Gastroenterology Research最新文献

{"title":"Real-World Patient-Reported Outcomes With Piromal in Gastroesophageal Reflux Symptoms.","authors":"Marco Mantoan, Antonio Colantoni, Andrea Carlo Sironi, Valentina Nola, Elena Aragona, Giovanni Grava, Edoardo Baldini, Salvatore Emanuele Aragona","doi":"10.14740/gr2160","DOIUrl":"10.14740/gr2160","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux and acid-related symptoms substantially impair quality of life. Proton pump inhibitors (PPIs) remain the first-line therapy, but concerns regarding their long-term use and the persistence of symptoms in a significant proportion of patients highlight the need for complementary mucosal protection strategies. Real-world patient-reported outcomes (PROs) for barrier-forming medical devices (MDs) in individuals with reflux symptoms remain limited.</p><p><strong>Methods: </strong>An anonymous questionnaire was administered to 155 adults presenting with reflux-related symptoms. Assessments were conducted at baseline and after 7, 15, and 25 days of using the MD Piromal^®. Symptom domains included typical reflux manifestations (heartburn, regurgitation, epigastric pain), atypical/extra-esophageal symptoms (sore throat, hoarseness, globus, throat clearing, supine cough), and dyspeptic symptoms (early satiety, postprandial fullness), rated using Likert-type severity (0-5) and frequency (0-4) scales. Nocturnal disturbances and quality-of-life impact (Verbal Numeric Rating Scale (VNRS) 0-10 for daily and social interference) were also evaluated. Changes over time were analyzed using Wilcoxon signed-rank tests. Exploratory comparisons between the MD alone (n = 133) and MD + PPI (n = 22) were performed using Wilcoxon rank-sum tests.</p><p><strong>Results: </strong>Participants had a mean age of 53.2 ± 16.7 years; 55.5% were female, and 85.8% reported predominantly typical reflux symptoms. All diurnal and nocturnal symptoms showed significant reductions at 25 days (severity/frequency P < 0.0001, except hoarseness P = 0.004), with progressive improvements observed at 7 and 15 days. Quality-of-life interference decreased markedly (daily: 7.90 ± 0.87 to 2.85 ± 1.16; social: 8.86 ± 0.89 to 2.74 ± 1.01; both P < 0.0001). Overall satisfaction was high, with 90.4% reporting outcomes exceeding expectations. The most frequently reported adverse events were nausea (23.9%) and flatulence (14.8%).</p><p><strong>Conclusions: </strong>In routine clinical practice, the use of MD was associated with substantial improvements in patient-reported upper gastrointestinal symptoms and quality-of-life measures over 25 days. Exploratory subgroup findings did not show a consistent advantage of adding PPIs across most symptom domains, suggesting that meaningful symptom relief was already observed with the MD alone in this survey. However, these findings should be interpreted as hypothesis-generating. Further controlled studies are needed to clarify the role of the MD within integrated management strategies for reflux-related symptoms.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"190-203"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirtazapine in Treating Functional Dyspepsia: A Systematic Review and Meta-Analysis.","authors":"Hao The Nguyen, Arman Vaghefi, Paul Pardo, David Pitts","doi":"10.14740/gr2157","DOIUrl":"10.14740/gr2157","url":null,"abstract":"<p><strong>Background: </strong>Functional dyspepsia (FD) is a disease of gut-brain interaction that impacts the quality of life of many patients with limited effective pharmacologic options. Neuromodulators are increasingly used for refractory symptoms, but the efficacy of mirtazapine remains poorly defined. Although multiple randomized trials have evaluated mirtazapine for FD, its effects have not previously been pooled in a focused meta-analysis. The objective of our study was to synthesize results of randomized controlled trials (RCTs) to clarify their efficacy in treating this condition.