United European Gastroenterology Journal最新文献

{"title":"Assessment of PredictSURE IBD Assay in a Multinational Cohort of Patients With Inflammatory Bowel Disease.","authors":"Dahham Alsoud, Nurulamin M Noor, Lea Ann Chen, Vivian Abadom, Simon H C Anderson, Lediona Ardolli, Jordan Axelrad, Peter Bossuyt, Kenneth Croitoru, Oriana M Damas, Lily Deng, Parakkal Deepak, Juan De La Revilla Negro, Shanika de Silva, Marc Ferrante, Karen Hills, Peter M Irving, James O Lindsay, Dana J Lukin, Paul A Lyons, Eoin F McKinney, Maria Oliva-Hemker, Caterina Oneto, Roohi Patel, Miles Parkes, Lieven Pouillon, João Sabino, Lawrence J Saubermann, Jenny S Sauk, Sarah Sheibani, Kenneth G C Smith, Keith S Sultan, Tony C Tham, Sare Verstockt, Raluca Vrabie, Melissa Weidner, Huimin Yu, Bram Verstockt, James C Lee, Séverine Vermeire","doi":"10.1002/ueg2.70050","DOIUrl":"https://doi.org/10.1002/ueg2.70050","url":null,"abstract":"<p><strong>Background and aims: </strong>PredictSURE IBD is a prognostic blood test that classifies newly diagnosed, treatment-naïve Inflammatory Bowel Disease (IBD) patients into 'IBDhi' (high-risk) or 'IBDlo' (low-risk) groups (risk of future aggressive disease). We evaluated this assay in a multinational cohort and explored the effect of concomitant corticosteroids on its discrimination.</p><p><strong>Methods: </strong>One hundred thirty-six (71 Ulcerative colitis [UC], 65 Crohn's Disease [CD]) and 41 (15 UC, 26 CD) patients with active IBD were 'unexposed' and 'exposed', respectively, to corticosteroids at baseline blood sampling. The number of treatment escalations, time to first escalation, and need for repeated escalations were compared between the biomarker subgroups. Another 20 patients (13 UC, 7 CD) were longitudinally sampled over 6 weeks after commencing corticosteroids.</p><p><strong>Results: </strong>In corticosteroids-naïve UC and CD patients, all bowel surgeries (n = 6) and multiple therapy escalations (n = 10) occurred in IBDhi patients. IBDhi UC patients required significantly more treatment escalations, had a shorter time to first escalation, and a greater need for multiple escalations than IBDlo patients. No statistically significant differences were observed among CD patients. In corticosteroid-exposed patients, 66.6% of 'misclassifications' were IBDlo patients who required escalations. Among corticosteroid-treated patients with longitudinal sampling, 81.3% of those classified as IBDhi before steroids switched to IBDlo during therapy.</p><p><strong>Conclusions: </strong>No significant differences in treatment escalations were observed between biomarker-defined subgroups in CD. However, IBDhi UC patients required significantly earlier and more frequent therapy escalations, highlighting the need to further investigate PredictSURE IBD in UC. Notably, the discrimination ability of the biomarker was unreliable in patients receiving corticosteroid therapy.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic Exocrine Insufficiency Is Not Uncommon in Celiac Disease: A Systematic Review and Meta-Analysis.","authors":"Miroslav Vujasinovic, Nina Blazevic, Patrick Maisonneuve, Anders Forss, Nikola Panic, Nina Bloch, J Enrique Dominguez Munoz, Jonas F Ludvigsson, J-Matthias Löhr","doi":"10.1002/ueg2.70076","DOIUrl":"https://doi.org/10.1002/ueg2.70076","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic exocrine insufficiency (PEI) is seen in primary pancreatic disease but has also been seen in extrapancreatic conditions including celiac disease (CeD). The symptoms of PEI and CeD often overlap, which makes diagnostics challenging. In this systematic review and meta-analysis, we aimed to investigate the prevalence of PEI in CeD.</p><p><strong>Methods: </strong>With the assistance of a professional librarian, we searched five databases: PubMed, Embase, Cochrane, Web of Science Core Collection, and Google Scholar, up until October 21, 2024. The pooled prevalence of PEI in biopsy-confirmed CeD was estimated, and the quality of studies appraised.