Digestive Diseases and Sciences最新文献

{"title":"Predictors of Progression to Villous Atrophy in Children with Type 1 Diabetes and Potential Celiac Disease.","authors":"Madan Neelamegam, Raghav Lal, Sadhna B Lal, Alka Bhatia, Devi Dayal, Bijaya Kumar Padhi, Yashwant Kumar, Kaushal Kishore Prasad, Suvradeep Mitra, Chennakeshava Thunga","doi":"10.1007/s10620-026-10185-4","DOIUrl":"https://doi.org/10.1007/s10620-026-10185-4","url":null,"abstract":"<p><strong>Background: </strong>Children with type 1 diabetes (T1DM) and positive celiac serology but normal duodenal mucosa (potential celiac disease-CeD) often have spontaneous normalization of serology despite a gluten-containing diet. This results in either repeated biopsies or an upfront advice for gluten-free diet (GFD) if TTG is >10ULN.</p><p><strong>Objectives: </strong>To find the predictors of villous atrophy in children with T1DM and potential CeD.</p><p><strong>Design: </strong>Ambispective observational study: Children with T1DM and potential CeD on a gluten-containing diet were included. Clinical, serological, histological, and immunohistochemical parameters at baseline and follow-up biopsy were evaluated.</p><p><strong>Results: </strong>Of the 110 children with T1DM and positive celiac serology, 66 (60%) were potential CeD. Forty-three children had follow-up and repeat biopsy after a median of 12 months; 10 (23%) developed villous atrophy (VA), 16 (37%) remained potential CeD, and 17 (40%) had spontaneous normalization of serology. Children who developed VA had higher baseline counts of intraepithelial lymphocytes (IELs), γδ T cells, and CD3 T cells. In multivariate analysis, the baseline γδ T cell/CD3 T cell ratio was an independent predictor of progression to VA (OR 1.15; 95%CI 1.03-1.28; p=0.011; AUROC 0.918). Spontaneous normalization/reduction of TTG-IgA to < 5ULN was associated with reduced risk of VA (OR 0.007, 95%CI 0.00007-0.617; p = 0.030); Combined AUROC for both was 0.972. VA developed in only 26% (6/23) with TTG ≥10 ULN at baseline.</p><p><strong>Conclusions: </strong>Most children with T1DM and positive celiac serology do not progress to VA; initiating a GFD without biopsy solely on the basis of TTG>10ULN may be unjustified. Baseline elevation in γδ T-cells/CD3 T cell ratio and persistently high serological titres help identify the risk of progression to VA.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative ctDNA in Resectable Gastric Cancer: Prognostically Powerful, but Not Yet Actionable.","authors":"Mohammed Iyoob Mohammed Ilyas","doi":"10.1007/s10620-026-10187-2","DOIUrl":"https://doi.org/10.1007/s10620-026-10187-2","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bidirectional Psychosocial Burden in Autoimmune Hepatitis: Mental Health, Caregiver Strain, and the Potential Role of Patient Advocacy Programming.","authors":"Elizabeth Gentry, Anne Mary Montero, Nadia Blessing, Megan Apolzan-Smith, Kelsey Green, Mackenzie Woods, Craig Lammert","doi":"10.1007/s10620-026-10209-z","DOIUrl":"https://doi.org/10.1007/s10620-026-10209-z","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune hepatitis (AIH) is associated with substantial psychosocial burden, yet mental health challenges remain poorly characterized and caregiver experience has not been systematically described.</p><p><strong>Aims: </strong>We aimed to (1) characterize mental health burden among AIH patients; (2) provide the first systematic description of caregiver burden and unmet needs in AIH; (3) compare patient and caregiver intervention priorities; and (4) explore whether attendance at a disease-specific educational conference was associated with changes in self-reported psychological distress.</p><p><strong>Methods: </strong>Patients and caregivers attending the 2025 AIHA Patient Retreat completed an anonymous real-time survey (17 patient items; parallel caregiver items). A post-conference feedback survey captured retrospective pre/post-depression and anxiety self-ratings, analyzed as independent ordinal distributions using the Mann-Whitney U test given the absence of respondent-level pairing.