Gastroenterologia y hepatologia最新文献

{"title":"Development and validation of interpretable machine learning models to detect unconfirmed hepatitis C using electronic health records (LiverTAI).","authors":"G Sanchez-Antolín, G de la Poza, L Hidalgo, M V Aguilera, B Cuyàs, F Ledesma, E Sanz, V Fanjul, C L Oeste, J L Calleja","doi":"10.1016/j.gastrohep.2026.502774","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2026.502774","url":null,"abstract":"<p><strong>Objective: </strong>Hepatitis C virus (HCV) infection poses a global health threat with many undiagnosed cases despite advances in diagnosis and treatment. The LiverTAI project in Spain utilized electronic health records (EHRs) to study factors associated with HCV infection, aiming to develop a predictive model for identifying unconfirmed HCV cases in the hospital setting.</p><p><strong>Patients and methods: </strong>Clinical data from EHRs of six hospitals in Spain were analyzed using machine learning and natural language processing through EHRead®. Patients were categorized as HCV positive, negative, or unknown. A semi-supervised learning framework allowed to incorporate labeled and unlabeled patient data extracted from clinical narratives. Propensity score matching was applied to reduce bias. Seven classification algorithms were used to predict HCV status based on 117 selected features, including demographics, risk factors, comorbidities, and clinical events. Model performance was confirmed through independent geographic validation.</p><p><strong>Results: </strong>Among 2,440,358 screened patients, 44,235 were included in the training set, and 11,286 in the validation set. The Extreme Gradient Boosting model showed the best performance (AUC-ROC 0.794), followed by the Logistic Regression model (AUC-ROC 0.779). Key predictors included HCV risk factors (age, male sex, HIV, drug use), liver-related issues (cirrhosis, hepatocellular carcinoma), and extrahepatic conditions (neuropsychiatric, cardiovascular, immune-related disorders, cancer, and inflammatory processes).</p><p><strong>Conclusions: </strong>LiverTAI identified new patients with potential HCV infection in routine hospital EHRs, providing a proof of concept for risk-stratified opportunistic screening. The model supports more efficient in-hospital testing strategies, though further prospective validation is required to confirm generalizability and clinical utility.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502774"},"PeriodicalIF":1.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837148","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":"Factors associated with non‑adherence to colonoscopy after a positive test in a population‑based colorectal cancer screening program.","authors":"Àngels Pozo, Anna Serradesanferm, Lourdes Rubio, Maria Pellisé, Jaume Grau, Isabel Torá-Rocamora, Antoni Castells","doi":"10.1016/j.gastrohep.2026.502771","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2026.502771","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the sociodemographic and clinical profile of individuals with a positive fecal immunochemical test result in the population-based colorectal cancer screening program who refused the screening colonoscopy at the reference center, with no colonoscopy recorded thereafter, and to identify the reasons for such a refusal.</p><p><strong>Patients and methods: </strong>A descriptive, observational, cross-sectional, retrospective study including 128 participants who refused a colonoscopy at Clínic Barcelona after obtaining a positive fecal immunochemical test result through the population-based colorectal cancer screening program in 2022-2023. Data obtained from medical record reviews were described.</p><p><strong>Results: </strong>Individuals who refused colonoscopy had a mean age of 60.35 ± 5.25 years, 90.63% were Spanish nationals, and 85.16% had a high socioeconomic status. The median number of participations in the colorectal cancer screening program was 3. Most participants had no prior history of cancer (64.06%), no family history of colorectal cancer (64.84%), and no symptoms suggestive of colorectal cancer (71.09%). The main reasons for refusal were a preference to undergo colonoscopy in a center outside the screening program (21.09%) and multimorbidity, severe disease, or a condition requiring medical clearance to undergo the procedure (20.31%).</p><p><strong>Conclusions: </strong>Most people who declined the screening colonoscopy had a high socioeconomic status and one fifth preferred to undergo the procedure in an external center. The clinical profile of approximately one fifth of the subjects also corresponded to individuals with severe comorbidities, who required an individualized assessment of the risk-benefit balance of the procedure.