</p><p><strong>Results: </strong>We identified and screened the titles and abstracts of 1432 publications, of which 60 were reviewed in full text and 12 were included in the analyses. The overall pooled weighted prevalence of PEI in CeD was 13.5% (95% CI 7.2-21.0). The prevalence was similar among children (14.2%; 95% CI 2.0-32.8) and adults (12.8%; 95% CI 7.8-18.7) with CeD. The prevalence in studies that used secretory testing to define PEI was 13.1% (95% CI 6.4-21.3) and in those requiring digestive tests 17.1% (95% CI 5.8-32.1). The weighted prevalence of PEI was significantly higher among untreated CeD patients (18.2%) than patients on a gluten-free diet (6.9%) (p = 0.03), in both adults and children.</p><p><strong>Conclusion: </strong>One in eight individuals with CeD may suffer from PEI. The prevalence was particularly high in untreated CeD. PEI should be considered in patients who do not respond to a gluten-free diet.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Inflammatory Bowel Disease: Opportunities and Challenges for a New Era.","authors":"Ignacio Catalan-Serra, Shaji Sebastian","doi":"10.1002/ueg2.70075","DOIUrl":"https://doi.org/10.1002/ueg2.70075","url":null,"abstract":"<p><p>Inflammatory Bowel Disease (IBD) has become a global disease. The increasing incidence of inflammatory bowel disease across the world is challenging the traditional view of IBD as a western disease and represents a unique opportunity to gain an understanding of the disease in diverse ethnic groups and in different socio-economical and geographical environments. However, the continued growth in prevalence in developing countries in the coming years will lead to increased use of health-care resources due to IBD-related complications, costs of drugs and indirect health costs. Here we analyze the challenges and opportunities that this situation represents and suggest actions and potential solutions to improve the quality of IBD care globally.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Microcapsule Chromocolonoscopy With Patent Blue V Improves Adenoma Detection Safely and Effectively.","authors":"Berenice Schulte, Georg H Waetzig, Johannes Bethge, Konrad Aden, Claudio C Conrad, Eva-Maria Theismann, Julia K Keppler, Therese Ruhmlieb, Karin Schwarz, Stefan Schreiber, Mark Ellrichmann","doi":"10.1002/ueg2.70067","DOIUrl":"https://doi.org/10.1002/ueg2.70067","url":null,"abstract":"<p><strong>Background and objective: </strong>Chromocolonoscopy significantly improves polyp/adenoma detection rates (PDR/ADR). However, its integration into routine clinical practice is hindered by its cumbersome mode of application. The objective was to develop an oral nutritional grade delivery system and to assess its efficacy for colonic release, mucosal staining and PDR/ADR as a proof of concept.</p><p><strong>Methods: </strong>Food-grade shellac microcapsules releasing 87.5 mg of patent blue V (PBM) pH- and time-dependently were used in 35 volunteers receiving diagnostic colonoscopy either due to a positive fecal occult blood test or surveillance in inflammatory bowel disease. Six capsules were administered p.o. during the bowel preparation (Klean-Prep). Mucosal staining was assessed in total and per segment using a five-point grading scale. PDR and ADR were evaluated and compared to a propensity score-matched comparison cohort in a 1:3 ratio.</p><p><strong>Results: </strong>In the PBM cohort, 97.1% (34/35) achieved an optimal to acceptable staining quality (SQ) score of ≥ 8, with a mean total score of 13.4 ± 2.9. PDR was significantly higher in the PBM group at 62.8% compared to 42.9% in the comparison group (CG; p = 0.04). ADR showed no significant differences (p = 0.06). The use of PBM resulted in a significantly increased number of detected polyps and adenomas per colonoscopy compared with CG (polyps: PMB = 1.1 ± 1.1 vs. CG = 0.6 ± 0.8, p = 0.02; adenomas: PBM = 0.8 ± 0.9 vs. CG = 0.3 ± 0.5; p = 0.02).</p><p><strong>Conclusion: </strong>The novel PBM demonstrated uniform mucosal staining when utilized in chromocolonoscopy. Delayed-release patent blue V appears to be a safe and effective alternative to dye-spray techniques and existing oral chromoendoscopy modalities.