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and Cochrane was performed to identify studies evaluating mirtazapine for FD from inception through November 2025 (PROSPERO ID: CRD420251237233). Ninety-three records were identified through databases and two through additional sources. After removal of duplicates and screening of abstracts, six full-text articles were assessed. Three were excluded for lacking an appropriate control group or failing to meet predefined eligibility criteria, while three RCTs were included (n = 154). Study-level effect sizes comparing mirtazapine and control groups at the end of treatment were calculated and pooled using a random-effects model. Heterogeneity was assessed using I². Robustness was examined using leave-one-out analysis and influence diagnostics were visualized with a Baujat plot.</p><p><strong>Results: </strong>Across three RCTs, mirtazapine was associated with significantly lower FD symptom severity compared with control treatment. The pooled effect size demonstrated a large benefit, with a standardized mean difference of -1.39 (95% confidence interval (CI): -2.00 to -0.78). Heterogeneity was substantial (I² = 65.1%), which likely reflects variation in enrolled populations and dosing. Two trials focused on FD patients with associated weight loss, with one additionally requiring comorbid depressive symptoms. These studies also required washout of other gastrointestinal medications, while the third started continued background treatment. However, the overall pooled effect remained directionally consistent and clinically meaningful across all sensitivity tests, including leave-one-out analysis.</p><p><strong>Conclusion: </strong>Mirtazapine was associated with significantly lower symptom severity compared with control treatment across available RCTs of FD. Increased heterogeneity may reflect differences in dosing, patient selection, and study design. Despite this, sensitivity analyses indicate that the observed effect is robust. Given the limited therapeutic options for refractory FD, mirtazapine may warrant consideration in select patient populations. However, larger and more methodologically uniform trials are needed to better define its role before considering clinical use.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"184-189"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Prognostic Factors Implicated in Chronic Functional Abdominal Pain in Children: A Systematic Review.","authors":"Hannah Richardson, Ruth Bland, Kirsty Gray","doi":"10.14740/gr2141","DOIUrl":"10.14740/gr2141","url":null,"abstract":"<p><p>Pediatric functional abdominal pain can place a significant burden on children and their families. Recent guidance has identified the benefits of hypnotherapy and cognitive behavioral therapy as management options; however, pharmacological approaches have only low certainty evidence. The aim of this study was to identify prognostic factors of chronic pain and risk of developing additional functional gastrointestinal disorders, among children with functional abdominal pain. Potential therapies could be targeted towards a population of children identified at higher risk of developing chronic abdominal pain. Relevant studies were identified through a search undertaken on four databases: Ovid MEDLINE, Embase, APA PsychInfo, and the Cochrane library, using a combination of MeSH terms and free text. Two independent reviewers screened results of this search utilizing set eligibility criteria, summarizing the characteristics of each included study according to a standardized table and assessing for risk of bias. Eight prospective cohort studies were included in the final review, with a range of duration of follow-up between 6 months to 15 years. Later age of onset of pain appeared to predict chronicity of pain, however not the development of an additional functional gastrointestinal disorder. The use of pain profiles, combining gastrointestinal and non-gastrointestinal symptoms with intensity of pain, appeared to be particularly useful for predicting later development of a functional gastrointestinal disorder. Comparison between the studies was limited due to the heterogeneity of the patient profiles, prognostic factors and outcomes that were assessed. Future research should be directed to larger, standardized studies to assess the wide range of prognostic factors which may play a significant role in chronic functional abdominal pain.