Gut and Liver最新文献

{"title":"Early Antiviral Therapy and Hepatocellular Carcinoma Incidence in Chronic Hepatitis B Patients with Normal Alanine Aminotransferase Levels: A Prospective Phase II Study.","authors":"Dong Hyun Sinn, Ji Hoon Kim, Hyung Joon Kim, June Sung Lee, Jae Young Jang, Kyunga Kim, Joonghyun Ahn, Yoon Jun Kim, Joon Hyeok Lee","doi":"10.5009/gnl260219","DOIUrl":"https://doi.org/10.5009/gnl260219","url":null,"abstract":"<p><strong>Background/aims: </strong>Whether antiviral therapy with nucleos(t)ide analogs is necessary for chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) levels remains controversial. The D₂AS score is a validated model for identifying patients at high risk of hepatocellular carcinoma (HCC) despite normal or mildly elevated ALT levels. We explored whether the observed HCC incidence with immediate antiviral therapy differed from that predicted by the D₂AS model.</p><p><strong>Methods: </strong>In this prospective, multicenter phase II trial, 115 non-cirrhotic CHB patients with ALT <80 U/L and a D₂AS score ≥2.0 received generic entecavir (0.5 mg daily) for 5 years. The primary endpoint was the standardized incidence ratio (SIR), defined as the ratio of the observed to the expected number of HCC cases based on the D₂AS score.</p><p><strong>Results: </strong>The virological response rates were 79.4%, 90.2%, and 92.4% at 1, 3, and 5 years, respectively. The median ALT concentration decreased from 37 U/L at baseline to 23, 20, and 19 U/L at 1, 3, and 5 years, respectively. Six patients developed HCC, with cumulative incidences of 2.0%, 5.1%, and 6.1% at 1, 3, and 5 years, respectively. Although the observed HCC incidence was not significantly lower than expected overall, a decreasing trend was noted at year 5 (SIR, 0.53; 95% confidence interval, 0.24 to 1.20).</p><p><strong>Conclusions: </strong>Immediate antiviral therapy achieved sustained viral suppression and ALT reduction and showed a trend toward a lower-than-expected HCC incidence. Although exploratory, these findings provide a rationale for conducting future controlled studies to evaluate potential clinical benefits of early antiviral therapy in this population.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor-Promoting Inflammation in Serrated Colorectal Neoplasia: Immune Ecosystems and Clinical Implications.","authors":"Jiayu Chen, Yuki Nakanishi, Xiaomeng Yin, Mami Bamba, Yu Muta, Takahiro Utsumi, Hiroaki Kasashima, Akihisa Fukuda, Hiroshi Seno","doi":"10.5009/gnl260271","DOIUrl":"https://doi.org/10.5009/gnl260271","url":null,"abstract":"<p><p>Serrated colorectal neoplasia represents a biologically distinct route to colorectal cancer that differs from the conventional adenoma-carcinoma sequence in its molecular alterations, epithelial programs, and microenvironmental evolution. Recent studies indicate that tumor-promoting inflammation and dynamic tumor-microenvironment interactions are integral to the evolution of serrated tumors. In this review, we discuss serrated neoplasia as a process shaped by heterogeneous immune ecosystems rather than a uniform inflammatory state. We propose two broad immune trajectories: an inflamed/antigenic trajectory frequently associated with mismatch repair deficiency and microsatellite instability and a stromal-dominant, immune-excluded trajectory more commonly linked to microsatellite stable serrated cancers. We further organize the major proposed mechanistic axes of tumor-promoting inflammation into interconnected processes: epithelial reprogramming, stromal immune exclusion, and persistent inflammatory signaling. Finally, we highlight the potential clinical relevance of immune ecosystem divergence, particularly during the transition from sessile serrated lesions to sessile serrated lesions with dysplasia, and discuss future directions for risk stratification and ecosystem-based intervention in serrated colorectal neoplasia.