Digestive Diseases and Sciences最新文献

{"title":"Occult Free Perforation in a Patient with Poorly Controlled Crohn's Disease.","authors":"Daniele Giuliani, Alessandro Spizzirri, Napolitano Vincenzo, Francesca Pennetti Pennella, Valentina Bartolini, Roberto Cirocchi, Marco Coccetta","doi":"10.1007/s10620-026-10125-2","DOIUrl":"10.1007/s10620-026-10125-2","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"6113-6118"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535518","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":"ALG10 Alleviates IBD-Related Intestinal Fibrosis by Modulating the TGF-β1/PI3K/Akt Signaling Pathway.","authors":"Mengmeng Yang, Xingshu Wei, Renhui Wu, Yuhui Wang, Xiaotian Xu","doi":"10.1007/s10620-026-10132-3","DOIUrl":"10.1007/s10620-026-10132-3","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the role of asparagine-linked glycosylation 10 (ALG10) in intestinal fibrosis (IF) and elucidate its underlying molecular mechanisms.</p><p><strong>Methods: </strong>Western blot and RT-qPCR were employed to detect ALG10 expression in a TNBS/DSS-induced mouse IF model and in primary colonic fibroblasts. TNBS/DSS-induced ALG10^-/- mouse models were established, and primary colonic fibroblasts were isolated in vitro. Pathological changes and collagen deposition in colon tissues were evaluated via Masson's trichrome staining and H&E staining. RT-qPCR, Western blot, and ELISA were performed to measure the expression of IF-related markers. A TGF-β1-induced CCD-18Co cell model was established, and immunofluorescence was used to detect the fluorescence intensity of COL I and E-cadherin. The interaction mechanism between ALG10 and TGF-β1 was further explored by molecular docking, MD simulation, Co-IP and dual-luciferase reporter gene experiments.</p><p><strong>Results: </strong>Compared with the WT group, ALG10 expression was significantly increased in the TNBS/DSS group. In both in vivo and in vitro models, ALG10 silencing markedly alleviated fibrosis severity and pathological damage, downregulated the expression of COL I and α-SMA, and upregulated E‑cadherin expression and significantly reduced the levels of p‑PI3K, p‑Akt, and the target genes FGF2 and p‑FoxO1/3a. Molecular docking, MD simulations, and Co-IP assays suggested that ALG10 potentially interacts with TGF-β1, while dual-luciferase reporter assays further demonstrated that ALG10 promotes TGF-β1 promoter activity.</p><p><strong>Conclusion: </strong>ALG10 acts as a key mediator promoting the progression of IF. Silencing ALG10 can alleviate IBD-related IF, a mechanism that may involve the regulation of the TGF‑β1/PI3K/Akt signaling pathway.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5666-5682"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520199","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":"Upper Versus Lower Gastrointestinal Bleeding in Percutaneous Coronary Intervention Hospitalizations: A National Analysis, 2016-2022.","authors":"Akram Alnounou, Brian Nohomovich, Mohammad Alabbas, Austin Brubaker, Dimitar Bahariev, John Brown, Amy Welch, Tooba Tariq, Neil Hughes, Santhosh K G Koshy, Eric Martin Sieloff, Neil Sengupta","doi":"10.1007/s10620-026-10179-2","DOIUrl":"10.1007/s10620-026-10179-2","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal bleeding (GIB) during a percutaneous coronary intervention (PCI) hospitalization can interrupt antithrombotic therapy and worsen outcomes. National data comparing upper GIB (UGIB) versus lower GIB (LGIB) in PCI hospitalizations are limited.</p><p><strong>Aims: </strong>To compare incidence, clinical characteristics, and in-hospital outcomes of UGIB versus LGIB events in PCI hospitalizations.</p><p><strong>Methods: </strong>We analyzed PCI hospitalizations in the 2016-2022 National Inpatient Sample. UGIB and LGIB were identified from site-specific ICD-10-CM diagnosis codes. Hospitalizations with both UGIB and LGIB codes, or with unspecified gastrointestinal hemorrhage (K92.2) without a site-specific code, were excluded. Survey-weighted regression adjusted for demographics, comorbidities, acuity markers, hospital and PCI procedural characteristics.</p><p><strong>Results: </strong>Among 3,227,805 weighted PCI hospitalizations, 41,225 (1.28%) had GIB: 34,215 UGIB-only (83.0%) and 7010 LGIB-only (17.0%). GIB incidence rose from 1.10% to 1.36% (2016-2022), driven by UGIB (0.90% to 1.13%; P < 0.001); LGIB was stable (0.20-0.26%; P = 0.1022). Compared with LGIB, UGIB was independently associated with higher in-hospital mortality (12.35% vs. 6.14%; adjusted odds ratio 1.74, 95% confidence interval 1.36-2.23), longer median stay (7.27 vs. 5.96 days), and higher median cost ($44,712 vs. $36,046; both P < 0.001), with no significant difference in transfusion (P = 0.2134). Excluding variceal-source UGIB did not alter this association.