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"175-183"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of <i>Clostridioides difficile</i> Infection Incidence in Cirrhotic Patients Receiving Secondary Spontaneous Bacterial Peritonitis Prophylaxis With Ciprofloxacin vs. Trimethoprim-Sulfamethoxazole.","authors":"Allen Barbarovich, Rahul Patel, Hardeep Singh, Jake Slaton, Nelson A Royall","doi":"10.14740/gr2155","DOIUrl":"10.14740/gr2155","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous bacterial peritonitis (SBP) remains a life-threatening complication in patients with cirrhosis and ascites. Preventing recurrence is a major clinical objective, and prophylactic antibiotic strategies are routinely implemented. Ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) are two widely used alternatives to norfloxacin, especially in regions where norfloxacin is not available. However, comparative data on adverse outcomes such as <i>Clostridioides difficile</i> infection (CDI) and mortality remain scarce. This retrospective cohort study examined the incidence of CDI and mortality in cirrhotic patients receiving ciprofloxacin or TMP-SMX for secondary SBP prophylaxis.</p><p><strong>Methods: </strong>A total of 6,948 patient encounters were analyzed. Ciprofloxacin was used in 75.4% (5,236) and TMP-SMX in 24.6% (1,712) of cases.</p><p><strong>Results: </strong>CDI occurred in 0.4% (21) of ciprofloxacin recipients and 0.6% (11) of TMP-SMX recipients. Mortality rates were 0.3% and 0.6%, respectively. A generalized estimating equation (GEE) model showed no statistically significant difference in CDI risk (odds ratio (OR) = 0.623; 95% confidence interval (CI): 0.299-1.296; P = 0.206) or mortality (OR = 0.539; 95% CI: 0.158-1.844; P = 0.320). These findings suggest no statistically significant difference in adverse outcomes between the two regimens, although low event rates may have limited the statistical power of the analysis.</p><p><strong>Conclusion: </strong>No statistically significant differences in CDI incidence or all-cause mortality were observed between prophylactic regimens. However, low event rates resulted in wide confidence intervals, limiting precision and precluding conclusions regarding comparative effectiveness or equivalence. Larger studies are warranted to validate these observations.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"226-232"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonlinear Associations of Estimated Pulse Wave Velocity With Hepatic Steatosis and Liver Stiffness in Community-Based People.","authors":"Tian Hao Wang, Xue Ying Ru, Xiao Xi Zhang, Tian Tian Fu, Hua Yang, Hai Rong Zhu, Zhi Gang Pan","doi":"10.14740/gr2165","DOIUrl":"10.14740/gr2165","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated fatty liver disease (MAFLD) and its progressive complication, liver fibrosis, have emerged as global public health burdens. Noninvasive tools for integrated assessment of MAFLD and early fibrogenesis remain limited. This study investigated the association between estimated pulse wave velocity (ePWV) and hepatic steatosis/liver fibrosis and assessed ePWV's utility in evaluating these conditions.</p><p><strong>Methods: </strong>This cross-sectional study included participants from Shanghai community health centers (March-November 2021) as part of a nationwide MAFLD screening project, \"Screening of Metabolic Associated Fatty Liver Disease.\" Demographic data, medical history, and laboratory/imaging results were collected. Multiple logistic regression and restricted cubic spline (RCS) curves identified associations between ePWV and MAFLD/liver fibrosis.</p><p><strong>Results: </strong>A total of 1,116 participants from four community health service centers in Shanghai were enrolled. Among them, 613 had no MAFLD, 232 had light, 202 had moderate and 69 had severe MAFLD, while 886 had no liver fibrosis, 172 had light, 52 had moderate, and six had severe liver fibrosis. Participants with MAFLD or liver fibrosis exhibited higher ePWV values and demonstrated increasing trends across disease severity categories. RCS analyses revealed nonlinear associations between ePWV and both MAFLD and liver fibrosis. When ePWV exceeded 13.26 m/s, the odds ratios (ORs) for MAFLD and liver fibrosis were consistently greater than 1.</p><p><strong>Conclusions: </strong>ePWV showed nonlinear associations with MAFLD and liver fibrosis. Values above 13.26 m/s were associated with higher odds of both conditions, suggesting that ePWV may serve as a practical vascular marker of hepatic metabolic dysfunction.