</p><p><strong>Results: </strong>Sixty-eight patients and 28 caregivers completed the survey. Most patients (88%) reported depressive symptoms on self-report items; 52% reported moderate-to-high anxiety. A bidirectional relationship was identified: 68% reported AIH symptoms worsened mood and 53% reported emotional distress worsened physical symptoms. Despite this, 32% rarely or never sought mental healthcare, and only 5% turned to their hepatologist for support. Caregivers reported high confidence (78%) alongside meaningful personal cost: 39% reported physical health effects and 62% cited work/family balance as their greatest barrier. Both groups identified expanded behavioral health resources as their top unmet need (32.8% each). In a separate post-conference survey (n=51), self-reported depression and anxiety scores were significantly lower after than before the conference (both p<0.05).</p><p><strong>Conclusion: </strong>AIH carries a substantial psychosocial burden affecting patients and caregivers. Both groups prioritize expanded mental health resources, and disease-specific community education may reduce psychological distress, warranting prospective evaluation.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hot and Cold Polypectomy Techniques in Children: A 13-Year Comparative Study of 2,000 Polyps.","authors":"Matthew Murray, Anthony J Perkins, Brett J Hoskins","doi":"10.1007/s10620-026-10230-2","DOIUrl":"https://doi.org/10.1007/s10620-026-10230-2","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric polypectomy is routine, yet no prior study has directly compared cold forceps (CFP), hot forceps (HFP), cold snare (CSP), and hot snare polypectomy (HSP). This study evaluated techniques, polyp characteristics, and outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed patients aged 0-20 years who underwent polypectomy at Riley Hospital for Children from 2/2012-7/2025. Demographic, morphologic, histologic, and outcome data were analyzed at procedure and polyp levels.</p><p><strong>Results: </strong>Across 320 procedures, 2,000 polyps were removed from 203 patients (mean age, 9.5 ± 5.2 years). Polyps were predominantly colorectal, with gastric lesions the most common upper gastrointestinal location. HSP was most common (67.2%), followed by CFP (40.6%), CSP (21.6%), and HFP (1.6%). Beginning in 2020, CSP use increased while CFP/HSP declined. Sessile/flat polyps were predominantly removed with CFP/CSP, whereas pedunculated lesions were almost exclusively resected with HSP. Adenomas were the most common histology overall, predominantly removed with CFP/CSP; juvenile polyps with HSP. No perforations occurred. Immediate bleeding requiring endoscopic therapy occurred in 8.7% of CSP, 2.8% of HSP, and 0.8% of CFP cases. Delayed bleeding occurred only after HSP cases (1.4%). Recurrence in patients without hereditary polyposis syndromes occurred exclusively after CFP, including two adenomas.</p><p><strong>Conclusions: </strong>Pediatric polypectomy outcomes paralleled adult trends, with higher immediate bleeding after CSP, delayed bleeding after HSP, and recurrence exclusively after CFP. Technique selection reflected distinct pediatric morphology and histology. These findings support the safety and feasibility of CSP, reinforce caution with CFP, and provide benchmark data to inform pediatric polypectomy practice and future guideline development.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food Insecurity and Gastrointestinal Health: Examining Links Between Food Security, Constipation, and Diarrhea in the National Health and Nutrition Examination Survey.","authors":"Madeline Berschback, Christopher Vélez, Adjoa Anyane-Yeboa, Braden Kuo, Kyle Staller","doi":"10.1007/s10620-026-09927-1","DOIUrl":"10.1007/s10620-026-09927-1","url":null,"abstract":"<p><strong>Purpose: </strong>Food insecurity impacts health in a multifactorial fashion, but the relationship with bowel habits is poorly understood. We aimed to examine the association between food insecurity status and bowel habits in a large cohort of US adults.</p><p><strong>Methods: </strong>We analyzed adults (age 20-59 years) who completed both the bowel habits questionnaire and the food security survey module in the National Health and Nutrition Examination Survey over a 6-year period from 2005 to 2010 (n = 9,637). Constipation and diarrhea were defined according to Bristol Stool Form Scale and/or stool frequency. Adjusted odds ratios (AORs) for the likelihood of constipation or diarrhea were estimated in a multinomial logistic model across levels of food security.