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence of Hepatocellular Carcinoma After Liver Transplantation: The Blind Spot of HCC Management.","authors":"M Ningarhari, G Lassailly, S Dharancy, C Moreno, E Trépo","doi":"10.1002/ueg2.70078","DOIUrl":"https://doi.org/10.1002/ueg2.70078","url":null,"abstract":"<p><p>Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) significantly impacts transplant outcomes, responsible for half of all deaths in the first 5 years after LT for HCC, with a 12-15-month median overall survival after recurrence. Recent advances in post-LT risk stratification and efficacy data of radical local treatments with curative intent support risk-adapted tailored surveillance. To date, only immunosuppressive regimen minimisation has been recognised as a potential preventive measure, although the respective roles of calcineurin inhibitor minimisation and mTOR inhibitor introduction remain inconclusive. Retrospective studies highlight the considerable heterogeneity between patients with recurrent HCC after LT in terms of timing, anatomical distribution, and applicability of treatments. Selected patients may benefit in a durable manner from local approaches with a curative intent, while tyrosine kinase inhibitors remain the first line systemic treatments. The use of immune checkpoint inhibitors is a major challenge associated with major risks of graft rejection and related mortality, that should be evaluated in prospective clinical trials. The impact on recurrent HCC of recent changes of pre-LT management, such as expanded selection criteria or the increasing use of downstaging strategies including post-ICI LT, has not been evaluated yet. Recurrent HCC after LT is a major unmet need, calling for a prospective and multicentre effort to improve outcomes for this special population.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Alcohol-Related Liver Disease and Alcohol Use Disorder in Asia.","authors":"Pojsakorn Danpanichkul, Yanfang Pang, Kanokphong Suparan, Preenapun Saokhieo, Pimtawan Jatupornpakdee, Natchaya Polpichai, Tanawat Attachaipanich, Thanathip Suenghataiphorn, Andrew F Ibrahim, Polathep Vichitkunakorn, Sakkarin Chirapongsathorn, Ashok Choudhury, Anand V Kulkarni, Karn Wijarnpreecha, Apichat Kaewdech, Suthat Liangpunsakul","doi":"10.1002/ueg2.70077","DOIUrl":"https://doi.org/10.1002/ueg2.70077","url":null,"abstract":"<p><strong>Background: </strong>As alcohol consumption continues to rise rapidly in Asia, research into its significant consequences, alcohol-related liver disease (ALD), and alcohol use disorder (AUD) is still limited.</p><p><strong>Objective: </strong>This study examines the burden of alcohol-related liver disease and alcohol use disorder in Asia from 2000 to 2021.</p><p><strong>Methods: </strong>We analyzed data from the global burden of disease (GBD) Study 2021 to assess age-standardized prevalence, incidence, and mortality rates for alcohol-related liver disease and alcohol use disorder in Asia from 2000 to 2021.</p><p><strong>Results: </strong>In 2021, there were approximately 1.40 million cases of ALD, resulting in 175,370 deaths and 53.18 million cases of AUD, with 57,110 deaths. Asia accounted for 46.35% of the global prevalence of ALD (an increase of 6.87% since 2000) and 47.86% of the global prevalence of AUD (an increase of 0.82% since 2000). A 91.2% increase in crude ALD prevalence, incidence, and mortality from 2000 to 2021 in Asia was observed. South Asia exhibited the highest crude burden of ALD, while Central Asia had the highest age-standardized rate. Notably, ALD prevalence increased in South Asia (Annual Percent Change [APC]: 0.10%, 95% CI: 0.08-0.13) and Central Asia (APC: 0.88%, 95% CI: 0.79-0.97), even as other regions experienced declines.</p><p><strong>Conclusions: </strong>This study reveals a disproportionately increasing burden of ALD and AUD in Asia compared with global trends, with significant variability across subregions. Central and South Asia are identified as the primary drivers of the burden associated with ALD and AUD in this region.