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"204-216"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Fixed-Dose Pantoprazole and Sustained Release Levosulpiride for Short-Term Management of Gastroesophageal Reflux Disease.","authors":"Yogesh Garje, Vijay Kamat, Kalidas Biswas, M Murugesh, Manoj Kumar Agarwal, Pushparaj Karmarkar, Narendra D Kulkarni, Jitendra Anand, Sunil Kumar Mahavar, B Ramesh Kumar, Mukesh Mishra, P Shravan Kumar, Ashwini Satpathy, Shruti Dharmadhikari, Chintan Khandhedia, Neeraj Markandeywar, Amey Mane, Suyog Mehta","doi":"10.14740/gr2117","DOIUrl":"10.14740/gr2117","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) and dyspepsia are highly prevalent in India. Pantoprazole suppresses gastric acid secretion by inhibiting H⁺, K⁺-ATPase enzyme, yet patients experience inadequate symptom control with proton pump inhibitor (PPI) monotherapy. Levosulpiride, a selective dopamine D2 receptor antagonist, enhances gastrointestinal motility and visceral sensitivity, offering additional symptomatic relief. The aim of the study was to evaluate the safety and efficacy of a fixed-dose combination (FDC) of pantoprazole sodium 40 mg and levosulpiride sustained-release 75 mg for short-term therapy of GERD in patients unresponsive to PPI monotherapy.</p><p><strong>Methods: </strong>This phase IV, open-label, single-arm study was conducted at 11 sites across India. Of 540 screened patients, 509 were enrolled and received FDC once daily for 4 weeks. Safety was evaluated through adverse events (AEs) and serious AEs (SAEs). Efficacy was assessed using the Frequency Scale for the Symptoms of GERD (FSSG), Likert Scale, Clinical Global Impression of Improvement (CGI-I), Clinical Global Impression of Severity (CGI-S), and Modified Simpson Angus Scale (MSAS).</p><p><strong>Results: </strong>Of 509 patients, 492 completed the study. Seventy-nine AEs were documented in 69 patients, all mild-to-moderate and no SAEs were reported. The FDC demonstrated significant reduction in GERD symptom severity, with a mean (standard deviation) change from baseline of -16.99 (8.76) (P < 0.0001) on FSSG Scale at visit 4. Additionally, reductions were observed in acid reflux symptoms with a mean (SD) change from baseline of -9.15 (5.25) and dyspeptic symptoms -7.8 (4.05); both changes were statistically significant (P < 0.0001). The Likert Scale also demonstrated a significant reduction in symptom severity indicated by a mean (standard deviation) change from baseline of -1.26 (1.00) (P < 0.0001). At visit 4, CGI-I scores classified 196 patients as \"very much improved\", while CGI-S indicated \"normal\" status in 173 patients. The absence of significant movement disorders, assessed by MSAS at visit 4, further supports the favorable safety profile of FDC in management of GERD.</p><p><strong>Conclusion: </strong>The FDC of pantoprazole and levosulpiride is well tolerated and effective for the short-term treatment of GERD in patients unresponsive to PPI therapy. Symptom reductions and favorable global assessments indicate therapeutic benefit of therapy in refractory GERD population.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"233-242"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Relationship Between Sarcopenia and Perioperative Outcomes Among Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt: A Nationwide Analysis (2016-2022).","authors":"Mariam Alamgir, Bipneet Singh, Sahiljot Bhupal, Carol Singh, Aalam Sohal, Nilofar Najafian, Mohanad Al-Qaisi","doi":"10.14740/gr2162","DOIUrl":"10.14740/gr2162","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia which is characterized by the loss of muscle mass, strength, and function is a common complication in patients with chronic liver disease and contributes to poor clinical outcomes. While transjugular intrahepatic portosystemic shunt (TIPS) has shown some improvement in muscle mass and body mass index in patients with sarcopenia, the impact of sarcopenia on post-TIPS morbidity and mortality has not been examined at a national level. This study aims to evaluate the effect of sarcopenia on outcomes in patients undergoing TIPS, to enhance management and improve clinical outcomes.</p><p><strong>Methods: </strong>We analyzed data from National Inpatient Database (NIS) database from 2016 to 2022, using ICD-10 codes to identify adult patients who underwent TIPS. Patients were classified into two groups, those with and without sarcopenia, based on ICD-10 sarcopenia codes. We compared the prevalence of perioperative adverse outcomes between the groups and used multivariate logistic and linear regression to assess the impact of sarcopenia on these outcomes.