</p><p><strong>Conclusions: </strong>GIB during PCI hospitalizations was predominantly UGIB, and the rise in incidence was driven by UGIB. UGIB was associated with higher adjusted in-hospital mortality and greater resource utilization than LGIB, suggesting UGIB and LGIB carry different associated mortality risk in this population, though residual confounding cannot be excluded. These findings support attention to upper-GI risk factors and gastroprotection in PCI patients.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5899-5912"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757731","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":"Absence of a Weekend Effect on In-Hospital Mortality in Upper Gastrointestinal Bleeding: A Multisite Study from an Integrated Health System.","authors":"Ali Sohail, Uday Sankar Akash Vankayala, Bivin George, Jon Javor, Liliane Deeb","doi":"10.1007/s10620-026-10157-8","DOIUrl":"10.1007/s10620-026-10157-8","url":null,"abstract":"<p><strong>Objectives: </strong>The \"weekend effect\"-worse outcomes among patients admitted on Saturdays or Sundays-has been reported in upper gastrointestinal bleeding (UGIB) and attributed to delayed endoscopy and reduced after-hours resources. We examined whether weekend admission is associated with worse outcomes within a contemporary integrated health system with continuous endoscopy availability.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adults (18-89 years) admitted to Northwell Health hospitals with a primary or secondary diagnosis of UGIB between January 2019 and January 2024. Weekend admission was defined as arrival on a Saturday or Sunday. The primary outcome was in-hospital mortality; secondary outcomes were intensive care unit (ICU) admission, length of stay (LOS), and 30-day readmission. Groups were compared using chi-square and Wilcoxon rank-sum tests. A multivariable logistic regression model for mortality included weekend admission (forced entry), age, liver cirrhosis, and shock.</p><p><strong>Results: </strong>Of 7,640 patients, 1,927 (25.2%) were admitted on a weekend. Baseline characteristics were broadly similar, although liver cirrhosis was modestly more frequent among weekend admissions (8.0% vs 6.5%, P = 0.03). Overall in-hospital mortality was 5.5% and did not differ by admission timing (adjusted odds ratio [aOR] 1.06, 95% CI 0.83-1.35, P = 0.67). Independent predictors of mortality were shock (aOR 19.08, 95% CI 15.33-23.76), liver cirrhosis (aOR 1.81, 95% CI 1.23-2.67), and age (aOR 1.04 per year, 95% CI 1.03-1.05). ICU admission (23.3% vs. 21.9%, P = 0.21), median LOS (4.49 vs. 4.66 days, P = 0.43), and 30-day readmission (1.8% vs. 2.3%, P = 0.18) did not differ significantly. The null association persisted in sensitivity analyses using an off-hours exposure window (aOR 1.02) and holiday reclassification (aOR 1.04), after adjustment for AIMS65 severity (aOR 1.08), and in a prespecified clinically informed model (aOR 1.06).</p><p><strong>Discussion: </strong>In a large multicenter cohort within an integrated health system, weekend admission was not associated with worse outcomes in UGIB, and this null association was robust across alternative off-hours and holiday exposure definitions, severity adjustment, and a prespecified clinically informed model. Disease severity, particularly shock and cirrhosis, was the dominant determinant of mortality. These findings are consistent with standardized, continuously available GI bleed care pathways mitigating temporal disparities in UGIB outcomes.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5794-5800"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663634","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":"Confounding by Indication in Real-World Indomethacin Use for Post-ERCP Pancreatitis: Implications for Severity and Cost.","authors":"Aziz Eshov, Sharleen Legaspi, Harsh Parikh, Devansh Dwivedy, Gurvansh Mann, Jayanta Datta, Sankar Alagugurusamy, Samit Datta","doi":"10.1007/s10620-026-10151-0","DOIUrl":"10.1007/s10620-026-10151-0","url":null,"abstract":"<p><strong>Background and aims: </strong>Rectal indomethacin is recommended for PEP prevention, but real-world effectiveness may differ due to selective use in higher-risk patients. This study evaluated the association between indomethacin use and PEP, severity, and cost implications of selective versus routine prophylaxis.