Digestive and Liver Disease最新文献

{"title":"Pattern-based histologic approach in colitis without chronic architectural damage: GIPAD recommendations.","authors":"Iacopo Panarese, Paola Spaggiari, Luca Albarello, Giovanni Arpa, Alessandro Gambella, Federica Grillo, Alessandro Vanoli, Luca Mastracci, Carla Giordano, Francesco Vasuri, Rossano Ambu, Claudia Mescoli, Graziana Arborea, Fabrizio Bossa, Edoardo Vincenzo Savarino, Alessandro Caputo, Luca Reggiani-Bonetti, Francesca Rosini, Antonio Di Sabatino, Matteo Fassan, Paola Parente","doi":"10.1016/j.dld.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.008","url":null,"abstract":"<p><p>In patients presenting with intestinal symptoms who undergo colonoscopy with mucosal sampling, the pathologist plays a central role in identifying the underlying etiology in order to guide appropriate clinical management. However, common intestinal symptoms such as diarrhea are shared by a broad spectrum of conditions, including infectious diseases, functional disorders (e.g., irritable bowel syndrome), inflammatory bowel disease (IBD), drug-induced injury, and metabolic disorders (e.g., diabetes mellitus). Although serological biomarkers may support the diagnostic workup, they are frequently insufficient to establish a definitive diagnosis. Moreover, endoscopic examination may fail to detect significant mucosal abnormalities even when histology reveals disease-specific patterns, as occurs in lymphocytic and collagenous colitis (i.e., microscopic colitis). In this complex diagnostic landscape, histomorphological evaluation represents a crucial element, allowing integration of microscopic findings with clinical and endoscopic data to reach an accurate interpretation. In recent years, accumulating evidence has demonstrated that similar histological patterns of intestinal injury-such as IBD-like architectural and inflammatory changes or eosinophil-rich infiltrates-may be associated with different underlying etiologies. This overlap is particularly relevant in patients treated with novel oncologic therapies, including tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs), and emerging treatments such as chimeric antigen receptor T-cell (CAR-T) therapy. In addition, in daily practice, pathology request forms often lack essential clinical, endoscopic, and laboratory information, further increasing the risk of diagnostic misinterpretation and inappropriate disease attribution. To address these challenges, the Italian Group of Digestive Disease Pathology (GIPAD) proposes a pattern-based histological approach for reporting mucosal damage in patients with colitis. In this first paper, we focus on non-chronic patterns of mucosal injury and discuss their principal differential diagnoses, with the aim of supporting standardized reporting and improving clinicopathological correlation.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant polycystic liver disease presenting with rapid abdominal enlargement and jaundice.","authors":"Binglin Lai","doi":"10.1016/j.dld.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.012","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic portal venous gas: An ominous sign of death.","authors":"Binglin Lai","doi":"10.1016/j.dld.2026.04.010","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.010","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sotorasib plus panitumumab and 5-fluorouracil in first-line treatment of patients with unresectable KRAS G12C mutated colorectal cancer unfit for a doublet/triplet chemotherapy: ENGIC 01 - PRODIGE 107 - FFCD 2306 - COLOSOTO trial.","authors":"Adrien Grancher, Matteo Landi, Alexej Ballhausen, Rosario Vidal Tocino, Annabel Alig, Ada Taravella, Karine Le Malicot, Emilie Soularue, Claire Gallois, Meriem Guarssifi, Manon Pelkowski, Marta Beltran, Lisa Kochen, Laura Delliponti, Julien Taïeb, Javier Sastre, Dominik Paul Modest, Chiara Cremolini, Thibault Mazard, David Tougeron","doi":"10.1016/j.dld.2026.04.009","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.009","url":null,"abstract":"<p><strong>Introduction: </strong>5-fluorouracil (5-FU) ± targeted therapy is a standard of care in frail/elderly patients with an unresectable colorectal adenocarcinoma (CRC) in first-line setting. Panitumumab plus sotorasib combination (KRAS G12C inhibitor) are promising in advanced line in KRAS G12C-mutated CRC. Here we assess the safety and efficacy of 5-FU combination with panitumumab and sotorasib as first-line treatment in frail/elderly patients with unresectable KRAS G12C-mutated CRC.