</p><p><strong>Results: </strong>A total of 19,610 patients who underwent TIPS were included in the study, with 3,510 (17.9%) diagnosed with sarcopenia. Patients with sarcopenia had a higher incidence of in-hospital mortality (11.8% vs. 7.7%, P < 0.001) and a greater overall complication rate (56.4% vs. 38.8%, P < 0.001), including gastrointestinal (10.3% vs. 3.6%, P < 0.001), cardiovascular (36.9% vs. 27.2%, P < 0.001), pulmonary (23.5% vs. 12.2%, P < 0.001), and infectious (14.1% vs. 5.5%, P < 0.001) complications. Patients with sarcopenia also had a significantly longer mean length of stay (14.7 vs. 7.0 days) and higher mean total charges ($280,818 vs. $159,272).</p><p><strong>Conclusion: </strong>This study demonstrates that patients with sarcopenia have worse outcomes and increased resource utilization in patients undergoing TIPS. Early identification and assessment of sarcopenia are crucial for identifying at-risk patients and guiding targeted interventions to improve recovery and reduce complications.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 4","pages":"217-225"},"PeriodicalIF":2.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-Like Peptide-1 Receptor Agonist Therapy Reduces Fibrosis-4 Index in Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Jonathan Weng, Anderson Huang, Tamiru B Berake, Sarah L Chen, Brian M Yan, Raffi Karagozian","doi":"10.14740/gr2136","DOIUrl":"10.14740/gr2136","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading contributor to liver-related morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promise in improving MASLD-related outcomes, but their effect on hepatic fibrosis remains unclear. This study evaluated the impact of GLP-1 RA therapy on liver fibrosis, utilizing the validated fibrosis-4 (FIB-4) index as a noninvasive marker of fibrosis severity.</p><p><strong>Methods: </strong>In this retrospective cohort study, we identified patients within a large academic health system with MASLD, a baseline FIB-4 ≥ 1.3 (indicating intermediate or higher risk of hepatic fibrosis), and at least two GLP-1 RA prescriptions within a 90-day period between 2020 and 2024. Patients with cirrhosis or alcohol use disorder were excluded. Values were collected at treatment initiation and 12 months later. One-tailed paired <i>t</i>-tests assessed differences in FIB-4 and secondary outcomes, and multivariable linear regression identified independent predictors of FIB-4 change.</p><p><strong>Results: </strong>Among 229 patients with MASLD who were treated with GLP-1 RAs, 29 had a baseline FIB-4 ≥ 1.3. After 12 months, mean FIB-4 decreased by 0.21 from 1.94 to 1.73 (95% confidence interval (CI) -0.38 to -0.05; P = 0.019). Significant reductions were also observed in AST (-15.8 U/L), ALT (-21.9 U/L), body mass index (BMI, -2.6 kg/m²), and hemoglobin A1c (A1c, -1.1%; all P < 0.001). On multivariable analysis, baseline FIB-4 index was the strongest predictor of FIB-4 change (β = -0.538; P < 0.001), and FIB-4 improvement was independent of BMI change (β = 0.020; P = 0.243).</p><p><strong>Conclusion: </strong>In patients with MASLD at intermediate or higher risk of hepatic fibrosis, GLP-1 RA therapy was associated with significant reductions in FIB-4, AST, ALT, BMI, and A1c over 12 months, supporting a potential antifibrotic effect. The FIB-4 index may serve as a practical noninvasive marker for monitoring fibrosis response in MASLD.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 3","pages":"147-154"},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography-Based Assessment of Sarcopenia and Disease Progression in Pancreatic Ductal Adenocarcinoma: A Radiomics and Machine Learning Approach.","authors":"Jean-Philippe R Krieg, Luisa Gallee, Daniel Wolf, Konstantin Muller, Michael Goetz, Thomas J Ettrich, Thomas Seufferlein, Christopher Kloth, Meinrad Beer, Daniel Vogele","doi":"10.14740/gr2132","DOIUrl":"10.14740/gr2132","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a known negative prognostic factor in oncology and is frequently observed in patients with pancreatic ductal adenocarcinoma (PDAC). Computed tomography (CT) enables longitudinal muscle assessment and may provide additional prognostic information. This study aims to assess their association with prognosis in pancreatic cancer and explore the diagnostic and prognostic value of CT radiomics.