Digestive Diseases and Sciences最新文献

{"title":"Recruitment of Minority Patients in Metabolic Dysfunction-Associated Steatotic Liver Disease Clinical Trials.","authors":"Sarah E Park, Yael Wollstein, Alan L Hutchison, Sonali Paul","doi":"10.1007/s10620-026-09939-x","DOIUrl":"https://doi.org/10.1007/s10620-026-09939-x","url":null,"abstract":"<p><strong>Purpose: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the second leading indication for liver transplant in the United States, but the prevalence is unevenly distributed across ethnic groups with 22.3% of Hispanic patients affected. This study aimed to assess racial and ethnic diversity among MASLD clinical trials.</p><p><strong>Methods: </strong>We performed a meta-analysis of 91 randomized controlled trials (RCTs) of MASLD therapies in the US and Canada, and multinational RCTS involving the US from 2005 to 2024.</p><p><strong>Results: </strong>78 studies (85.7%) reported racial data and only 56 (61.5%) included ethnicity data. Meta-analysis revealed a pooled prevalence of 78.8% (95% CI 72.9 - 84.6, I² = 97.0%) in White patients, 6.2% (95% CI 4.1 - 8.3, I² = 94.1%) in Asian patients, 2.5% (95% CI 1.6 - 3.5, I² = 70.2%) in Black patients, and 31.7% (95% CI 26.8-36.6, I² = 96.2%) in Hispanic patients. This prevalence was higher than the reported national Hispanic prevalence, and Hispanic enrollment also increased over time from 20.3% (2009 - 2014), 30.8% (2015-2019), to 40.0% (2020-2024).</p><p><strong>Conclusion: </strong>Our results show that compared to previous efforts, clinical trials are increasingly including Hispanic patients, yet they still need to increase inclusion of ethnicity data. Since MASLD disproportionately affects Hispanic patients, it is imperative that clinical trials make a targeted effort to diversify patient recruitment.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835135","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":"Strength of Association: How Useful Is Handgrip Strength as a Functional Biomarker in Patients with Inflammatory Bowel Disease?","authors":"Stephanie Brown","doi":"10.1007/s10620-026-09959-7","DOIUrl":"https://doi.org/10.1007/s10620-026-09959-7","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835122","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":"A Polypoid Encounter with Colonic Mature Renal Heterotopia.","authors":"Lin Zhong, Xiao-Yu Cai, Xian-Ming Xia, Yin-Peng Li","doi":"10.1007/s10620-026-09967-7","DOIUrl":"https://doi.org/10.1007/s10620-026-09967-7","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834809","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":"A Workforce at a Crossroads: Rural Gastroenterology Supply in the United States.","authors":"I Midura, L G Rabinowitz","doi":"10.1007/s10620-026-09938-y","DOIUrl":"https://doi.org/10.1007/s10620-026-09938-y","url":null,"abstract":"<p><p>Despite the significant gastrointestinal (GI) disease burden in rural America, prior research has highlighted persistent disparities in access to care for GI diseases for patients in non-metropolitan regions. In the study by Cwalina et al. [5], the authors analyze gastroenterologist data from the Physician Compare Database collected from 2014 to 2025, finding that while the absolute number of rural gastroenterologists increased, the proportion practicing rurally remained stable at approximately 7.7%. Late career stage and the Midwest region were associated with increased odds of rural practice, whereas female sex, hepatology subspecialization, academic affiliation, and both small and large practice sizes were associated with decreased odds. These findings reveal a workforce that has grown numerically, but has not kept sufficient pace with the access needs of rural patients, thereby highlighting two intersecting vulnerabilities: an aging rural GI workforce and a rising proportion of women in gastroenterology who face structural barriers to rural practice. This commentary contextualizes these findings, calling for proactive, patient-centered strategies to sustain rural gastroenterology care.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834831","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":"The Application of the Plan-Do-Check-Act Management Model in Improving the Diagnostic Yield of Autoimmune Gastritis.","authors":"Yixin Zhu, Shisong Wang, Qian Yu, Shuhao Zheng, Zhixin Zhang, Lei Xu, Pengyao Lin","doi":"10.1007/s10620-026-09956-w","DOIUrl":"https://doi.org/10.1007/s10620-026-09956-w","url":null,"abstract":"<p><strong>Background: </strong>Due to the lack of unified diagnostic standards and low clinical awareness, autoimmune gastritis (AIG) remains underdiagnosed globally. This study aimed to employ the Plan-Do-Check-Act (PDCA) cycle to enhance the diagnostic rate of AIG.</p><p><strong>Methods: </strong>This single-center, prospective, observational study enrolled 20 endoscopists from two hospital campuses (10 each in the intervention and control groups). The intervention group underwent PDCA cycle management, including standardized training and dynamic data monitoring, while the control group received no intervention. Diagnostic rates were compared before and after the intervention.</p><p><strong>Results: </strong>A total of 9,763 patients underwent gastroscopy by 20 endoscopists, among whom 67 were diagnosed with AIG. Application of the PDCA cycle further standardized the diagnostic process of AIG in the Department of Gastroenterology at the First Affiliated Hospital of Ningbo University. The diagnostic rate of AIG in the PDCA group reached 0.987%, while that in the control group was 0.423% (P < 0.001), exceeding the target of 0.9% and higher than previously reported baseline rates in Asia. Moreover, the diagnostic rates at all stages of the PDCA cycle in the PDCA group were higher than those in the control group.</p><p><strong>Conclusion: </strong>Implementation of the PDCA cycle was associated with a higher diagnostic rate of AIG in this quality-improvement setting, supporting its potential value in improving case detection and standardizing the diagnostic workflow. Trial registration Clinical Trials.gov,NCT06557252. Registered on 13/8/2024. https://register.