</p><p><strong>Methods: </strong>In this ENGIC 01 - PRODIGE 107 - FFCD 2306 - COLOSOTO multicenter, open-label, prospective single-arm phase II trial, the main inclusion criteria are adult patients with unresectable locally advanced or metastatic KRAS G12C-mutated CRC, unfit for a doublet/triplet chemotherapy. All patients will receive 5-FU plus panitumumab and sotorasib in 2-week-cycles until progression or intolerance. The primary endpoint is 8-months progression-free survival (PFS). The secondary endpoints include median PFS, disease control rate, time to progression, overall survival, best objective response rate, duration of response, safety profile, quality of life and geriatric assessment. A 70% 8-months PFS is expected (H₀ <50%), and 37 patients will need to be included.</p><p><strong>Perspectives: </strong>Treatment with 5-FU plus panitumumab and sotorasib could be a promising alternative to 5-FU ± targeted therapy in first-line setting in frail/elderly patients with unresectable KRAS G12C-mutated CRC.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term effects of faecal immunochemical test screening on colorectal cancer incidence by tumour site.","authors":"Lauro Bucchi, Silvia Mancini, Flavia Baldacchini, Alessandra Ravaioli, Orietta Giuliani, Rosa Vattiato, Federica Zamagni, Debora Canuti, Priscilla Sassoli de Bianchi, Fabio Faccini, Maria Michiara, Lucia Mangone, Giuliano Carrozzi, Paolo Pandolfi, Stefano Ferretti, Annibale Biggeri, Fabio Falcini","doi":"10.1016/j.dld.2026.03.019","DOIUrl":"https://doi.org/10.1016/j.dld.2026.03.019","url":null,"abstract":"<p><strong>Background and aims: </strong>The supposedly lower sensitivity of the faecal immunochemical test (FIT) for proximal colon tumours is an open question. We compared the observed annual (1997-2017) tumour site-specific incidence rates of colorectal cancer (CRC) in the target population (over 1,300,000 aged 50-69 years) of an Italian regional FIT screening programme with the rates that would be expected in the absence of screening.</p><p><strong>Methods: </strong>For proximal colon cancer, the expected rates were estimated with an age-period model in both sexes combined, showing an increasing trend. For distal colon cancer and rectal cancer, the best fit to the observed rates was provided by an age-period-cohort model (men) and an age-period model (women), both showing a stable trend.</p><p><strong>Results: </strong>In the 11th and 12th full years of screening, the decrease in incidence was of the same magnitude for proximal colon cancer (rate ratio: 0.55 and 0.49 among men; 0.63 and 0.57 among women) and distal colon cancer (0.50 and 0.50; 0.60 and 0.61). The decrease was less pronounced for rectal cancer.</p><p><strong>Conclusion: </strong>Thanks to the increase in the modelled expected incidence of proximal colon cancer alone, the impact of FIT screening on the incidence of CRC was similar between colonic segments.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary pancreatic cancer: A proposal for surveillance from the Italian Association for the Study of the Pancreas (AISP).","authors":"Silvia Carrara, Livia Archibugi, Maria Terrin, Erica Secchettin, Raffaele De Luca, Salvatore Paiella","doi":"10.1016/j.dld.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.007","url":null,"abstract":"<p><p>Genetic and familial susceptibility accounts for 10% of pancreatic ductal adenocarcinoma (PDAC) cases and represents a small but relevant subgroup in which early detection may meaningfully affect outcomes. Pathogenic germline variants (PGVs) in susceptibility genes, such as BRCA2/ATM/CDKN2A/STK11/PALB2/TP53, as well as mismatch repair genes, confer a substantially higher lifetime risk, while families fulfilling the criteria for familial pancreatic cancer (FPC) exhibit disease clustering in the absence of an identifiable PGV. Over the past two decades, surveillance strategies for