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food Insecurity and Its Association with the Spectrum of Steatotic Liver Disease and Hepatic Fibrosis.","authors":"Donghee Kim, Pojsakorn Danpanichkul, Anoushka Shenoy, Karn Wijarnpreecha, Aijaz Ahmed","doi":"10.5009/gnl260342","DOIUrl":"https://doi.org/10.5009/gnl260342","url":null,"abstract":"<p><p>The impact of food insecurity on the subtypes of steatotic liver disease (SLD) under the updated nomenclature remains undefined. We aimed to assess the relationship between food insecurity and metabolic dysfunction-associated SLD (MASLD), alcohol-related liver disease (ALD), and metabolic dysfunction and alcohol-related SLD (MetALD), with a focus on significant fibrosis. Using data from the 2017 to 2023 U.S. National Health and Nutrition Examination Survey, we defined food security as full, marginal, low, or very low. We defined SLD subtypes and significant fibrosis using transient elastography. Food insecurity was independently associated with 37% higher odds of MASLD (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.15 to 1.64). A dose-response relationship was evident, with low/very low food security conferring the highest risk. In contrast, the association between food insecurity and MetALD or ALD was not statistically significant. Food insecurity was linked to increased odds of significant fibrosis (OR, 1.34; 95% CI, 1.09 to 1.64); after adjusting for diabetes and obesity, this association was attenuated but remained statistically significant (OR, 1.22; 95% CI, 1.00 to 1.49; p=0.048). Food insecurity is independently associated with MASLD in the United States but not with MetALD or ALD. Food insecurity is significantly associated with significant hepatic fibrosis.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on Baseline and Longitudinal MASLD Status Is Associated with Increased Risk of Pyogenic Liver Abscess.","authors":"Guoqin Yang, Lichun Fang","doi":"10.5009/gnl260413","DOIUrl":"https://doi.org/10.5009/gnl260413","url":null,"abstract":"","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton Pump Inhibitor Use Increases the Risk of Recurrent <i>Clostridioides difficile</i> Infection: A Bias-Controlled Nationwide Real-World Data Study.","authors":"Jiyoung Yoon, Seung In Seo, Woon Geon Shin, You Sun Kim","doi":"10.5009/gnl260151","DOIUrl":"https://doi.org/10.5009/gnl260151","url":null,"abstract":"<p><strong>Background/aims: </strong>The association between proton pump inhibitors (PPIs) and the risk of recurrent <i>Clostridioides difficile</i> infection (CDI) remains unclear. We evaluated whether PPI use after initial CDI treatment increases the risk of recurrence using multicenter electronic health records converted to a Common Data Model (CDM).</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study across eight hospitals using the CDM. Patients with newly diagnosed CDI who received adequate initial therapy were included. The target cohort included individuals prescribed a PPI for ≥7 consecutive days within 90 days after CDI diagnosis; the comparator cohort included those with no PPI exposure. Propensity score matching was performed based on age, sex, comorbidities, cardiovascular disease history, and medication use. Cox proportional hazards models were used to estimate hazard ratios (HRs) for CDI recurrence at 1 and 2 years. Study-specific HRs were combined using random-effects meta-analysis.</p><p><strong>Results: </strong>Between 1986 and March 2025, 5,622 PPI users and 6,719 non-users were initially identified. After matching, 1,682 pairs (PPI vs non-PPI) were included in the final analysis. PPI use after CDI treatment was associated with an increased recurrence risk compared with no PPI use during the first year (HR, 1.49; 95% confidence interval [CI], 1.15 to 1.92). The risk of CDI recurrence was even higher in the PPI use group when followed up over 2 years (HR, 1.66; 95% CI, 1.19 to 2.32).</p><p><strong>Conclusions: </strong>Across eight CDM-based hospital databases, PPI exposure after CDI treatment was significantly associated with an increased recurrence risk, highlighting the need for careful risk-benefit considerations when prescribing PPIs to patients with CDI.