Arab Journal of Gastroenterology最新文献

{"title":"The use of anti-IL-5 in eosinophilic gastrointestinal disorders (EGIDs); a systematic review.","authors":"Mohamed Elsaid, Mai Alaaeldin Temraz Elsebaie, Mayam Mohamed Aziz, Hadeer Sherif, Mohamed H Mahmoud, Hamsa Hassan, Alaa Soliman","doi":"10.1016/j.ajg.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.08.004","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis (EoE), are a chronic, immune-mediated conditions characterized by eosinophilic infiltration of the gastrointestinal tract. Current treatments have limitations in either efficacy or tolerability. Anti-interleukin-5 (IL-5) therapies, as mepolizumab, reslizumab, and benralizumab, have emerged as potential treatment options. This systematic review aimed to assess the efficacy and safety of these therapies in the treatment of EGIDs.</p><p><strong>Methods: </strong>A systematic review of six major electronic databases, identified 1437 records. After removing duplicates and screening for relevance, six RCTs published between 2009 and 2023 met the inclusion criteria. These studies evaluated the efficacy and safety of anti-IL-5 therapies in patients with (EGIDs). Data on histologic outcomes, clinical symptoms, endoscopic findings, and adverse events were extracted. Only RCTs focusing on IL-5 inhibitors were included, while combination therapies or non-interventional studies were excluded. Risk of bias was assessed using Cochrane ROB 2 tool, and results were narratively synthesized due to study heterogeneity.</p><p><strong>Results: </strong>Patient ages ranged from 10 to 38 years, with a slight male predominance. Asthma and allergies were common comorbidities. Histologic outcomes showed significant reductions in peak esophageal eosinophil counts in treatment groups, particularly with mepolizumab and reslizumab (p < 0.001), and complete eosinophil depletion with benralizumab. All studies reported clinical symptom improvements, five studies also showed endoscopic improvements including lower EREFS scores and mucosal healing. Adverse events were mild and infrequent, with all therapies demonstrating good overall tolerability.</p><p><strong>Conclusion: </strong>The study highlights the delay in diagnosis due to non-specific symptoms. While systemic corticosteroids remain the cornerstone of treatment, emerging biologics and non-invasive biomarkers offer promise. Early clinical suspicion, comprehensive endoscopic evaluation with biopsies, and standardized diagnostic criteria are essential for improving patient outcomes.</p><p><strong>Study limitations: </strong>The review is limited by small sample sizes, short follow-up periods, varied outcome measures, and moderate to high risk of bias in some studies. These issues emphasize the need for larger, long-term RCTs with standardized outcome metrics to better assess clinical benefit.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate-induced liver fibrosis in chronic inflammatory diseases: A cross-sectional study in the Tunisian population.","authors":"Sarra Laabidi, Amal Hajlaoui, Maissa Abbes, Tayssir Ben Achour, Mariem Tabka, Donia Gouiaa, Fatma Said, Sahar Chtioui, Safa Rahmouni, Khaoula Zouaoui, Soumaya Boussaid, Sonia Rekik, Nadia Ben Mustapha, Mariem Serghini, Mourad Mokni, Hela Sahli, Asma Labidi, Monia Fekih","doi":"10.1016/j.ajg.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.09.002","url":null,"abstract":"<p><strong>Background and study aims: </strong>Methotrexate (MTX) is an immunosuppressive drug used to treat various chronic inflammatory diseases. While its association with liver fibrosis is concerning, several associated factors appear to play a major role. This study aimed to assess the frequency of fibrosis in MTX-treated patients and identifies its associated factors.</p><p><strong>Patients and methods: </strong>A descriptive cross-sectional study was conducted including patients with chronic inflammatory diseases who had been on MTX for at least 6 months. Liver fibrosis was assessed using transient elastography. A comparative analysis was performed between patients with and without fibrosis, defined by liver stiffness >7 kPa.</p><p><strong>Results: </strong>A total of 160 patients were included (rheumatoid arthritis (45%), psoriasis (19%), Crohn's disease (19%)), with a mean age of 53.8 years and sex-ratio F/M = 2.1. The mean duration of MTX treatment was 38 months, with an average cumulative dose of 2.340 mg. Liver fibrosis, was detected in 11.9% of patients. In a multivariate study, independent factors associated with liver fibrosis included age > 59 years (OR = 18), alcohol consumption >15.17 g/day (OR = 4.2), metabolic syndrome (OR = 9), and obesity (OR = 18).