</p><p><strong>Methods: </strong>A retrospective cohort study of 332 ERCP procedures at a level III community hospital compared two endoscopists: selective versus routine administration. Firth penalized logistic regression evaluated PEP predictors. Severity was classified using Cotton and Revised Atlanta criteria. Cost analysis incorporated institutional acquisition and estimated hospitalization costs.</p><p><strong>Results: </strong>Indomethacin was administered in 100 cases (30.1%). PEP occurred in 19 patients (5.7%), with no significant difference between groups. In adjusted analysis, indomethacin was not associated with PEP (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.32-4.56, p = 0.74), while guidewire passage into the pancreatic duct (OR 5.25, p = 0.004) and prior PEP (OR 5.68, p = 0.001) were significant predictors. Indomethacin use was strongly associated with procedural difficulty, consistent with confounding by indication. Severe pancreatitis occurred only in the non-indomethacin group, though underpowered. Acquisition costs ranged from $262 to $532 per dose ($79-$160 per ERCP). At base-case PEP hospitalization cost of $20,000, mean total cost per ERCP was $1,263 for selective versus $1,173 for routine use; across all assumptions, costs were driven by PEP incidence rather than medication utilization.</p><p><strong>Conclusion: </strong>Indomethacin use was driven by procedural risk factors and not independently associated with reduced PEP. Economic outcomes were more sensitive to complication rates than drug costs.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5869-5879"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701002","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":"Metachronous Gastric Cancer After Endoscopic Submucosal Dissection in Helicobacter pylori-Uninfected Patients: Time to Individualize Surveillance?","authors":"Gwang Ha Kim","doi":"10.1007/s10620-026-10162-x","DOIUrl":"10.1007/s10620-026-10162-x","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5320-5321"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697277","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":"Type 3 Autoimmune Pancreatitis: What Do We Know So Far?","authors":"Miłosz Caban, Barbara Włodarczyk, Łukasz Durko, Renata Talar-Wojnarowska","doi":"10.1007/s10620-026-10120-7","DOIUrl":"10.1007/s10620-026-10120-7","url":null,"abstract":"<p><p>The increasing use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to a rise in immune-related adverse events (irAEs). Type 3 autoimmune pancreatitis (AIP-3) has been proposed as a rare form of pancreatic injury induced by ICIs with autoimmune pancreatitis-like features and variable presentations. Its diagnosis is not straightforward. Moreover, the role of available therapeutic options, particularly mainly glucocorticosteroids (GCS), remains uncertain. Currently, there are no clear guidelines for AIP-3 management. Data on AIP-3 are derived mainly from small retrospective studies and provide limited-quality evidence. In addition, the diagnostic criteria and management of AIP-3 vary substantially between studies. Some researchers have classified asymptomatic pancreatic enzyme elevations during ICI therapy as AIP-3; however, isolated hyperlipasemia should not be considered sufficient for this diagnosis. This comprehensive, narrative review summarizes current knowledge about AIP-3 and discusses epidemiology, etiopathogenesis, clinical presentations, diagnosis, and treatment based on the most recent evidence.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"6039-6052"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragility of Randomized Controlled Trials for Fluid Resuscitation in Acute Pancreatitis.","authors":"Anshuman Elhence, Abhishek Patel, Durga Prasanna Misra, Praveer Rai","doi":"10.1007/s10620-026-10099-1","DOIUrl":"10.1007/s10620-026-10099-1","url":null,"abstract":"<p><strong>Background and aim: </strong>Majority trials evaluating fluid resuscitation in acute pancreatitis (AP) are small and contradictory. Fragility score is the minimum number of participants in a randomized controlled trial (RCT) whose outcome would have to change from non-event to event to overturn the results. We planned to evaluate the fragility of RCTs evaluating fluid resuscitation in AP.</p><p><strong>Methods: </strong>After a systematic review of literature (CRD420261321080), fragility index (FI), reverse fragility index (RFI), and fragility quotient (FQ) were calculated. The results were labeled as fragile if FI ≤ 3, RFI ≤ 5, or FQ ≤ 0.10. Further sub-group comparisons of fragility scores were conducted as a secondary outcome.