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postendoscopic Submucosal Dissection Bleeding Risk of Periprocedural Aspirin Maintenance Therapy in Clopidogrel Users as Single or Dual Antiplatelet Agents.","authors":"Young-Il Kim, Bo Young Lee, Jong Yeul Lee, Chan Gyoo Kim, Il Ju Choi","doi":"10.5009/gnl260007","DOIUrl":"https://doi.org/10.5009/gnl260007","url":null,"abstract":"<p><strong>Background/aims: </strong>Aspirin maintenance is recommended during endoscopic submucosal dissection (ESD) in patients with antiplatelet therapy (APT) who are at high-thromboembolic risk. We evaluated the post-ESD bleeding risk during aspirin maintenance therapy and the timing of clopidogrel resumption.</p><p><strong>Methods: </strong>Patients who underwent ESD for early gastric cancer or adenoma between 2011 and 2020 were included. Patients receiving APT who were at low thromboembolic risk stopped APT 7 days before ESD and resumed it 1 month after ESD (interrupted group). Patients receiving APT who were at high thromboembolic risk were maintained on aspirin (maintenance group), and pre-ESD clopidogrel users receiving one or two antiplatelet agents stopped clopidogrel 7 days before ESD and resumed it on day 15 after ESD. The primary outcome was post-ESD bleeding.</p><p><strong>Results: </strong>Of the 2,346 ESD cases, the overall post-ESD bleeding rate was 3.8% (90/2,346). The bleeding incidence was higher in the aspirin maintenance group (13.0%, 16/123) than in the interrupted group (2.9%, 6/209) and nonusers (3.4%, 68/2,014; p<0.001). The increase in bleeding rate was significant within 14 days, whereas it became insignificant ≥15 days after ESD. In the maintenance group, bleeding risk was not significantly increased in pre-ESD single clopidogrel users (hazard ratio [HR], 1.38; p=0.582) or dual APT users (HR, 1.18; p=0.797) compared with the single aspirin users. No bleeding events occurred after clopidogrel resumption on post-ESD day 15. Additionally, no thromboembolic events occurred in the maintenance or interrupted therapy groups.</p><p><strong>Conclusions: </strong>Periprocedural aspirin maintenance increased post-ESD bleeding within 2 weeks of gastric ESD. Resuming original clopidogrel therapy 2 weeks after ESD did not increase bleeding risk in patients receiving periprocedural aspirin maintenance therapy.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine-Data Triage for MASLD Positive on Vibration-Controlled Transient Elastography after FIB-4: An Exploratory NHANES Pathway Comparison Study with Temporal Validation.","authors":"Wenbin Jiang, Yao Ge, Yihan Chai, Kexin Jiang, Qijiang Mao","doi":"10.5009/gnl260210","DOIUrl":"https://doi.org/10.5009/gnl260210","url":null,"abstract":"<p><strong>Background/aims: </strong>Contemporary metabolic dysfunction-associated steatotic liver disease (MASLD) pathways use the fibrosis-4 index (FIB-4) before vibration-controlled transient elastography (VCTE), but FIB-4-based rules may miss adults with VCTE-defined increased liver stiffness. We quantified VCTE-positive burden across low-risk and indeterminate FIB-4 groups and evaluated an exploratory routine-data second-stage triage strategy in the National Health and Nutrition Examination Survey (NHANES).</p><p><strong>Methods: </strong>Adults with MASLD from NHANES 2017 to March 2020 formed the development cohort, and those from August 2021 to August 2023 formed the temporal validation cohort. MASLD required controlled attenuation parameter-defined steatosis, cardiometabolic risk, and exclusion of significant alcohol use and viral hepatitis. The primary endpoint was liver stiffness measurement (LSM) ≥8 kPa; LSM thresholds of 7, 10, and 12 kPa were tested. A regularized logistic model was developed among adults with FIB-4 ≤2.67. The enhanced hybrid pathway referred adults with FIB-4 >2.67 or, among those with FIB-4 ≤2.67, model probability ≥0.159561.