</p><p><strong>Methods: </strong>A retrospective single-center study included 62 patients with primary PDAC who underwent at least three abdominal CT scans: baseline (t0), 3 months (t1), 6 months (t2), and, in 35 patients, 12 months (t3). CT-based sarcopenia was assessed using the psoas muscle index (PMI) based on reference cutoffs and cohort-specific sex-specific quartiles. Skeletal muscles at the L3 level were semi-automatically segmented. Radiomic features of the psoas were extracted and analyzed using k-nearest neighbor, decision tree, and random forest models. Prognostic relevance was evaluated using logistic regression and feature selection via least absolute shrinkage and selection operator (LASSO) regression. Tumor progression was assessed radiologically according to RECIST 1.1 criteria.</p><p><strong>Results: </strong>CT-based sarcopenia prevalence was 45.3% using reference-based PMI thresholds. PMI declined significantly from baseline to t1 and remained stable thereafter, with women exhibiting consistently lower values. Outcome analysis showed a higher proportion of disease progression at t1 in sarcopenic patients using reference cutoffs, whereas cohort-specific quartiles demonstrated no consistent differences. Random forest models predicted sarcopenia with up to 0.73 accuracy and receiver operating characteristics area under the curve (ROC-AUC) of 0.81. LASSO regression identified the psoas short axis and cross-sectional area as the most informative features. Logistic regression using baseline radiomic features predicted disease progression status at 12 months with 0.85 accuracy, weighted F₁ 0.841, and AUC 0.823. Interobserver agreement for psoas measurements was high (r = 0.86).</p><p><strong>Conclusion: </strong>Longitudinal CT-based assessment of PMI demonstrates progressive sarcopenia within the studied PDAC cohort, with sex-specific declines. Radiomic analysis of skeletal muscle provides complementary information and predictive insights, highlighting their potential to enhance the characterization of muscle status and its association with disease course in patients able to undergo repeated imaging.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 3","pages":"136-146"},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroperitoneal Basidiobolomycosis Mimicking a Malignant Neoplasm.","authors":"Abdullah Saad Alqahtani, Mahmoud Rezk Abdelwahed Hussein, Mohammed Abdulrahman Alshehri, Saeed Ali Alqahtani, Turki Mohammad Hamdi, Ali Amer Al Shehri, Mohammed Kamal Semary, Asim A Elyas, Toka Mahmoud Rezk A Hussein","doi":"10.14740/gr2138","DOIUrl":"10.14740/gr2138","url":null,"abstract":"<p><p>Basidiobolomycosis is a rare and potentially fatal fungal infection caused by <i>Basidiobolus ranarum</i> (<i>B. ranarum</i>). Retroperitoneal or mesenteric basidiobolomycosis can mimic malignant tumors clinically and radiologically. We describe a 15-year-old girl who developed retroperitoneal and mesenteric fungal masses due to <i>B. ranarum</i>. The patient presented with gradual onset of jaundice, significant weight loss, abdominal pain, and vomiting. Computed tomography revealed masses in the retroperitoneal and mesenteric regions with radiological findings suggestive of malignant neoplasm. Tru-Cut biopsy of the retroperitoneal mass confirmed basidiobolomycosis on histological examination. Following diagnosis, antifungal therapy was initiated with intravenous voriconazole (4 mg/kg/day for 2 weeks), followed by oral itraconazole (200 mg every 12 h). Regular follow-up through May 2026 demonstrated significant clinical improvement without major adverse effects. This case underscores the importance of recognizing basidiobolomycosis as a potential cause of retroperitoneal or mesenteric masses that may be misinterpreted as malignant tumors. Non-specific symptoms often delay diagnosis and appropriate treatment. Clinicians in regions where <i>B. ranarum</i> is endemic should include basidiobolomycosis in the differential diagnosis when evaluating patients with retroperitoneal or mesenteric masses.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 3","pages":"165-174"},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}