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interpretable Artificial Intelligence System for Crohn's Disease Ulcer Identification and Grading on Double-Balloon Enteroscopy Images.","authors":"Qiuyuan Liu, Wanqing Xie, Aodi Wang, Wei Han, Yaonan Zhu, Jing Hu, Pengcheng Liang, Juan Wu, Xiaofeng Liu, Xiaodong Yang, Baoliang Zhang, Nannan Zhu, Bingqing Bai, Yiqing Mei, Zhen Liang, Mingmei Cheng, Qiao Mei","doi":"10.1002/ueg2.70068","DOIUrl":"https://doi.org/10.1002/ueg2.70068","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is an incurable inflammatory bowel disease that can lead to a variety of complications and requires lifelong treatment. However, the diagnosis and management of Crohn's disease exhibit high rates of misdiagnosis and missed diagnoses, along with significant variability, among primary care facilities and novice endoscopists. Therefore, we established an interpretable artificial intelligence (AI) system using double-balloon enteroscopy to facilitate Crohn's disease ulcer identification and grading.</p><p><strong>Objective: </strong>To develop an interpretable AI system for the identification and grading of Crohn's disease ulcer images, offering bounding box localization for visual interpretability and factor-specific grading explanations for each ulcer to improve assessment performance.</p><p><strong>Methods: </strong>We constructed a region and grading model of individual ulcers based on the YOLO-v5 algorithm. By analyzing the predicted results of all ulcers in each image, the clinical interpretation for the screening and assessment of Crohn's disease ulcer images was further achieved. To evaluate the system, we prepared the training and validation datasets (17,036 double-balloon enteroscopy images, 558 patients) and further collected a test cohort (2018 images, 70 patients) and an external validation set. A further reader study was conducted on the internal test set in which nine endoscopists participated to evaluate the auxiliary effectiveness of the explainable system.</p><p><strong>Results: </strong>The Crohn's disease ulcer image detection sensitivity and area under the curve (AUC) were 91.8% and 0.949. The accuracies in assessing the severity of Crohn's disease ulcer images on three factors (size/ulcerated surface/depth) were 94.1%/92.5%/93.0%, respectively. With the system's support of visualized and analyzable predictions, junior endoscopists improved their Crohn's disease ulcer image recognition sensitivity by 12.7% and their accuracy and consistency of severity assessment by 26% and 27.4%.</p><p><strong>Conclusion: </strong>The AI system outperformed general endoscopists in approaching expert-level proficiency in Crohn's disease ulcer identification and assessment. Its transparency in decision-making facilitated integration into clinical workflows, enhancing trust and consistency among endoscopists.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rising Global Burden of MASLD and Other Metabolic Diseases (2000-2021).","authors":"Pojsakorn Danpanichkul, Kanokphong Suparan, Luis Antonio Diaz, Michael B Fallon, Vincent L Chen, Kornnatthanai Namsathimaphorn, Krittameth Rakwong, Torlap Inkongngam, Chuthathip Kaeosri, Markos Kalligeros, Phuuwadith Wattanachayakul, Cheng Han Ng, Hirokazu Takahashi, Daniel Q Huang, Mark D Muthiah, Juan Pablo Arab, Donghee Kim, Trenton M White, Mazen Noureddin, Elisabetta Bugianesi, Peter Jepsen, Vincent W S Wong, Jeffrey V Lazarus, Karn Wijarnpreecha","doi":"10.1002/ueg2.70072","DOIUrl":"https://doi.org/10.1002/ueg2.70072","url":null,"abstract":"<p><strong>Background: </strong>Metabolic diseases are a public health threat to diverse populations worldwide. This study aims to update the epidemiological trends of metabolic diseases across regions and sociodemographic stratifications using the Global Burden of Diseases Study 2021.</p><p><strong>Methods: </strong>This study focused on metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) along with obesity, hypertension, and dyslipidemia. The prevalence and disability-adjusted life years (DALYs) with their age-standardised prevalence rate and DALYs (ASPR and ASDALYs) and uncertainty intervals (UIs) were estimated and stratified by sex, geography, and the Sociodemographic Index (SDI). Epidemiological trends were analysed using the Joinpoint Regression method, which calculated the annual percent change (APC) and confidence intervals (CIs) of age-standardised rates (ASRs) from 2000 to 2021.