielded mixed results in unselected populations, real-world monitoring remains inconsistent, and the most clinically pressing question, whether asymptomatic patients with residual inflammation benefit from optimising or switching advanced therapies, remains unanswered. In this review, we critically examine both pillars: the evolution and evidence base for treatment targets in IBD, the ability of current therapies to achieve them, the lessons from pivotal treat-to-target trials, and the barriers to real-world implementation. We propose a framework for individualising treat-to-target decisions based on disease history, inflammatory trajectory, therapeutic options, and patient preferences. Ongoing trials including QUOTIENT, VERDICT, and VECTORS may define whether the second pillar can be placed on as firm a footing as the first.","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"7 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149087099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in MASLD: A Three-Level Framework Across Clinical, Health-System, and Policy Decisions","authors":"Markos Kalligeros, Margarita Papatheodoridi, Linda Henry, Saleh A. Alqahtani, Zobair M. Younossi","doi":"10.1016/j.cgh.2026.09.034","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.034","url":null,"abstract":"Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent worldwide, yet most affected individuals remain undiagnosed, and pathways for non-invasive risk stratification and linkage to specialty care remain inconsistently implemented. With the emergence of pharmacologic therapies for metabolic dysfunction–associated steatohepatitis (MASH), accurate patient identification, disease staging, treatment selection, and longitudinal monitoring have become increasingly consequential. In this narrative review, we examine the evolving role of artificial intelligence (AI) across three levels of MASLD care, defined by where an AI output informs a decision and who acts on it: the individual patient, the health system, and health policy. At the patient level, machine-learning and deep-learning approaches have demonstrated potential applications in fibrosis assessment, histopathologic and imaging interpretation, multi-omics integration, treatment-response prediction, and hepatocellular carcinoma risk stratification. Across selected datasets, several models have performed comparably to or better than conventional non-invasive tests and expert interpretation, although no validated tool currently predicts treatment response before therapy. At the health-system level, AI may support population-level case finding, extraction of clinically relevant information from unstructured health records, prognostic assessment, and more efficient allocation of confirmatory testing and specialty care. At the policy level, AI-informed disease-burden modeling and risk stratification may help guide decisions regarding workforce capacity, resource allocation, reimbursement, and treatment coverage. However, most available studies are retrospective, frequently originate from single centers, and have limited external validation. No randomized trial has yet demonstrated that AI-guided management improves clinical outcomes in MASLD, while governance, transparency, and equity frameworks remain underdeveloped. Realizing the clinical value of AI will require prospective multicenter studies embedded within clearly defined MASLD care decisions, validation across genetically and socioeconomically diverse populations and health-system settings, standardized reporting and risk-of-bias assessment, and sustained attention to implementation, governance, and equity.","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149087100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFICACY AND SAFETY OF ADVANCED THERAPIES AS INDUCTION THERAPY FOR ULCERATIVE COLITIS: AN UPDATED SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS","authors":"Pablo A. Olivera,Juan S. Lasa,Siddharth Singh,Vipul Jairath,Mathurin Fumery,Bruce E. Sands,Silvio Danese,Laurent Peyrin-Biroulet","doi":"10.1016/j.cgh.2026.09.038","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.038","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"46 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Referent Choice and Dose - Response Modeling Behind Moderate, Unsweetened Coffee","authors":"Derin Celtik,Hyun-seok Kim","doi":"10.1016/j.cgh.2026.09.037","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.037","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"1 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Janus Kinase Inhibitors for Acute Severe Ulcerative Colitis: Comparing Upadacitinib to Tofacitinib and Rescue to Sequential Salvage therapy","authors":"R. Gilmore,R. Fernandes,N. Goetz,S. Chin,D. Con,P. De Cruz,K. Demase,M.P. Sparrow,S. Lucas,M. Garg,Z. Tuttle,N. Clark,D. Tassone,N. Ding,M. Loebenstein,A. Nguyen,G.T. Moore,L. Thin,K. MacFarlane,K.D. Lynch,D. Subhaharan,W. Mohsen,A. Haig,M. Day,L. White,J. Baker,K. Venugopal,B. Tandon,R.V. Bryant,A. Etchegaray,G. Tambakis,G. Walker,A. Pelecanos,J. Begun,Y.K. An","doi":"10.1016/j.cgh.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.10.001","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"480 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time abdominal pain – daily life trigger associations in IBS: a multicenter Experience Sampling Method Study","authors":"Michelle Bosman,Lisa Vork,Maaike Van Den Houte,Lukas van Oudenhove,Irina Midenfjord,Magnus Simren,Amanda Rodríguez-Urrutia,Javier Santos,Maria Raffaella Barbaro,Giovanni Barbara,Andrei Pop,Dan Dumitrascu,Rabia Topan,Qasim Aziz,Daisy Jonkers,Daniel Keszthelyi,John Bothmer,Maura Corsetti,Joanna Kruimel,Sander van Kuijk,Carsten Leue,Ad Masclee,Zlatan Mujagic,Silvia Muñoz,Emilio Quetglas,Josep Antoni Ramos,Hans Tornblom","doi":"10.1016/j.cgh.2026.09.042","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.042","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"39 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of mucosal healing by biologics is topographically comparable in proximal and distal small bowel Crohn's disease","authors":"Offir Ukashi,Uri Kopylov,Bella Ungar,Adi Talan Asher,Eyal Shachar,Tal Engel,Ahmad Albshesh,Adam Goldman,Doron Yablecovitch,Rami Eliakim,Shomron Ben-Horin","doi":"10.1016/j.cgh.2026.09.043","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.043","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"19 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REFINED-ASUC: an important framework requiring prospective validation","authors":"Alexander Elford,Shaji Sebastian,Neeraj Bhala","doi":"10.1016/j.cgh.2026.09.054","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.054","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"11 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}