</p><p><strong>Conclusion: </strong>Liver fibrosis under MTX was observed in 11.9% of patients, influenced by advanced age, alcohol consumption, metabolic syndrome, and obesity. These findings highlight the need for targeted monitoring to prevent complications.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic utility of abdominal and bowel ultrasound in detecting gastrointestinal and hepatic manifestations of rheumatoid arthritis.","authors":"Mira Atef, Rash Ahmed Abdalaziz, Ahmed Badry, Hanan Darweesh, Mohammed Mostafa Abdel Razik, Hala Ramadan, Yasmin Gaber","doi":"10.1016/j.ajg.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.09.003","url":null,"abstract":"<p><strong>Background and study aims: </strong>Patients with Rheumatoid arthritis (RA) may develop digestive and hepatic complications. Abdominal ultrasound is sensitive to assess bowel abnormalities. We aimed to evaluate the frequency of gastrointestinal (GI) and hepatic disorders in RA patients and study the reliability of abdominal ultrasound in detecting these disorders to allow early management and better prognosis.</p><p><strong>Patients and methods: </strong>70 RA patients and 70 non-RA people as a reference control group were included in this study. Both study groups were subjected to the Rome IV criteria, the gastroesophageal reflux disease questionnaire, and trans-abdominal ultrasound. Transient elastography was done for subjects with bright or bright coarse liver on ultrasound.</p><p><strong>Results: </strong>Irritable bowel syndrome (IBS) and Gastroesophageal reflux disease (GERD) were statistically significantly higher in RA patients (28.5% and 51.4% respectively) than in the non-RA group (11.4% and 12.8% respectively) (p value = 0.019 and 0.000 respectively). Bright or bright coarse liver was statistically significantly higher in RA patients than in the non-RA group (p value = 0.000) and was statistically significantly higher in RA patients on methotrexate-based therapy (p value = 0.012). Only 2 RA patients (5.4%) had significant fibrosis (≥F2).</p><p><strong>Conclusion: </strong>Abdominal ultrasound is recommended in the routine evaluation of the liver besides liver enzymes while bowel ultrasound is not recommended as routine screening in RA patients in the absence of complaint.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum hypoxia-inducible factor-1α levels in compensated and decompensated liver cirrhosis: Association with disease severity and MELD score.","authors":"K A Hasanova, T A Asgarova, N Y Bayramov, A A Ibrahimova","doi":"10.1016/j.ajg.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.08.005","url":null,"abstract":"<p><strong>Background and study aims: </strong>Liver cirrhosis represents the end stage of chronic liver disease and carries high morbidity and mortality. Hypoxia-inducible factor-1α (HIF-1α) is a key regulator of cellular adaptation to hypoxia. This cross-sectional study evaluated serum HIF-1α levels in compensated and decompensated liver cirrhosis, their association with clinical and biochemical parameters, and their independent association with the presence of decompensation.</p><p><strong>Patients and methods: </strong>This cross-sectional study included 31 patients with decompensated cirrhosis (DC), 39 with compensated cirrhosis (CC), and 20 healthy controls. Serum HIF-1α was measured by ELISA (Sunlong Biotech, Catalog No. SL0905Hu; range 8-500 pg/mL; sensitivity 4.5 pg/mL). Disease severity was assessed using the MELD score. Statistical analyses included the Mann-Whitney U test, Spearman correlation, multivariate logistic regression, and ROC curve analysis with bootstrap 95% confidence intervals.</p><p><strong>Results: </strong>Serum HIF-1α was significantly higher in DC (313.5 pg/mL; IQR 264.2-359.0) than CC (165.0 pg/mL; IQR 128.5-208.0) and controls (70.3 pg/mL; IQR 68.1-92.8) (p < 0.001). HIF-1α correlated positively with AST, ALP, ALT, bilirubin, and MELD score, and negatively with albumin (all p < 0.05). On multivariate logistic regression, HIF-1α remained an independent predictor of decompensation after adjustment for bilirubin and albumin (OR = 1.035; 95% CI: 1.016-1.054; p < 0.001; Nagelkerke R² = 0.812; accuracy 90.0%). ROC analysis showed excellent diagnostic performance (AUC = 0.925; bootstrap 95% CI: 0.861-0.975; cut-off 215.5 pg/mL; sensitivity 93.5%; specificity 79.5%).