</p><p><strong>Results: </strong>In 2021, MASLD had a prevalence of 1.27 billion people (ASPR: 15,018.07, 95% UI: 13,756.47 to 16,361.44; ASDALYs: 42.40, 95% UI: 33.60 to 53.31), while T2DM had a prevalence of 0.51 billion people (ASPR: 5885.40, 95% UI: 5467.62 to 6334.18; ASDALYs: 871.78, 95% UI: 735.05 to 1044.78) worldwide. ASPRs of MASLD and T2DM increased over the 2 decades. ASDALYs decreased over time for dyslipidemia (APC: -1.43%, 95% CI: -1.58 to -1.27%) and hypertension (APC: -1.32%, 95% CI: -1.43 to -1.21%) but increased for T2DM (APC: 1.09%, 95% CI: 1.04 to 1.14%) and obesity (APC: 0.70%, 95% CI: 0.63 to 0.78%), while it remained stable for MASLD. The global burden of metabolic diseases was generally higher in males compared to females. The highest ASDALYs for all these metabolic diseases were observed in low-middle SDI countries.</p><p><strong>Conclusion: </strong>The global burden of MASLD and other metabolic diseases is substantial. National and global policies must better address metabolic diseases including the MASLD public health threat.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Fecal Elastase-1 Test for Pancreatic Exocrine Insufficiency: A Systematic Review and Meta-Analysis.","authors":"Daniel de la Iglesia, Belén Agudo-Castillo, Marco Galego-Fernández, Alberto Rama-Fernández, J Enrique Domínguez-Muñoz","doi":"10.1002/ueg2.70061","DOIUrl":"https://doi.org/10.1002/ueg2.70061","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic exocrine insufficiency (PEI) results from a reduction in pancreatic secretion of enzymes, leading to malabsorption of nutrients, intestinal symptoms, nutritional deficiencies and related comorbidities. The diagnosis of pancreatic exocrine insufficiency should be based on digestive tests, mainly the coefficient of fat absorption (CFA), based on the quantification of 72 h fecal fat excretion (FFE). However, this test is rarely performed in clinical practice. Fecal elastase-1 (FE-1) is a simple and widely used alternative. This meta-analysis evaluates the diagnostic accuracy of fecal elastase-1 for the diagnosis of PEI diagnosed by CFA or 72h-FFE.</p><p><strong>Methods: </strong>A systematic search of databases was performed to identify studies evaluating fecal elastase-1 and CFA/FFE for the diagnosis of pancreatic exocrine insufficiency. Inclusion criteria required original studies with data on sensitivity, specificity and other diagnostic metrics. Two independent reviewers performed data extraction and quality assessment using the QUADAS-2 tool. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR) were calculated and heterogeneity was assessed using I-squared tests.</p><p><strong>Results: </strong>Thirteen studies with 888 patients were included. Fecal elastase-1 at a cut-off of 200 μg/g showed a pooled sensitivity and specificity of 0.94 and 0.69, respectively, with a DOR of 35.27. Lowering the cut-off to 100 μg/g improved specificity to 0.82 but decreased sensitivity to 0.88. Subgroup analyses showed different diagnostic performance in different clinical contexts, with higher sensitivity in cystic fibrosis (0.98) and higher specificity in chronic pancreatitis (0.81). The positive and negative predictive values are limited in situations with low and high probability of pancreatic exocrine insufficiency, respectively.</p><p><strong>Conclusions: </strong>Fecal elastase-1 is a sensitive and moderately specific diagnostic tool for pancreatic exocrine insufficiency and is suitable for initial screening in high-risk populations. However, its moderate specificity requires careful interpretation in lower risk settings.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Contagious Cause of Rectal Bleeding: Misleading Presentation of Chlamydia trachomatis Infection.","authors":"Irene Marafini, Joana Roseira, Giovanni Monteleone","doi":"10.1002/ueg2.70066","DOIUrl":"https://doi.org/10.1002/ueg2.70066","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}