</p><p><strong>Results: </strong>The development cohort included 3,004 adults, 503 (16.7%) with LSM ≥8 kPa; validation included 1,959 adults, 408 (20.8%) with LSM ≥8 kPa. In validation, LSM ≥8 kPa occurred in 221/1,228 with FIB-4 <1.3 and 111/473 with FIB-4 1.3 to 2.67. Standard FIB-4 referral detected 137/408 cases while referring 528 of 1,959 adults; the enhanced pathway detected 233 of 408 while referring 621 of 1,959. In low/intermediate FIB-4 validation adults, the model area under the receiver operating characteristic curve was 0.742.</p><p><strong>Conclusions: </strong>Low-risk and indeterminate FIB-4 groups contained substantial VCTE-positive burden. This exploratory enhanced pathway identified more VCTE-positive adults with modestly higher referral burden, supporting prospective validation.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative Local and Metachronous Recurrence Rates in Patients with Ulcerative Colitis-Associated Neoplasia after Endoscopic Submucosal Dissection.","authors":"Hyunho Seol, Dong-Hoon Yang, Min Kyu Kim, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Jihun Kim, Sehee Kim, Suk-Kyun Yang","doi":"10.5009/gnl260132","DOIUrl":"https://doi.org/10.5009/gnl260132","url":null,"abstract":"<p><strong>Background/aims: </strong>Endoscopic submucosal dissection (ESD) has emerged as a curative alternative for ulcerative colitis-associated neoplasia (UCAN), particularly when endoscopic mucosal resection is not feasible for complete resection. This study aimed to evaluate cumulative incidence and timing of local and metachronous dysplasia in UCAN patients after ESD.</p><p><strong>Methods: </strong>We retrospectively reviewed 55 patients diagnosed with established or suspected UCAN at Asan Medical Center between August 2009 and August 2025. The patients were classified as colectomy or ESD candidates according to endoscopic resectability. The primary outcome was the cumulative incidence of local and metachronous dysplastic recurrence after ESD.</p><p><strong>Results: </strong>ESD was performed for 46 lesions in 45 patients. <i>En bloc</i> and R0 resection rates were 91.3% and 82.6%, respectively; no perforations were observed. Among 40 patients who underwent post-ESD surveillance, local recurrence and metachronous dysplasia were identified in 3 and 12 patients, respectively, over a median follow-up of 39 months. The cumulative incidence of local recurrence reached 7.6% at 1 year and remained unchanged thereafter. The cumulative incidence of metachronous dysplasia was 10.5% at 1 year, 22.6% at 3 years, and 39.4% at 5 years. Three patients underwent colectomy during surveillance due to local (n=1) or metachronous (n=2) recurrence.</p><p><strong>Conclusions: </strong>ESD appears to be a feasible and effective therapeutic option for selected nonpolypoid UCAN when performed by experienced endoscopists. The observed recurrence patterns may help inform post-ESD surveillance strategies, although the optimal surveillance interval requires validation in larger multicenter cohorts.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Gastric Neoplasms in Patients with Autoimmune Gastritis: A Systematic Review and Meta-Analysis.","authors":"Yong Hwan Ahn, Tae-Se Kim, Min-Ji Kim, Jun Haeng Lee","doi":"10.5009/gnl250515","DOIUrl":"10.5009/gnl250515","url":null,"abstract":"<p><strong>Background/aims: </strong>Autoimmune gastritis (AIG) underlies type 1 gastric neuroendocrine tumors (NETs) and pernicious anemia (PA), a late-stage manifestation of AIG. Although PA is a risk factor for gastric cancer (GC), the independent neoplastic risk of AIG and the modifying role of <i>Helicobacter pylori</i> infection remain uncertain. We evaluated the risk of gastric neoplasms in patients with AIG and assessed associations with PA and <i>H. pylori</i> exposure.</p><p><strong>Methods: </strong>A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and meta-analysis were performed. PubMed, EMBASE, and the Cochrane Library were searched for studies of gastric neoplasms in adults with AIG or PA. Pooled incidence rates and risk estimates were calculated. Between-study heterogeneity was explored by using meta-regression. Publication bias, sensitivity, and <i>H. pylori</i>-stratified subgroup analyses were performed.