</p><p><strong>Clinicaltrials: </strong>gov/prs/beta/studies/S000ESP900000038/recordSummary . Registered 6 July 2021.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835061","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":"https://doi.org/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":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","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":"Advancing the Efficacy and Safety of Advanced Therapies in Older Adults with Inflammatory Bowel Disease.","authors":"Kian Keyashian","doi":"10.1007/s10620-026-09947-x","DOIUrl":"https://doi.org/10.1007/s10620-026-09947-x","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834862","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":"Evaluation of Obesity as an Independent Risk Factor for Colorectal Dysplasia Development in Inflammatory Bowel Disease: A Matched Case-Control Study.","authors":"Naveena Luke, Carlos Echeverria, Jahnavi Udaikumar, Olivia Delau, Adam Faye, Jordan Axelrad","doi":"10.1007/s10620-026-09951-1","DOIUrl":"https://doi.org/10.1007/s10620-026-09951-1","url":null,"abstract":"<p><strong>Background: </strong>Chronic intestinal inflammation is a well-established driver of colorectal dysplasia in inflammatory bowel disease (IBD). However, the role of metabolic factors such as obesity remains poorly understood. We evaluated whether chronic obesity, measured using five-year longitudinal body mass index (BMI), is independently associated with colorectal dysplasia in patients with IBD.</p><p><strong>Methods: </strong>We conducted a retrospective 1:1 matched case-control study at a tertiary academic center. Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) who underwent surveillance colonoscopy between 2019 and 2025 were included. Cases had biopsy-confirmed colorectal dysplasia (indefinite, low grade, or high grade). Controls were dysplasia-free and matched by age (± 5 years), sex, and IBD subtype. Obesity was defined as a mean body mass index (BMI) ≥ 30 kg/m² using all outpatient measurements over a five-year period prior to the index colonoscopy. Multivariable conditional logistic regression was used to evaluate the association between obesity and dysplasia, adjusting for established dysplasia risk factors and surveillance-related variables.</p><p><strong>Results: </strong>A total of 312 patients were included (156 dysplasia cases and 156 matched controls). Dysplasia cases had significantly longer IBD duration compared with controls (median 12.1 vs. 8.0 years, p < 0.01) and were more likely to have a history of prior colorectal dysplasia (16.0% vs. 3.8%, p < 0.01). In multivariable analysis, obesity was independently associated with colorectal dysplasia (adjusted odds ratio [aOR] 2.23, 95% CI 1.08-4.57). Longer disease duration (aOR 1.05 per year, 95% CI 1.02-1.08) and prior dysplasia (aOR 4.88, 95% CI 1.69-14.06) were also independently associated with dysplasia. In a secondary model adjusting for additional surveillance-related and structural colonic factors, obesity remained significantly associated with dysplasia (aOR 2.11, 95% CI 1.05-4.24).</p><p><strong>Conclusions: </strong>Obesity is independently associated with colorectal dysplasia in patients with IBD, suggesting that metabolic factors contribute to neoplastic risk beyond traditional inflammation-driven pathways. Incorporation of metabolic risk into dysplasia risk stratification may improve CRC prevention strategies in IBD.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835109","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":"Comparative Outcomes of Primary Sclerosing Cholangitis With and Without Comorbid Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Bachviet Nguyen, Stephanie Quon, Daljeet Chahal","doi":"10.1007/s10620-026-09964-w","DOIUrl":"https://doi.org/10.1007/s10620-026-09964-w","url":null,"abstract":"<p><strong>Purpose: </strong>Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease frequently associated with inflammatory bowel disease (IBD). While PSC with IBD is recognized as a distinct entity, comparative outcomes of PSC with IBD versus PSC alone remain uncertain. This systematic review and meta-analysis aimed to compare clinical outcomes in patients with PSC with and without comorbid IBD.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. MEDLINE, PubMed, Embase, Scopus, and CENTRAL were searched to October 2025. Eligible studies included adults with PSC stratified by IBD status, reporting risk of all-cause mortality or liver transplant, malignancy, graft survival, or recurrent PSC. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models.</p><p><strong>Results: </strong>Twenty-six studies involving 23,837 patients (16,502 PSC-IBD; 7,335 PSC only) were included. PSC-IBD was associated with a significant decrease in all-cause mortality or liver transplantation compared with PSC alone (HR 0.77, 95% CI, 0.62-0.97). Subgroup analysis showed that both PSC with Crohn's disease (HR 0.67, 95% CI 0.54-0.84) or ulcerative colitis (HR 0.72, 95% CI 0.55-0.95) had a significantly lower risk of all-cause mortality or liver transplantation compared to PSC alone. Indeterminate colitis carried a higher risk compared with Crohn's disease (HR 1.57, 95% CI 1.00-2.4). PSC-IBD was associated with increased risk of hepatopancreatobiliary cancer (HR 2.37, 95% CI 1.35-4.15). There was no significant difference in risk of recurrent PSC between PSC-IBD and PSC only.</p><p><strong>Conclusion: </strong>PSC-IBD may be associated with a lower risk of all-cause mortality and liver transplant compared to PSC alone, although these findings should be interpreted cautiously given the limited number of studies for several outcomes. Further prospective studies are needed to refine risk stratification.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834924","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":"Altered Intestinal Neurotransmission in Autism Spectrum Disorder: Expanding the Molecular Landscape of the Gut-Brain Axis.","authors":"Valentine Turpin, María Rodriguez Aburto","doi":"10.1007/s10620-026-09911-9","DOIUrl":"https://doi.org/10.1007/s10620-026-09911-9","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834931","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}