Clinical Gastroenterology and Hepatology最新文献

{"title":"Comment on “Use of Artificial Intelligence for Duodenal Biopsy for Celiac Disease: Developing a Prediction Model for Histopathology Diagnosis”","authors":"Hakim Rahmoune,Nada Boutrid,Isra Benchoufi","doi":"10.1016/j.cgh.2026.09.055","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.055","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"25 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208631","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":"AGA Clinical Practice Update on Surveillance of Pancreatic Cystic Lesions and Hepatocellular Carcinoma in Older Adults: Expert Review","authors":"Koushik K. Das, Marina Serper, Santhi Swaroop Vege","doi":"10.1016/j.cgh.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.08.005","url":null,"abstract":"There is a demographic explosion of patients over the age of 60 expected in the United States and worldwide in the next 20 years. Pancreatic cystic lesions (PCLs) are frequently, incidentally identified in more than a quarter of patients above the age of 70 and while the vast majority of these lesions are indolent, some may develop into malignancy. Similarly, while the risk of hepatocellular carcinoma (HCC) is well established in patients with cirrhosis, the proportion of the elderly population with cirrhosis is rapidly expanding, especially in the setting of metabolic dysfunction–associated steatohepatitis. While multiple guidelines define these high-risk populations and provide recommendations on how and when to implement surveillance, these same guidelines rarely specify when to stop surveillance particularly in cases of advanced age or infirmity where the patient’s attributable mortality to the surveyed condition or fitness to receive invasive treatments is unclear. In this Clinical Practice Update (CPU), we review evidence-based, patient-centered, practical approaches to assess appropriateness for PCL and HCC surveillance in older individuals, weighing the balance of potential benefit vs harms and the impact of comorbidities and life expectancy on shared decision-making.","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"53 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149087106","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":"Characterizing the Benefits of Serial Ascitic Fluid Testing in Ambulatory Patients with Cirrhosis: A National Cohort Study.","authors":"Nadim Mahmud, Alexandra A McCullough, Siqi Zhang, Jinxuan Hao, Douglas E Schaubel, David E Kaplan, Marina Serper","doi":"10.1016/j.cgh.2026.09.029","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.029","url":null,"abstract":"<p><strong>Background and aims: </strong>Spontaneous bacterial peritonitis (SBP) is a life-threatening cirrhosis complication, yet guidance for sending fluid studies from outpatient paracentesis remains limited with unclear clinical impact. We aimed to characterize variation in ascitic fluid testing practices during outpatient paracentesis in cirrhosis and evaluate its association with short-term hospitalization and mortality.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 60,619 outpatient paracenteses among 4,467 patients with cirrhosis in the Veterans Health Administration from 2012-2023. Testing frequency was defined as the proportion of procedures in which diagnostic fluid studies for SBP were sent. Inverse probability treatment weighting and marginal proportional rates models were used to estimate associations with 30-day outcomes. Exploratory analyses evaluated interactions with Child-Turcotte-Pugh (CTP) score.</p><p><strong>Results: </strong>Diagnostic fluid studies were performed in 32.7% of outpatient paracenteses, however testing frequency varied by region, provider type, and facility. Compared to intermediate-frequency testing, both always (100%) and never (0%) testing strategies demonstrated lower 7-day hospitalization risk. In final models, patients tested at every paracentesis had the lowest rates of hospitalization (RR 0.65 vs. 50% testing frequency, 95% CI 0.58-0.72) and 30-day mortality (p<0.001), with associations favoring universal testing particularly among patients with higher CTP scores. These patients were also more likely to receive outpatient SBP antibiotics.</p><p><strong>Conclusion: </strong>Ascitic fluid testing practices for outpatient paracentesis vary substantially and are associated with differences in outcomes. Universal testing was associated with lower short-term hospitalization and mortality among patients with higher CTP scores, although these observational findings may reflect differences in patient selection and care delivery. Evaluation of standardized, risk-adapted testing protocols is warranted.