Gut最新文献

{"title":"Skin lesions and chest pain in a patient with Crohn’s disease","authors":"Ouwais Alkhateb, Racha Ftouni, Ossama Abbas, Fadi H Mourad","doi":"10.1136/gutjnl-2025-335547","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335547","url":null,"abstract":"A male patient aged 28 years with an 8-year history of ileal Crohn’s disease was started on combination therapy with infliximab and azathioprine 12 months ago. He was maintained on infliximab at a dose of 5 mg/kg administered every 8 weeks, and achieved sustained clinical remission. After receiving his sixth dose of infliximab, the patient developed intensely pruritic, erythematous papules and pustules on the palms and soles, associated with desquamation (figure 1A,B). This was followed by acneiform eruptions on the back (figure 1C), and subsequently, similar lesions appeared on the face, scalp and postauricular areas. Concurrently, he reported acute-onset, rapidly progressing chest pain predominantly localised to the sternoclavicular and sternocostal joints. Physical examination revealed marked tenderness over the costochondral joints. A comprehensive cardiac workup—including ECG, serum troponin levels and stress echocardiography—was unremarkable. However, chest MRI demonstrated bone marrow oedema at …","PeriodicalId":12825,"journal":{"name":"Gut","volume":"78 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare cause of long-segment colitis","authors":"Tien Yew Chern, Saiumaeswar Yogakanthi, William Chiang, Mustafa Mohamedrashed, Sophie Hale, Basil D’Souza, Neil Strugnell, Mayur Garg","doi":"10.1136/gutjnl-2025-335552","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335552","url":null,"abstract":"A 65-year-old previously well man presented with 3 weeks of generalised abdominal pain and diarrhoea up to three times per day after overseas travel. White cell count (9.6×106/L) and C-reactive protein (196 mg/L) were raised; however, comprehensive stool testing was negative for viral, bacterial and parasitic causes. Faecal calprotectin was <5 µg/g. CT demonstrated a long segment of circumferential bowel wall thickening and oedema from the rectosigmoid to the splenic flexure with normal enhancement of the mesenteric arteries (figure 1). Figure 1 Radiological, endoscopic and histological findings. (A) CT showing diffusely thickened rectosigmoid and descending colon with associated mesenteric stranding. (B) Endoscopic view of the sigmoid colon with pale, oedematous and friable mucosa with telangiectasia. (C) The histology showed marked myointimal hyperplasia of the submucosal veins. The lack of an internal elastic lamina …","PeriodicalId":12825,"journal":{"name":"Gut","volume":"33 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: ‘Perspective on enhancing CRC risk prediction’ by Zheng and Wang","authors":"Craig Mowat","doi":"10.1136/gutjnl-2025-335774","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335774","url":null,"abstract":"We are very grateful for the interest in our paper on improving colorectal cancer (CRC) risk prediction in symptomatic patients attending primary care1 expressed by Doctors Zheng and Wang,2 and they highlight some interesting points which we address in the Discussion. To date, the generalisability of Faecal Immunochemical Test (FIT)-based research conducted on a specific FIT analyser has been questioned because the stool collection devices used by analyser manufacturers are not standardised and contain different buffer fluid/antibodies which …","PeriodicalId":12825,"journal":{"name":"Gut","volume":"55 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cold snare endoscopic resection for large colon polyps: a randomised trial","authors":"Heiko Pohl, Douglas K Rex, Jeremy Barber, Matthew T Moyer, B Joseph Elmunzer, Amit Rastogi, Stuart R Gordon, Eugene Zolotarevsky, John M Levenick, Harry R Aslanian, Mazen Elatrache, Daniel von Renteln, Michael B Wallace, Bhaumik Brahmbhatt, Rajesh N Keswani, Nikhil A Kumta, Douglas K Pleskow, Zachary L Smith, Mouhanna K Abu Ghanimeh, Stephen Simmer, Omid Sanaei, Todd A Mackenzie, Cyrus Piraka","doi":"10.1136/gutjnl-2025-335075","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335075","url":null,"abstract":"Background Complications of endoscopic mucosal resection (EMR) of large colorectal polyps remain a concern. Objective We aimed to compare safety and efficacy of cold EMR (without electrocautery) to hot EMR (with electrocautery) of large colorectal polyps. Design In this multicentre randomised trial, patients with any large (≥20 mm) non-pedunculated colon polyp were assigned to cold or hot EMR (primary intervention), and to submucosal injection with a viscous or non-viscous solution (secondary intervention) following a 2×2 design. The primary outcome was the rate of severe adverse events (SAEs). The secondary outcome was polyp recurrence. In this study, we report results of the primary intervention. Results 660 patients were randomised and analysed. An SAE was observed in 2.1% of patients in the cold EMR