</p><p><strong>Results: </strong>Among these 13 included studies, 26 primary or key secondary outcomes were evaluated. The mean FI was 2.83 (2.08) among the studies with significant results. The mean RFI was 5.35 (2.59) among the studies with non-significant results. The median FQ was 0.023 (interquartile range 0.02 to 0.078). The FI was ≤ 3 for 9 (75%) outcomes with significant results. The RFI was ≤ 5 for 8 (57.1%) with non-significant results, 23 (88.5%) of the outcomes were fragile as defined by FQ ≤ 0.10, and 25 (96.2%) of the results were fragile by any definition. The mean FI 3 (2) was lower as compared to mean RFI 5.35 (2.59), p = 0.01.</p><p><strong>Conclusion: </strong>Majority of the studies evaluating fluid resuscitation in AP are fragile. Larger sample size or alternate designs should be considered in future trials evaluating fluid resuscitation.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5416-5427"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403900","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":"Comparison of PEG-Based and Non-PEG Bowel Preparation for Emergency Colonoscopy in Acute Lower Gastrointestinal Bleeding: A Real-World Cohort Study with IPTW Analysis.","authors":"Liyi Bai, Luoyu Zhang, Jinlong Chen, Shengyan Cui, Wenyu Wang, Li Min, Shutian Zhang","doi":"10.1007/s10620-026-10095-5","DOIUrl":"10.1007/s10620-026-10095-5","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal bowel preparation for acute lower gastrointestinal bleeding (ALGIB) in the emergency remains uncertain. This study aimed to compare the efficacy and safety of oral versus non-oral laxative approaches for emergency colonoscopy in ALGIB patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 157 patients undergoing emergency colonoscopy for ALGIB, stratified into PEG (n = 67) and non-PEG (n = 90) groups. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline confounders, including pre-procedural suspected etiology. Primary outcomes were endoscopic diagnosis (including definitive and presumptive) and hemostasis rates. Secondary outcomes included bowel preparation quality, procedural completion, and medical resource utilization. Post hoc analyses were performed by categorizing etiologies into focal/subtle and diffuse/obvious types.</p><p><strong>Results: </strong>After IPTW adjustment, overall core outcomes including endoscopic diagnosis (86.5% vs. 80.3%), stigmata of recent hemorrhage (SRH) detection (42.7% vs. 43.9%) and hemostasis (12.5% vs. 16.9%) were comparable between groups (all adjusted P > 0.05). The PEG group demonstrated significantly higher rates of adequate bowel preparation (BBPS ≥ 6: 70.6% vs. 31.8%, P < 0.001) and cecal intubation (86.2% vs. 55.9%, P = 0.001), with no significant differences between groups in procedural efficiency or resource utilization (all P > 0.05). However, outcomes were significantly etiology-dependent. Diffuse/obvious lesions were associated with significantly higher definite diagnosis rates (64.3% vs. 38.6%, P = 0.004) but lower cecal intubation success (66.1% vs. 84.3%, P = 0.017) compared to focal/subtle lesions.</p><p><strong>Conclusion: </strong>Clinical outcomes in ALGIB are fundamentally etiology-dependent. While PEG and non-PEG strategies achieve comparable overall diagnostic and therapeutic yields, their distinct clinical utilities vary across lesion types. These findings advocate for a stratified, etiology-driven approach to bowel preparation. Future efforts should prioritize the development of pre-procedural predictive models to refine individualized management strategies.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5532-5545"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445222","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":"Interventional Therapy for Hepatic Hydatidosis with Cavernous Transformation of Portal Vein.","authors":"Awu Luogu, Shuaijie Qian, Yang Tai, Bo Wei, Hao Wu","doi":"10.1007/s10620-026-10116-3","DOIUrl":"10.1007/s10620-026-10116-3","url":null,"abstract":"<p><p>A 56-year-old female suffered from recurrent esophagogastric varices bleeding for 2 years due to cavernous transformation of the portal vein caused by hepatic hydatidosis. Multiple esophageal variceal ligations failed to prevent rebleeding. Transmesenteric vein extrahepatic portosystemic shunt was performed to decrease portal pressure gradient and prevent rebleeding.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"5273-5274"},"PeriodicalIF":2.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430033","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}