high-risk individuals (HRIs) have evolved from exploratory registries to structured clinical programs, generating expanding evidence with tangible clinical implications. Data from the international CAPS (Cancer of the Pancreas Screening) consortium, the Dutch nationwide surveillance program, and the IRFARPC (Italian Registry of Families at Risk for Pancreatic Cancer) consistently demonstrate a stage shift toward earlier, resectable disease and improved survival among cancers detected under surveillance. However, uncertainties remain regarding the magnitude of benefit, eligibility criteria, surveillance start age, cost-effectiveness, and the risk of overdiagnosis. This review critically appraises current evidence, focusing on the Italian and European experience, evaluates the pros and cons of HRIs surveillance, and proposes updated criteria and considerations for a structured, registry-based national program aligned with new evidence.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver agreement in the assessment of active bleeding at endoscopy in patients with cirrhosis and acute variceal bleeding.","authors":"Simona Tripon, Amine Benmassaoud, Christophe Bureau, Maxime Mallet, Dominique Thabut, Marika Rudler","doi":"10.1016/j.dld.2026.03.021","DOIUrl":"https://doi.org/10.1016/j.dld.2026.03.021","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized scoring systems-essential for the AI Era in small-bowel capsule endoscopy.","authors":"Anastasios Koulaouzidis, Ramesh Arasaradnam, Wojciech Marlicz, Ervin Toth","doi":"10.1016/j.dld.2026.04.005","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.005","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable monitoring in inflammatory bowel disease: comparative carbon, energy, waste, and cost impact of intestinal ultrasound versus colonoscopy.","authors":"Arianna Dal Buono, Roberto Gabbiadini, Giuseppe Privitera, Benedetta Masoni, Matteo Spertino, Giulia Migliorisi, Gianluca Franchellucci, Laura Loy, Alessandro Repici, Cristina Bezzio, Alessandro Armuzzi","doi":"10.1016/j.dld.2026.04.002","DOIUrl":"https://doi.org/10.1016/j.dld.2026.04.002","url":null,"abstract":"<p><strong>Background: </strong>Treat-to-target strategies in inflammatory bowel disease (IBD) rely on repeated objective assessments, leading to frequent colonoscopy for therapeutic decision-making. Although effective, endoscopic monitoring is resource-intensive and may not be necessary in all stable patients.</p><p><strong>Aims: </strong>To evaluate the environmental and economic impact of intestinal ultrasound (IUS) compared with colonoscopy for therapeutic monitoring in IBD.</p><p><strong>Methods: </strong>In this single-center retrospective cohort (2022-2024), 200 adults with IBD undergoing both IUS and colonoscopy were analyzed. The functional unit was one monitoring episode. For each modality, we quantified carbon dioxide equivalent emissions (CO₂e), energy use (kWh), and disposable waste (g) within defined system boundaries. Procedure cost was assessed as a secondary outcome. A patient-level model projected cumulative impact across ten monitoring cycles, comparing an IUS + fecal calprotectin (FCP >250 μg/g) strategy with colonoscopy-for-all.</p><p><strong>Results: </strong>Per procedure, colonoscopy required +0.91 kWh, emitted +2.9 kg CO₂e, and generated +212 g disposables versus IUS (all p<0.001). IUS reduced energy use by ∼95%, CO₂e by ∼100-fold, and disposables by ∼85%. Over ten cycles, an IUS-first strategy reduced cumulative CO₂e emissions and costs by ∼40% (both p<0.05).</p><p><strong>Conclusions: </strong>IUS substantially lowers environmental and economic burden compared with colonoscopy while supporting timely therapeutic decisions. An IUS + FCP-first approach represents a pragmatic, sustainable monitoring strategy in IBD.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's reply: \"Inflammatory vs. Complicated Crohn's disease: Long-term outcomes after ileocecal resection\".","authors":"Nicolas Avellaneda, Paulo Gustavo Kotze, Annalisa Maroli, Michele Carvello, Gianluca Pellino, Antonino Spinelli","doi":"10.1016/j.dld.2026.03.014","DOIUrl":"https://doi.org/10.1016/j.dld.2026.03.014","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}