group and in 4.3% in the hot EMR group (p=0.10) (per protocol analysis 1.4 vs 5.0%, p=0.017) with fewer perforations following cold EMR (0%) compared with hot EMR (1.6%, p=0.028). Postprocedure bleeding did not differ (1.5% vs 2.2%, p=0.57). The effect of cold resection was independent of the type of submucosal injection solution, polyp size or antithrombotic medications. Recurrence was detected in 27.6% and 13.6% in the cold and hot EMR groups, respectively (p<0.001). Recurrence was not significantly different for 20–29 mm polyps (18.6% vs 13.4%, p=0.24) and for sessile serrated polyps (14.1% vs 8.5%, p=0.33). Conclusion Universal application of cold EMR did not significantly lower SAEs (unless cold EMR could be completed) and doubled the recurrence rate compared with hot EMR. Trial registration details ClinicalTrials.gov, number: [NCT03865537][1]. No data are available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03865537&atom=%2Fgutjnl%2Fearly%2F2025%2F05%2F19%2Fgutjnl-2025-335075.atom","PeriodicalId":12825,"journal":{"name":"Gut","volume":"18 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-protein diets alleviate tumour growth and drug resistance by promoting AKT aggregation and turnover","authors":"Lang Bu, Yi Zhang, Yaqing Su, Xueji Wu, Bing Gao, Lei Wang, Wei Xie, Qiwei Jiang, Jianping Guo","doi":"10.1136/gutjnl-2024-334630","DOIUrl":"https://doi.org/10.1136/gutjnl-2024-334630","url":null,"abstract":"Background Despite the long-standing recommendations of high-protein diets for patients with cancer, the precise mechanisms of this dietary approach in benefiting tumour suppression and enhancing sensitivity to chemotherapy remain elusive. Objective To investigate the effect and underlying mechanism of high-protein diets in promoting cancer drug resistance. Characterisation of AKT regulation in this setting will provide new strategies to combat liver cancer. Design The role of high-protein diets in cancer drug resistance was analysed in cells and in syngeneic mouse models. In vivo and in vitro kinase and ubiquitination assays were employed to detect AKT phosphorylation and ubiquitination modifications. Clustered regularly interspaced short palindromic repeats (CRISPR)-based screen was used to identify the E3 ligase for AKT. Generation of Akt1T72E knock-in mice and Traf5 knockout mice was employed. Results High-protein diets repress tumour growth and sensitise tumour to chemotherapies. Specifically, S6K1 directly phosphorylates AKT, leading to acute inactivation and long-term instability of AKT protein. S6K1 promotes AKT aggregation and facilitates its interaction with TRAF5, resulting in AKT degradation in response to amino acid stimuli. Traf5 knockout mice exhibit high AKT protein levels, insulin resistance and counteracting protein diet-induced tumour repression. While a reversible phenomenon has been observed in the constitutive phosphor-mimetic Akt1T72E knock-in mice, which manifest retarded liver tumourigenesis in C-Myc transgenic mice. Conclusions Our results highlight a fine-tuned regulation of AKT by S6K1-mediated phosphorylation and TRAF5-dictated ubiquitination and degradation, offering a strategy for integrating chemotherapy with high-protein diets to enhance cancer treatment efficacy. Data are available on reasonable request.","PeriodicalId":12825,"journal":{"name":"Gut","volume":"6 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purastat post-EMR: unresolved questions from the PURPLE trial","authors":"Pradeep Bhandari, Roberto de Sire, Alessandro Repici","doi":"10.1136/gutjnl-2025-335483","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335483","url":null,"abstract":"We read with interest the recently published PURPLE trial evaluating the prophylactic use of Purastat to prevent delayed bleeding following EMR of large duodenal and colorectal lesions.1 While we acknowledge the importance of randomised trials in shaping clinical practice, several methodological concerns in this study limit the interpretability and clinical applicability of its findings. The trial was prematurely halted following an interim analysis involving only 200 patients. We believe this pragmatic interim analysis might have been conducted too early on too small a sample size, potentially underpowering the study to detect a clinically relevant effect. The initial hypothesis of an 80% reduction in delayed bleeding in the Purastat arm, based on results from a clipping study by Albéniz et al ,2 appears overtly optimistic. The power calculation was based on an anticipated 2% delayed bleeding rate in …","PeriodicalId":12825,"journal":{"name":"Gut","volume":"16 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us","authors":"Chris Zielinski","doi":"10.1136/gutjnl-2025-335771","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335771","url":null,"abstract":"This May, the World Health Assembly (WHA) will vote on re-establishing a mandate for the WHO to address the health consequences of nuclear weapons and war.1 Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war. The