</p><p><strong>Results: </strong>In patients with AIG, pooled incidence rates (per 1,000 person-years) were 2.08 for GC, 5.35 for dysplasia, and 14.56 for NETs. The GC incidence was not statistically significant overall but became significant in sensitivity analyses when the Rugge <i>et al.</i> cohort was excluded. The dysplasia and NET incidence rates were significantly elevated. In patients with PA, GC risk was consistently elevated (relative risk, 2.78; standardized incidence ratio, 2.69). Meta-regression analysis identified age and diagnostic criteria as contributors to GC heterogeneity. Patients with <i>H. pylori</i>-positive AIG showed a trend toward reduced GC and NET risks.</p><p><strong>Conclusions: </strong>AIG was associated with increased risks of dysplasia and NETs, and GC risk might be underestimated in the presence of substantial heterogeneity. PA was associated with a higher risk of GC. Endoscopic surveillance may be considered in patients with AIG, particularly for dysplasia, NET, and GC risks in those with concomitant PA.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"715-727"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Dependent Microbial and Host Profiles Following Fecal Microbiota and <i>Bifidobacterium longum</i> Treatment in Stress-Induced Gut Dysbiosis.","authors":"Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Hoon Choi, Isom Jin, Eun Hye Kim, Sungchan Ha, Kisung Kang, Wonseok Lee, HyeLim Choi, Yeon-Ran Kim, Yeong-Jae Seok, Ho-Kyoung Lee, Cheol Min Shin, Dong Ho Lee","doi":"10.5009/gnl250440","DOIUrl":"10.5009/gnl250440","url":null,"abstract":"<p><strong>Background/aims: </strong>Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder influenced by stress, microbial dysbiosis, and immune activation. Microbiota-directed therapies, including fecal microbiota transplantation and probiotics, show promise, but their sex-specific effects remain unclear. We compared the therapeutic effects of lyophilized fecal microbiota (LFM) with <i>Bifidobacterium longum</i> BBH016 in male and female Wistar rats subjected to repeated water avoidance stress.</p><p><strong>Methods: </strong>Fecal pellet output (FPO), colonic mast cell infiltration, and fecal short-chain fatty acids were measured. Gut microbial composition and function were analyzed by 16S rRNA sequencing and Kyoto Encyclopedia of Genes and Genomes pathway prediction.</p><p><strong>Results: </strong>Both interventions significantly reduced FPO and mast cell infiltration in males but had less pronounced effects in females. Microbiota analyses revealed sex-dependent responses, with distinct microbial trajectories in each treatment group. Using linear discriminant analysis effect size, we identified seven key taxa with treatment- or sex-specific enrichment. <i>Alistipes onderdonkii</i> and <i>Bacteroides uniformis</i> consistently increased in both LFM- and <i>B. longum</i>-treated groups, regardless of sex. <i>Bacteroides finegoldii</i> and <i>Barnesiella intestinihominis</i> were specifically enriched in the LFM group. In males, <i>Blautia faecis</i> and <i>Fusicatenibacter saccharivorans</i> were enriched following the interventions, whereas <i>Parabacteroides goldsteinii</i> appeared exclusively in stressed males. Functional predictions revealed the enrichment of estrogen signaling and bile acid pathways in males and the attenuation of proinflammatory pathways in females following LFM. Correlations between microbial taxa and host outcomes were predominantly observed in male rats.</p><p><strong>Conclusions: </strong>These findings highlight sex-specific microbial and host responses to microbiota-targeted therapies in a stress-induced IBS model, emphasizing sex as a biological variable in designing personalized microbiome-based treatments.</p>","PeriodicalId":12885,"journal":{"name":"Gut and Liver","volume":" ","pages":"796-813"},"PeriodicalIF":4.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146062509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}