United European Gastroenterology Journal最新文献

{"title":"Beyond Volume: Does the Choice Between Lactate and Acetate Matter in Post-ERCP Pancreatitis Prevention?","authors":"Lucía Guilabert, Enrique de Madaria","doi":"10.1002/ueg2.70300","DOIUrl":"https://doi.org/10.1002/ueg2.70300","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70300"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom Profiles Compatible With Disorders of Gut-Brain Interaction in Individuals With Coeliac Disease on a Long-Term Gluten-Free Diet.","authors":"Tom van Gils, Hans Törnblom, Floris van Overveld, Olafur S Palsson, Ami D Sperber, Shrikant I Bangdiwala, Inês A Trindade, Marc A Benninga, Gerd Bouma, Magnus Simrén","doi":"10.1002/ueg2.70311","DOIUrl":"10.1002/ueg2.70311","url":null,"abstract":"<p><strong>Background: </strong>Persistent gastrointestinal (GI) symptoms are frequently reported in patients with coeliac disease (CD). Knowledge about the role of disorders of gut-brain interaction (DGBI) as the cause of these persistent symptoms remains limited.</p><p><strong>Objective: </strong>To assess the prevalence and factors associated with DGBI-compatible symptom profiles in individuals with CD on a long-term gluten-free diet (GFD).</p><p><strong>Methods: </strong>Adult members of the Dutch Coeliac Society completed an online survey, including the Rome IV diagnostic questionnaire and validated questionnaires assessing psychological distress, non-GI somatic symptom severity, and health-related quality of life (QOL). Only individuals with CD adhering to a GFD ≥ 1 year were included. A population-based Dutch cohort served as the reference group.</p><p><strong>Results: </strong>Among 1001 participants with CD (79.3% female; median age 50 years), 64.8% met the criteria for ≥ 1 DGBI-compatible symptom profile compared with 31.3% in the reference group (for confounders adjusted odds ratio (AOR) 3.2 (95% CI 2.6-3.8)). Irritable bowel syndrome showed the strongest association with CD (AOR 4.5 (95% CI 3.3-6.2)). Having DGBI-compatible symptom profiles was, like the reference group, associated with higher levels of psychological distress and non-GI somatic symptom severity and lower health-related QOL.</p><p><strong>Conclusions: </strong>Rome IV DGBI-compatible symptom profiles are highly prevalent in individuals with CD on a long-term GFD and are associated with impaired QOL. While ongoing gluten exposure and other comorbidities could not be excluded, these findings support the consideration of DGBI in the evaluation and treatment of persistent symptoms in patients with CD.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70311"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Before Reducing Seattle Biopsies, Quantify Their Incremental Dysplasia Yield.","authors":"Peng-Fei Wang","doi":"10.1002/ueg2.70302","DOIUrl":"https://doi.org/10.1002/ueg2.70302","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70302"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Dysfunction-Associated Steatotic Disease and Genetic Risk in Germany-An Observational Real-World Cohort Study.","authors":"Marcin Krawczyk, Frank Grünhage, Lisa Schubert, Nektarios Dikopoulos, Jeannette Schwenzer, Marion Muche, Johannes Wiegand, Gisela Felten, Renate Heyne, Patrick Ingiliz, Anna Schmidt, Kerstin Stein, Susanne N Weber, Heiner Wedemeyer, Stefan Zeuzem, Peter Buggisch, Frank Lammert, Andreas Geier, Wolf Peter Hofmann, Jörn M Schattenberg","doi":"10.1002/ueg2.70298","DOIUrl":"10.1002/ueg2.70298","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic disease (MASLD) affects increasing numbers of patients worldwide. The PNPLA3 p.I148M variant represents a major genetic determinant of MASLD progression. The loss-of-function HSD17B13 polymorphism rs72613567 was reported in turn to be hepatoprotective.</p><p><strong>Patients: </strong>We analysed blood samples of 507 patients recruited within the Fatty Liver Assessment in Germany (FLAG) study, of whom 476 (255 males, age 56 years) were genotyped. FLAG is a multicenter real-world MASLD cohort covering secondary and tertiary healthcare levels. The PNPLA3 p.I148M and the HSD17B13 rs72613567 polymorphisms were genotyped using allelic discrimination assays. The control cohort comprised 174 individuals.</p><p><strong>Results: </strong>The PNPLA3 p.I148M variant was prevalent among FLAG patients (p < 0.001 for the departure from Hardy-Weinberg equilibrium) and increased the risk of developing MASLD (common OR = 2.46, p = 6.238e-09). It was associated with increased ALT and AST, lower serum triglyceride concentrations, and independently with liver stiffness ≥ 9.1 kPa after adjustment for BMI and diabetes (OR = 2.57, p = 0.01). Carriers of the HSD17B13 rs72613567 variant had lower AST. HSD17B13 heterozygotes had lower FIB-4 (p = 0.028) and lower liver stiffness (p = 0.034). Among carriers of the PNPLA3 p.148M allele, the presence of the HSD17B13 variant was associated with lower ALT (p = 0.023) and AST (p = 0.041); however, HSD17B13 did not abrogate the association of PNPLA3 with liver fibrosis (adjusted p = 0.013).