first atomic bomb exploded in the New Mexico desert 80 years ago, in July 1945. Three weeks later, two relatively small (by today’s standards), tactical-size nuclear weapons unleashed a cataclysm of radioactive incineration on Hiroshima and Nagasaki. By the end of 1945, about 213 000 people were dead.2 Tens of thousands more have died from late effects of the bombings. Last December, Nihon Hidankyo, a movement that brings together atomic bomb survivors, was awarded the Nobel Peace Prize for its ‘efforts to achieve a world free of nuclear weapons and for demonstrating through witness testimony that nuclear weapons must never be used again’.3 For the Norwegian Nobel Committee, the award validated the most fundamental human right: the right to live. The Committee warned that the menace of nuclear weapons is now more urgent than ever before. In the words of Committee Chair Jørgen Watne Frydnes, “it is naive to believe our civilisation can survive a world order in which global security depends on nuclear weapons. The world is not meant to be a prison in which we await collective annihilation”.4 He noted that our survival depended on keeping intact the ‘nuclear taboo’ (which stigmatises the use of nuclear weapons as morally unacceptable).5 The nuclear taboo gains strength from recognition of compelling evidence of the catastrophic humanitarian consequences of nuclear war, its severe global climatic and famine consequences and the impossibility of any effective humanitarian response. This evidence contributed significantly …","PeriodicalId":12825,"journal":{"name":"Gut","volume":"27 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LECT2-PHB2 axis: a new mechanistic insight and therapeutic opportunity in alcohol-associated hepatitis.","authors":"Hui Li,Meiyi Song,Phillip B Hylemon,Huiping Zhou","doi":"10.1136/gutjnl-2025-335259","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335259","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"113 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of rebleeding after primary haemostasis using haemostatic powder in non-variceal upper gastrointestinal bleeding: a multicentre randomised controlled trial.","authors":"Jongbeom Shin,Boram Cha,Jitaek Hong,Kye Sook Kwon,Eunhye Lee,Jin Hee Maeng,Jun-Won Chung,Dong Kyun Park,Yoon Jae Kim,Kwang An Kwon,Jung Ho Kim,Kwang-Suk Seo,Su Jin Hong,Kyoung Oh Kim","doi":"10.1136/gutjnl-2024-332459","DOIUrl":"https://doi.org/10.1136/gutjnl-2024-332459","url":null,"abstract":"BACKGROUNDNon-variceal upper gastrointestinal bleeding (NVUGIB) remains a major cause of morbidity and mortality. Rebleeding rates following endoscopic treatment can reach up to 25% within 72 hours in patients with high-risk lesions.OBJECTIVETo evaluate the efficacy of a haemostatic powder (Nexpowder) in reducing rebleeding rates after conventional endoscopic treatment in patients with NVUGIB.DESIGNThis was a prospective, multicentre, randomised controlled trial involving patients with acute NVUGIB from high-risk lesions who achieved initial endoscopic haemostasis. Participants were randomised 1:1 to receive either the haemostatic powder or no further therapy (control group). The primary outcome was the rebleeding rate within 72 hours post-treatment. Secondary outcomes included the 30-day rebleeding rate and the safety profile.RESULTSA total of 341 patients (72.1% male; mean age 64.8 years) were included, with 173 in the powder group and 168 in the control group. Baseline characteristics were similar between groups. Ulcer bleeding was the predominant aetiology (n=317), with Forrest type I bleeding observed in two-thirds of cases. The 72-hour rebleeding rate was significantly lower in the powder group (2.9%, 95% CI 0.9 to 6.6%) compared with the control group (11.3%, 95% CI 6.9 to 17.1%; p =0.005). A significant reduction was also observed in the 30-day cumulative rebleeding rate (7.0% vs 18.8%), with similar findings in the ulcer subgroup for the 3-day rebleeding rate (3.0% vs 12.0%; p =0.004). No adverse events related to the powder application were reported.CONCLUSIONThe application of Nexpowder following endoscopic haemostasis significantly reduced both early (3 days) and late (30 days) rebleeding rates in patients with NVUGIB, particularly in cases of ulcer-related bleeding.TRIAL REGISTRATION NUMBERNCT04124588.","PeriodicalId":12825,"journal":{"name":"Gut","volume":"74 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large language models for detecting colorectal polyps in endoscopic images.","authors":"Luca Carlini,Davide Massimi,Yuichi Mori,Giulio Antonelli,Tommy Rizkala,Marco Spadaccini,Chiara Lena,Sravanthi Parasa,Raf Bisschops,Daniel von Renteln,Susanne O'Reilly,Prateek Sharma,Douglas K Rex,Michael Bretthauer,Alessandro Repici,Elena Demomi,Cesare Hassan","doi":"10.1136/gutjnl-2025-335091","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-335091","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"18 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}