</p><p><strong>Results: </strong>Constipation and diarrhea were more prevalent among individuals with lower food security compared to those with full food security (constipation: 19.6% vs. 14.2%; diarrhea: 14.8% vs. 11.0%; both p < 0.0001). Very low food security was associated with nearly twice the odds of constipation (OR 1.90, 95% CI: 1.48-2.42) and 54% greater odds of diarrhea (OR 1.54, 95% CI: 1.22-1.93). After stepwise adjustments for demographic, BMI, and dietary factors, these associations persisted (constipation AOR: 1.39, 95% CI 1.06-1.83; diarrhea AOR: 1.27, 95% CI 1.00-1.61). Adjustment for depression attenuated the significance of this association (constipation AOR: 1.25, 95% CI 0.97-1.63; diarrhea AOR: 1.16, 95% CI 0.90-1.51), suggesting a potential mediating role.</p><p><strong>Conclusion: </strong>In a nationally representative sample of community-dwelling US adults, decreasing food security was associated with increased odds of constipation and diarrhea. However, when multivariable adjustment included depression, this impact was attenuated, suggesting that depression may confound this relationship.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"4113-4121"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Removal of a Toothpick Penetrating the Psoas Major Through the Duodenum.","authors":"Jing Chen, Juncheng Zeng, Fuqun Wang","doi":"10.1007/s10620-026-09944-0","DOIUrl":"10.1007/s10620-026-09944-0","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"3940-3941"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal Gastrointestinal Stromal Tumor Resected by Endoscopic Submucosal Dissection.","authors":"Jun Ling, Wenyan He","doi":"10.1007/s10620-026-09954-y","DOIUrl":"10.1007/s10620-026-09954-y","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"3945-3947"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"n-3 Polyunsaturated Fatty Acids Improve DSS-Induced Acute Colitis in Mice via Intestinal Barrier Fortification and Gut Microbiome Modulation.","authors":"Xinyi Hu, Jiahui Chen, Yiqiu Zhou, Xinyue Ji, Siqi Shen, Junhui Qian, Tao Li, Feng Xu, Ying Zhou, Dezheng Zhou, Xiaohong Zhang","doi":"10.1007/s10620-026-09960-0","DOIUrl":"10.1007/s10620-026-09960-0","url":null,"abstract":"<p><strong>Background: </strong>The increasing global burden of ulcerative colitis (UC) is showing a high incidence in developed countries and a swift rise in developing countries. n-3 polyunsaturated fatty acids (PUFAs), particularly eicosatetraenoic acid (EPA) and docosahexaenoic acid (DHA), have demonstrated anti-inflammatory effects. However, their exact mechanisms in intestinal barrier repair for UC remain incompletely elucidated.</p><p><strong>Methods: </strong>Acute UC was induced using 2% dextran sulfate sodium (DSS) and the therapeutic effects of mesalazine, EPA, DHA, and EPA + DHA were evaluated. The mucus barrier was assessed histologically. RT-qPCR and Western blot were used to quantify the expression of Mucin2, mechanical barrier proteins (Claudin-1/Occludin), and key signaling pathways (PI3K/Akt, TNF-α/NF-κB, GPR120/PKA/CREB). Gut microbiome composition was analyzed via 16S rRNA sequencing.</p><p><strong>Results: </strong>EPA + DHA intervention demonstrated optimal efficacy in alleviating colitis, through establishing an anti-inflammatory colonic lipid microenvironment by elevating the EPA/AA and DHA/AA ratios. Inhibiting PI3K/Akt/NHE3, downregulating TNF-α/NF-κB/DRA, activating GPR120/PKA/CREB/AQP) improved the mucosal barrier and restored tight junction to enhance the mechanical barrier. Furthermore, EPA + DHA significantly increased the abundance of beneficial microbiome like Lachnospiraceae and Ruminococcaceae.</p><p><strong>Conclusion: </strong>EPA + DHA effectively alleviates acute UC in mice by fortifying the colonic mucus-mechanical dual barrier and regulating gut microbiome homeostasis, providing a novel potential strategy for UC adjunctive treatment.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"4252-4269"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Endoscopist Agreement for Size Measurement of Large (> 2 cm) Colorectal Laterally Spreading Tumors: A Prospective Video-Based Study.","authors":"Roupen Djinbachian, Jérémie Jacques, Victoire Michal, Ludovico Alfarone, Robert Bechara, Nicholas G Burgess, Mariana Figueiredo, Yusuke Fujiyoshi, Lucile Heroin, Michal F Kaminski, Eric Lam, Philippe Leclercq, Isabelle Lienhart-Chambon, Alexandru Lupu, Charles Menard, Jeffrey Mosko, Nima Mottacki, Heiko Pohl, Douglas K Rex, Enrique Rodriguez De Santiago, Yutaka Saito, Amrita Sethi, Sandro Sferazza, Neal Shahidi, Daniel von Renteln, Dennis Yang, Mathieu Pioche","doi":"10.1007/s10620-026-09924-4","DOIUrl":"10.1007/s10620-026-09924-4","url":null,"abstract":"<p><strong>Background: </strong>Accurate size estimation of large (≥ 20 mm) colorectal laterally spreading tumors (LSTs) is essential for procedural planning, risk stratification, and predicting technical difficulty. Yet, the reliability of visual LST size assessment among endoscopists has not been systematically evaluated.