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502771"},"PeriodicalIF":1.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837159","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":"Radiation-Based Indicators for ERCP Quality Evaluation.","authors":"Grecia C Celis-Valenzuela, Raúl A Jiménez-Castillo, Luis A González-Torres, Aldo A Garza-Galindo, José A González-González, Héctor J Maldonado-Garza, Joel O Jaquez-Quintana","doi":"10.1016/j.gastrohep.2026.502770","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2026.502770","url":null,"abstract":"<p><strong>Objective: </strong>Radiation exposure during ERCP lacks validated cut-off values as quality indicators (QIs). We propose using fluoroscopy time (FT) and radiation dose (RD) cut-off points as surrogate measures of radiation exposure to identify low-risk procedures.</p><p><strong>Patients and methods: </strong>Retrospective study of 1,328 consecutive ERCPs. We constructed a composite reference standard outcome (ERCP complications and ASGE grade 3 procedures). We performed Receiver Operating Characteristic (ROC) curves to identify optimal FT and RD thresholds for the composite outcome. Secondary objectives evaluated differences between FT and RD, across trainees and experts, and by ERCP complexity grade.</p><p><strong>Results: </strong>The optimal cut-off value for FR and RD were >4.32 minutes (AUC 0.672, 95% CI 0.65-0.7; p < 0.001, Youden Index 0.3) and >32.5 mGy (AUC 0.683, 95% CI 0.657-0.708; p < 0.001, Youden Index 0.28), respectively; their Negative Predictive Values were de 89.2 and 88.7% respectively.</p><p><strong>Conclusions: </strong>FT and RD are reproducible QIs for ERCP that may help identify low-risk procedures and may function as new academic and standardized objectives.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502770"},"PeriodicalIF":1.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837223","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":"Massive lower gastrointestinal bleeding of unusual origin: splenic artery pseudoaneurysm in necrotizing pancreatitis.","authors":"Miguel Ángel Lorente Martínez, Melody Moreno Barrueco, Fernando Berdugo Hurtado","doi":"10.1016/j.gastrohep.2026.502773","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2026.502773","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502773"},"PeriodicalIF":1.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837236","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 tale of two intestines: capsule endoscopy of native and transplanted small bowel.","authors":"Francisco López Romero-Salazar, Beatriz Conde García, Cristina Garfia Castillo, Carmelo Loinaz Segurola","doi":"10.1016/j.gastrohep.2026.502772","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2026.502772","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502772"},"PeriodicalIF":1.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837221","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":"Liver transplantation due to hepatocellular adenoma rupture associated with anabolic androgenic steroid abuse","authors":"Iñigo Jon Garaizabal Azkue ,&nbsp;Jon Stampa Ferro ,&nbsp;Silvia Torrente Iranzo ,&nbsp;Verónica Velasco Benito ,&nbsp;Eva García Alberdi ,&nbsp;Agustin Castiella Eguzkiza","doi":"10.1016/j.gastrohep.2025.502636","DOIUrl":"10.1016/j.gastrohep.2025.502636","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"49 5","pages":"Article 502636"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700845","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":"Evaluación subjetiva por endoscopistas expertos de la nueva prótesis de aposición luminal con diatermia incorporada y sistema de liberación clásico en indicaciones aprobadas (Hot-Spaxus©): un estudio piloto","authors":"Antonio Martinez-Ortega ,&nbsp;Marina de Benito Sanz ,&nbsp;Francisco J. García Alonso ,&nbsp;Irene Latras Cortés ,&nbsp;José Ramón Aparicio Tormo ,&nbsp;Vicente Sanchiz Soler ,&nbsp;Joan B. Gornals ,&nbsp;José Carlos Subtil Iñigo ,&nbsp;Belén Martínez Moreno ,&nbsp;Albert Sumalla-Garcia ,&nbsp;Ramón Sánchez Ocaña ,&nbsp;Carlos de la Serna-Higuera ,&nbsp;Manuel Perez-Miranda","doi":"10.1016/j.gastrohep.2025.502641","DOIUrl":"10.1016/j.gastrohep.2025.502641","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the potential acceptance of Hot-Spaxus in routine practice through a subjective technical assessment by expert endoscopists, and to assess its short-term efficacy and safety.</div></div><div><h3>Patients and methods</h3><div>Observational multicenter study based on a prospective database of the first cases of EUS-guided therapeutic drainage of on-label targets (pancreatic fluid collections [PFC] and gallbladder drainage [GD]) using Hot-Spaxus© doing by 6 expert endoscopist. After the endoscopic procedure, experts completed two questionnaires with 9 items each: one assessing technical difficulty and another evaluating preference for Hot-Spaxus, Hot-Axios, or no preference/similar.