</p><p><strong>Discussion: </strong>By analysing a real-world MASLD cohort in Germany, we further underscore the role of the PNPLA3 variant as the central genetic trigger and modulator of MASLD. The HSD17B13 polymorphism may exert protective effects in MASLD and could attenuate some PNPLA3-associated effects.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70298"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunoglobulin a Deficiency in Coeliac Disease: A Scoping Review.","authors":"Kristine Bech, Cæcilie Crawley, Rok Seon Choung, Joseph A Murray, Steffen Husby","doi":"10.1002/ueg2.70296","DOIUrl":"10.1002/ueg2.70296","url":null,"abstract":"<p><p>Coeliac disease (CeD) and immunoglobulin A deficiency (IgAD) frequently co-occur and share a genetic background within the HLA-DQ2 region. Although this has been known for decades, the underlying mechanisms linking the two conditions remain unclear. We conducted a scoping review to evaluate the prevalence, clinical characteristics, diagnostic challenges and histopathological features of IgAD in patients with CeD. Thirty-one studies published between 1985 and 2024 were included. IgAD was more prevalent among individuals with CeD, 1.4%-4.8% than in the general population, and CeD occurred in 5.9%-14.1% of patients with IgAD. Most patients presented with gastrointestinal symptoms, although selection bias was common. IgG-based serology remains essential for diagnosis and monitoring, but its reliability during follow-up is limited by the slow decline of antibodies. Histological findings indicate compensatory IgM and IgG responses and persistent mucosal immune activation. Improved strategies for diagnosis and long-term monitoring of patients with both conditions are warranted.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70296"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rome V Criteria for Adults: What's New and Why?","authors":"Amanda Krause, Lin Chang","doi":"10.1002/ueg2.70307","DOIUrl":"https://doi.org/10.1002/ueg2.70307","url":null,"abstract":"<p><p>The Rome V criteria, published in 2026, represent the culmination of a 7-year effort to refine and improve the diagnostic framework for disorders of gut-brain interaction. The revision incorporates the latest consensus guidelines and emerging research while moving away from stigmatizing language and toward a more personalized, patient-centered approach. It also more clearly distinguishes between clinical and research criteria, ensuring patients are diagnosed accurately and treated appropriately, and reinforces the roles of the multidimensional clinical profile and the biopsychosocial model in guiding personalized care. This paper reviews these changes and the rationale behind them.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70307"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving Digital Deprescribing-Enhancing PPI Discontinuation With an App-Based Strategy.","authors":"Jacob Hamm, Christoph Ammer-Herrmenau","doi":"10.1002/ueg2.70310","DOIUrl":"10.1002/ueg2.70310","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70310"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Stewardship in Cirrhosis: Current Recommendations and Clinical Challenges.","authors":"Solaiman Ezzafzafi, Kimberly K I M Bot, Lucas H P Bernts, Reinier M van Hest, Alastair O'Brien, Michiel A van Agtmael, Jarne M van Hattem, Marten A Lantinga","doi":"10.1002/ueg2.70317","DOIUrl":"10.1002/ueg2.70317","url":null,"abstract":"<p><p>Bacterial infections are a major cause of mortality in cirrhosis, with antibiotic prophylaxis and empirical treatment embedded in international guidelines. However, the prevalence of multidrug-resistant organisms and the epidemiology of infections have shifted considerably in recent decades. This review critically appraises the evidence underlying guideline recommendations on antibiotic prophylaxis for spontaneous bacterial peritonitis and acute variceal bleeding in cirrhosis, and antimicrobial management in acute liver failure. The evidence-underlying current recommendations is limited and predates the current era of widespread antimicrobial resistance, challenging their applicability in current practice. Emerging evidence suggests that primary prophylaxis should be reconsidered, alternatives such as rifaximin warrant further evaluation against established fluoroquinolone regimens, and shorter antibiotic courses may be non-inferior to standard durations. New double-blind placebo-controlled, non-inferiority and Bayesian trials are needed to evaluate antibiotic regimens and microbiome- and barrier-directed interventions, supported by improved diagnostics, while minimising treatment duration, toxicity and selection for antimicrobial resistance.