</p><p><strong>Patients and methods: </strong>46 LSTs were recorded during colonoscopy. Twenty-four international expert endoscopists independently reviewed de-identified videos and provided visual estimates for (1) maximal diameter, (2) oral-anal axis, (3) left-right axis, and (4) percentage of colonic circumference involved. Each lesion was assessed twice in randomized order. Fleiss's kappa, Krippendorff's alpha, and intraclass correlation coefficients (ICC) were used to evaluate inter- and intra-rater agreement.</p><p><strong>Results: </strong>A total of 1104 measurements were collected. Inter-endoscopist kappa agreement for maximal diameter was poor (κ = 0.16), with similarly poor agreement for the oral-anal (κ = 0.15) and left-right axes (κ = 0.14). The percentage of circumferential involvement demonstrated moderate reproducibility (ICC 0.74 and 0.70 across rounds). Subgroup analyses showed consistently poor agreement for larger lesions for diameter-based methods, whereas circumferential percentage estimation ranged from poor to good depending on LST size and morphology. Intra-endoscopist agreement for diameter- and axis-based approaches showed wide variability (κ range 0.01-0.67), while circumferential estimates achieved good to excellent agreement for most endoscopists.</p><p><strong>Conclusions: </strong>Visual estimation of large colorectal LST size is highly variable among expert endoscopists. Maximal diameter and axial lengths demonstrate poor inter- and intra-observer reliability. Circumferential extent is the most reproducible descriptor and may be the preferred approach for reporting LST size in clinical practice and research.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"4202-4210"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal Manifestations of Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: A Mentored Review.","authors":"Abdillahi Ahmed, Bishal Paudel, Anil Sharma","doi":"10.1007/s10620-026-09958-8","DOIUrl":"10.1007/s10620-026-09958-8","url":null,"abstract":"<p><strong>Background: </strong>Hypermobile Ehlers-Danlos Syndrome (hEDS) is a connective tissue disorder that is often diagnosed after diagnostic delays due to reliance on heightened clinical suspicion. Hypermobility spectrum disorders (HSD) bridge the gap between asymptomatic joint hypermobility and hEDS. Due to overlapping features and evolving diagnostic criteria, these entities are often discussed collectively as hEDS/HSD. Patients commonly present with gastrointestinal (GI) symptoms, prompting referral for specialized care.</p><p><strong>Objectives: </strong>This review summarizes the diagnostic criteria, epidemiology, and GI manifestations of hEDS/HSD to aid gastroenterologists in recognizing common presentations and facilitating earlier diagnosis and appropriate management.</p><p><strong>Methods: </strong>We conducted a narrative review of the GI manifestations of hEDS/HSD, including associations with disorders of gut-brain interaction (DGBIs), organic GI disease, structural abnormalities, motility disorders, postural orthostatic tachycardia syndrome (POTS), and mast cell activation syndrome (MCAS).</p><p><strong>Results: </strong>The strongest GI association in hEDS/HSD is with DGBIs. Evidence suggests possible associations with organic conditions, such as celiac disease and eosinophilic esophagitis, as well as structural GI abnormalities and dysmotility. In addition, hEDS/HSD is closely linked with POTS and MCAS, which may share pathophysiologic mechanisms and have synergistic effects on symptoms.</p><p><strong>Conclusion: </strong>Gastroenterologists should maintain a high index of suspicion for hEDS/HSD, which can be readily screened for using the Beighton score. Earlier diagnosis may be therapeutic by reducing uncertainty related to multisystem symptoms. A multidisciplinary approach incorporating mental health, nutrition, and pain management may be required to optimize patient outcomes.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"4474-4482"},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}