</div></div><div><h3>Results</h3><div>Twelve patients were included (4 PFC / 8 GD); 66% were women, with a median age of 84.8 years (IQR 71.7–89.4). In the questionnaire on perceived difficulty, most items were rated as easy or moderate, while the “very difficult” category was reported infrequently. Endoscopists preferred Hot-Axios© over Hot-Spaxus© regarding position control during deployment (58.3%) and management of the delivery system (58.3%). Technical and clinical success rates were 91.7% and 90.9%, respectively. One case of bleeding was reported as an adverse event (8.3%).</div></div><div><h3>Conclusions</h3><div>Deployment system friction, endoscope channel friction, and guidewire passage through the delivery system were perceived as less complex. In contrast, penetration, position control, and LAMS deployment were considered more challenging and were rated less favorably compared with Hot-Axios©.</div></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"49 5","pages":"Article 502641"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800293","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":"Corrigendum. Guía de práctica clínica multidisciplinar de manejo de la esteatosis hepática metabólica","authors":"Manuel Romero-Gómez ,&nbsp;Javier Escalada ,&nbsp;Mar Noguerol ,&nbsp;Antonio Pérez ,&nbsp;Juana Carretero ,&nbsp;Javier Crespo ,&nbsp;Juan J. Mascort ,&nbsp;Ignacio Aguilar ,&nbsp;Francisco Tinahones ,&nbsp;Pedro Cañones ,&nbsp;Ricardo Gómez-Huelgas ,&nbsp;Daniel de Luis ,&nbsp;Idoia Genúa Trullos ,&nbsp;Rocío Aller ,&nbsp;Miguel A. Rubio ,&nbsp;José Luis Calleja","doi":"10.1016/j.gastrohep.2025.502639","DOIUrl":"10.1016/j.gastrohep.2025.502639","url":null,"abstract":"<div><div>Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).</div></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"49 5","pages":"Article 502639"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029467","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":"Hernia hiatal con repercusión cardíaca: cuando el síncope no es lo que parece","authors":"Ana Plaza Fernández,&nbsp;Marta Fernández Carrasco,&nbsp;María del Mar Calvo Bernal","doi":"10.1016/j.gastrohep.2025.502630","DOIUrl":"10.1016/j.gastrohep.2025.502630","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"49 5","pages":"Article 502630"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530607","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":"Manejo de la proctitis ulcerosa refractaria","authors":"Manuel Barreiro-de Acosta ,&nbsp;Francisco Mesonero ,&nbsp;Rocío Ferreiro-Iglesias ,&nbsp;Santiago García-López ,&nbsp;Mariam Aguas Peris ,&nbsp;Mónica Sierra Ausín ,&nbsp;Noelia Cano Sanz ,&nbsp;Antonio Valdivia Martínez ,&nbsp;Ana Cábez ,&nbsp;Susan Ramírez ,&nbsp;Daniel Ginard","doi":"10.1016/j.gastrohep.2025.502646","DOIUrl":"10.1016/j.gastrohep.2025.502646","url":null,"abstract":"<div><h3>Objective</h3><div>Ulcerative proctitis (UP) usually presents a milder course, but some patients develop significant symptom burden, severe forms, or refractory UP (RUP). Our objective was to characterise RUP and generate recommendations for daily practice.</div></div><div><h3>Methods</h3><div>A systematic review (SR) was conducted to analyze epidemiological, clinical, and pharmacological treatment aspects of RUP. The results were discussed in a nominal focus group meeting composed of seven gastroenterologists specialized in the management of inflammatory bowel disease, a nurse, and a patient. Several statements on the management of PU were proposed and voted to achieve agreement.</div></div><div><h3>Results</h3><div>The SR included 43 articles of low to moderate quality. Nearly 30% of patients presented RUP, and the impact of the disease on their quality of life was highly significant. Different gaps of knowledge related to the clinical characteristics and course of the disease, efficacy, safety, and selection of pharmacological treatments were identified. The experts proposed 13 practical statements that reached the established level of agreement. These address the diagnosis of UP and RUP, their therapeutic goals and treatment selection, monitoring, treatment response, and the role of the nurse.</div></div><div><h3>Conclusions</h3><div>RUP is common and can have a significant impact on patients. More research is needed to characterize RUP and the long-term efficacy of available treatments. The proposed statements aim to address the knowledge gaps related to RUP.</div></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"49 5","pages":"Article 502646"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809725","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}