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079902","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":"Upadacitinib Is Associated with the Lowest Risk of Treatment Failure Among Advanced Therapies for Ulcerative Colitis: A Real-World Administrative Claims Study.","authors":"Marianne Hupé, Dhruv Ahuja, Kuan-Hung Yeh, Sagar B Patel, Ronghui Xu, Sudheer Kumar Vuyyuru, Anna Silverman, Ashwin N Ananthakrishnan, Ola Olén, Shane W Goodwin, Vipul Jairath, Siddharth Singh","doi":"10.1016/j.cgh.2026.09.020","DOIUrl":"10.1016/j.cgh.2026.09.020","url":null,"abstract":"<p><strong>Background and aims: </strong>We compared the real-world effectiveness of advanced therapies (AT) in patients with ulcerative colitis (UC).</p><p><strong>Methods: </strong>Using the OptumLabs® Data Warehouse, a nationally representative US administrative claims database, we identified patients with UC initiating infliximab, adalimumab, vedolizumab, ustekinumab, tofacitinib, or upadacitinib between 2016 and 2023. The primary outcome was time to treatment failure (composite of IBD-related hospitalization, IBD-related surgery, or new corticosteroid prescription occurring >90 days after index date); treatment discontinuation and switching were treated as censoring events. The secondary outcome was proportion of quarters in corticosteroid-free disease stability. Confounding was addressed using multinomial propensity score-based inverse probability weighting with generalized boosted models and competing risk adjustment for mortality.</p><p><strong>Results: </strong>We identified 7,283 patients contributing 9,078 treatment episodes with initiation of infliximab (n=1,624), adalimumab (n=2,315), vedolizumab (n=3,164), ustekinumab (n=1,274), tofacitinib (n=547), or upadacitinib (n=154). After IPW adjustment, upadacitinib was associated with significantly lower risk of treatment failure compared with infliximab (HR 0.61 [95% CI, 0.42-0.88]), adalimumab (HR 0.59 [0.41-0.86]), vedolizumab (HR 0.69 [0.48-1.00]), ustekinumab (HR 0.65 [0.45-0.95]), and tofacitinib (HR 0.59 [0.40-0.88]). Vedolizumab was associated with lower risk of treatment failure compared with infliximab (HR 0.88 [0.79-0.98]) and adalimumab (HR 0.86 [0.78-0.95]). Upadacitinib had the highest adjusted proportion of quarters in corticosteroid-free disease stability (0.70 [0.63-0.77]). Findings were consistent in patients with and without prior AT exposure.</p><p><strong>Conclusions: </strong>In this large real-world UC cohort, upadacitinib was associated with the lowest risk of treatment failure and greatest corticosteroid-free disease stability compared with all other ATs evaluated.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079918","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":"Microscopic Colitis Beyond Histology: Biomarkers and Candidate Endotypes.","authors":"Sarah Bencardino, Antonio Lo Bello, Snehali Majumder, Robert Hughes, Santanu Das, Irene Zammarchi, Cecilia Lina Pugliano, Marietta Iacucci","doi":"10.1016/j.cgh.2026.09.028","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.028","url":null,"abstract":"<p><p>Microscopic colitis (MC) is a chronic inflammatory bowel disorder characterised by chronic watery diarrhoea in the setting of a normal or near-normal endoscopic appearance, with diagnosis relying on histologic evaluation of colonic biopsies. It is traditionally divided into lymphocytic colitis (LC), defined by an increased intraepithelial lymphocyte count, and collagenous colitis (CC), characterised by a thickened subepithelial collagen band. However, these categories do not fully capture the biological heterogeneity of the disease. Conventional histology remains crucial for diagnosis yet provides only a static morphological assessment of a biologically dynamic disease and offers limited prognostic or treatment-predictive information. Nevertheless, several clinically recognisable mechanisms and phenotypes already provide opportunities for patient stratification and, in selected cases, mechanism-informed management, including medication-associated MC, bile acid malabsorption, immune checkpoint inhibitor-associated MC, coexistent coeliac disease, and smoking-related risk. Beyond these clinically identifiable phenotypes, emerging OMICS evidence reveals heterogeneity across immune, epithelial barrier, stromal, microbial-metabolic, and genetic domains. Importantly, these molecular domains currently represent candidate mechanistic phenotypes rather than validated endotypes, as patient-level reproducibility and associations with disease trajectory or differential treatment response remain insufficiently established. This narrative review critically appraises current histological and molecular biomarkers in MC and their potential to improve disease stratification. Moreover, artificial intelligence-driven multimodal approaches may ultimately complement morphological assessment, improve patient characterisation and support the prediction of treatment response. We further define the validation steps required to translate emerging biological signatures into clinically meaningful endotypes and precision medicine.