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70317"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiology-Specific Pancreatic Enzyme Dose Requirements and Treatment Outcomes in Pancreatic Exocrine Insufficiency: The Multicentre EURO-PEI Registry.","authors":"J Enrique Domínguez-Muñoz, Yessica Domínguez-Novoa, Xurxo Martínez-Seara, Peter Hegyi, Vinciane Rebours, Mary E Phillips, Federico Bolado, Gabriele Capurso, Giulia de Marchi, Keith J Roberts, Orsolya Eperjesi, Sandra Salmeron, David Ruiz-Clavijo, Gaetano Lauri, Alessandro Brillo, Sarah Powell-Brett, Jose Lariño-Noia, Julio Iglesias-García","doi":"10.1002/ueg2.70282","DOIUrl":"https://doi.org/10.1002/ueg2.70282","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic exocrine insufficiency (PEI) is a maldigestion syndrome leading to symptoms and nutritional deficiencies. Prospective real-world data on pancreatic enzyme replacement therapy (PERT) dose requirements across aetiologies are limited.</p><p><strong>Objective: </strong>To define PERT dose requirements and treatment outcomes across PEI aetiologies in specialist European practice.</p><p><strong>Methods: </strong>EURO-PEI was a multicentre observational registry with predominantly prospective data collection conducted at eight pancreatic centres in five European countries between June 2021 and September 2025. Adults with clinician-established PEI in whom PERT was initiated or actively optimised were included. The primary outcome was the optimised PERT dose associated with the achievement of a clinician-assessed therapeutic goal: improvement or resolution of PEI-related symptoms with normalisation or clinically relevant improvement of nutritional abnormalities.</p><p><strong>Results: </strong>Among 1015 patients, PEI was secondary to chronic pancreatitis in 496 (48.9%), pancreatectomy in 185 (18.2%), pancreatic cancer in 174 (17.1%), and acute pancreatitis in 95 (9.4%). Median total daily optimised doses were highest after pancreatectomy (240,000 PhU, IQR 175,000-375,000) and in pancreatic cancer (210,000 PhU, 175,000-325,000), compared with chronic pancreatitis (175,000 PhU, 120,000-210,000) and acute pancreatitis (100,000 PhU, 75,000-200,000). After optimisation, the therapeutic goal was achieved in 951 patients (93.7%); of these, 446 (46.9%) required enzyme doses exceeding commonly recommended starting doses. Related adverse events occurred in 38 patients (3.7%).</p><p><strong>Conclusions: </strong>PERT dose requirements vary substantially by PEI aetiology, supporting aetiology-aware starting doses, early reassessment, and individualised optimisation in high-risk groups.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70282"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discontinuing Surveillance of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms in Routine Practice: An External Application of the \"Trivial\" Criteria and the Resources it Would Release in Fourteen Health Systems.","authors":"Claudio Ricci, Vincenzo D'Ambra, Martina Casarotto, Laura Alberici, Carlo Ingaldi, Marco Fichera, Cristina Mosconi, Marina Migliori, Riccardo Casadei","doi":"10.1002/ueg2.70304","DOIUrl":"10.1002/ueg2.70304","url":null,"abstract":"<p><strong>Background: </strong>Surveillance of low-risk branch-duct intraductal papillary mucinous neoplasms is usually lifelong. Criteria to stop it after 5 years of stability in older patients have not been tested outside the center that devised them, nor has their economic value been measured.</p><p><strong>Objective: </strong>To test these criteria in an independent cohort and measure the lesions missed and the resources released.</p><p><strong>Methods: </strong>Single-center cohort of patients with a low-risk lesion at diagnosis was followed for at least 12 months with cross-sectional imaging at baseline and during surveillance. The outcome was any new worrisome feature or high-risk stigma. Risk after stability was estimated by conditional analysis. Released resources were valued at the marginal cost beyond the fifth year and priced with fourteen tariffs. Sensitivity analyses addressed discounting, horizon, adherence and basket composition.</p><p><strong>Results: </strong>Among 392 patients followed for 2375 person-years, 66 (16.8%) developed a new feature; three had high-grade dysplasia or carcinoma, and none died of the neoplasm. The 5-year risk of a new feature did not fall with stability (14.3% after 2 years, 12.5% after five), but no resection and no high-grade lesion occurred after 4 years. Discontinuation would have discharged 101 patients (25.8%), releasing 298 person-years and 79,316 euro per 1000 patients entering surveillance, with no high-grade lesion missed. Across health systems, the same rule released 42,000 to 170,000 euros.</p><p><strong>Conclusion: </strong>Discontinuation missed no high-grade lesion, although the upper bound of that rate remained 0.84 per 100 person-years. The resources released varied more than fourfold between health systems and must be recomputed locally.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":"14 8","pages":"e70304"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}