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073674","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":"Clinical and oncological outcomes of gastroduodenal neuroendocrine tumours after endoscopic resection in the Western setting - a target trial emulation.","authors":"Francisco Mendes, Rafael José Vieira, Maria Alípio, Gianluca Esposito, Francesco Panzuto, Elisabetta Dell'Unto, Enrique Rodriguez-Santiago, Alberto Velasco Hernandez, Ignacio Ruz Caracuel, Joana Camões Neves, Aníbal Ferreira, Frederic Moll, Mathieu Pioche, Elisa Gravito Soares, Pedro Amaro, Mariana Souto, Sofia Xavier, José Cotter, Sofia Ponte, Joana Alves Silva, Ricardo Küttner Magalhães, Luís Correia Gomes, Ana Laranjo, Rute Gomes, Caroline Soares, Ricardo Cardoso, Sunil Gupta, Michael Bourke, Nuno Gonçalves, Raquel Ortigão, Diogo Libânio, Alessandro Rimondi, Alberto Murino, Edward J Despott, Georgios Tribonias, Petros Zormpas, Alice Wartski, Jeremie Jacques, Paolo Cecinato, Giovanni Barbara, Romano Sassatelli, Giuliana Sereni, Katrin Marlene Schaffitzel, Stefan Goelder, Giulio Calabrese, Sandro Sferrazza, Ana Craciun, Miguel Moura, Tamas Tornai, David Tate, Georgios Mavrogenis, Benjamin Walter, Hugo Uchima, Hans-Peter Allgaier, Frieder Berr, Joana Frias, Margarida Marques, Irene Gullo, Fátima Carneiro, Dermot O'Toole, João Santos-Antunes, Bernardo Sousa Pinto, Guilherme Macedo, Rui Morais","doi":"10.1016/j.cgh.2026.09.021","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.09.021","url":null,"abstract":"<p><strong>Background and aims: </strong>Gastroduodenal neuroendocrine tumours (GD-NETs) are increasingly diagnosed. We aimed to (i) evaluate the long-term outcomes following endoscopic resection (ER) of GD-NETs, and (ii) compare the effectiveness of different ER techniques.</p><p><strong>Methods: </strong>We conducted a multinational retrospective study (24 centres, 10 Western countries) of consecutive patients undergoing ER of GD-NETs. The main evaluated outcomes were the frequency of curative resection and residual disease. Additional evaluated outcomes included R0 resection rate and local recurrence. We performed a target-trial emulation to compare endoscopic submucosal dissection (ESD), conventional endoscopic mucosal resection (C-EMR), and modified-EMR for these outcomes, while adjusting for potential cofounders.</p><p><strong>Results: </strong>We analysed 444 GD-NETs (304 gastric, 140 duodenal) from 434 patients (median follow-up of 36 months). The curative resection rate was 51.6% for gastric NETs and 33.6% for duodenal NETs. The residual disease rate was 19.0% for gastric NETs and 10.8% for duodenal NETs. GD-NET-related mortality was 0.2%. Target-trial emulation demonstrated that ESD, compared with C-EMR, achieved a significantly higher R0 resection (60.9% vs. 45.6%; risk difference=15.3 percent points [pp]) and lower risk of local recurrence at 4 (risk difference=12.0 pp) and 5 years (risk difference=14.3 pp). No significant differences were observed between the three ER approaches for other outcomes.</p><p><strong>Conclusion: </strong>GD-NETs were associated with frequent non-curative ER resections, but low recurrence and tumour-related mortality. ESD achieved a higher adjusted R0 resection rate and lower local recurrence compared with C-EMR. These results support the refinement of not only the curative resection criteria but also patient and ER technique selection.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073740","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":"Workforce Disruption in Gastroenterology: Playbooks for Unionization, Staffing Volatility, and Care-Team Redesign.","authors":"Sumant Inamdar, V Raman Muthusamy, Sri Komanduri, Harrison Reed, Arvind J Trindade","doi":"10.1016/j.cgh.2026.08.016","DOIUrl":"10.1016/j.cgh.2026.08.016","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849792","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":"Correction.","authors":"","doi":"10.1016/j.cgh.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.08.007","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036836","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.","authors":"Leonel Rodriguez","doi":"10.1016/j.cgh.2026.09.013","DOIUrl":"10.1016/j.cgh.2026.09.013","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024118","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":"From Gut to Brain: Integrating Gastropsychology Training Into Gastroenterology Fellowship.","authors":"Cameron Henneberg, Amitha Gumidyala, Larissa Muething","doi":"10.1016/j.cgh.2026.08.017","DOIUrl":"10.1016/j.cgh.2026.08.017","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029916","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}