</p><p><strong>Conclusion: </strong>Serum HIF-1α is significantly elevated in liver cirrhosis, particularly in decompensated disease, and is independently associated with decompensation status. In this single-center cohort without an independent validation set, HIF-1α shows preliminary promise for discriminating compensated from decompensated cirrhosis; its predictive and diagnostic utility requires confirmation in larger, multicenter, prospectively validated cohorts.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hsa_circ_0001839 is associated with poor prognosis and promotes tumor progression in gastric cancer.","authors":"Zhengliang Li, Xiaojing Liu, Jundong Wang, Jiaxi Wang, Guoxiang Jiang, Haizhou Yu","doi":"10.1016/j.ajg.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.07.010","url":null,"abstract":"<p><strong>Background and study aims: </strong>Circular RNAs (circRNAs) are characterized by their covalently closed-loop configuration. They are increasingly being recognized as key modulators of tumorigenesis and cancer progression. Studies have revealed aberrant hsa_circ_0001839 expression in various cancer types. However, its effect and underlying mechanisms in gastric cancer (GC) remain unknown. Therefore, we systematically investigated the clinical importance of hsa_circ_0001839 in gastric cancer and its molecular mechanisms in disease progression.</p><p><strong>Patients and methods: </strong>Paired tumor specimens and histologically normal adjacent tissues were collected from 117 patients with GC who underwent curative surgery. RT-qPCR was performed to measure hsa_circ_0001839 expression in clinical samples and cell lines. Kaplan-Meier survival curves and Cox proportional hazards models were used to evaluate the prognostic relevance of this circRNA. Lastly, cell transfection, CCK-8, Transwell invasion, and dual-luciferase reporter assays were performed to validate the functional effects on GC cells and regulatory interactions with target genes.</p><p><strong>Results: </strong>Compared with matched non-tumor tissues, hsa_circ_0001839 expression was markedly increased in gastric cancer tissues. High hsa_circ_0001839 expression significantly correlated with larger tumor dimensions, deeper invasion depth, advanced TNM stage, and the presence of lymph node metastasis. Multivariate Cox analysis revealed that high hsa_circ_0001839 expression is an independent predictor of poor prognosis. Functionally, hsa_circ_0001839 knockdown effectively suppressed the malignant phenotypes of GC cells, significantly decreasing their proliferative, migratory, and invasive abilities. Mechanistically, hsa_circ_0001839 directly binds to the 3'-untranslated region of miR-634, thereby repressing its function.</p><p><strong>Conclusion: </strong>As an oncogenic circRNA, hsa_circ_0001839 is critically implicated in gastric cancer progression and unfavorable patient outcomes, underscoring its dual application as a promising prognostic biomarker and a potential therapeutic intervention target.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of celiac disease in type 1 diabetes mellitus children in the Eastern Mediterranean Region: A systematic review and meta-analysis.","authors":"Firdous Fatima, Siddique Mashhood Ahmed","doi":"10.1016/j.ajg.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.08.003","url":null,"abstract":"<p><strong>Background: </strong>Children with type 1 diabetes (T1D) have an elevated risk of celiac disease (CD), but region-specific prevalence estimates for the Eastern Mediterranean Region (EMR) are inconsistent and methodologically heterogeneous. So, we conducted a systematic review and meta-analysis to obtain a pooled estimate of CD in T1D children in EMR.</p><p><strong>Methods: </strong>A comprehensive search was conducted across three databases. Observational studies that assessed the prevalence of CD in children with diabetes (<18 years) in EMR were included. We assessed the quality of included studies with the JBI critical appraisal tool. Data extraction and assessment were guided by the PRISMA checklist. The primary outcome was pooled CD prevalence (seropositive and biopsy-confirmed). Publication bias and heterogeneity were assessed. The certainty of evidence was reported using the GRADE framework. Subgroup analysis of seropositive CD across countries in EMR and mean T1D duration.</p><p><strong>Findings: </strong>We identified 15 studies (N = 4740 type 1 diabetes children) from 8 countries -namely Saudi Arabia, Jordan, Iran, Iraq, Morocco, Egypt, Turkey, Oman. Of these, 7 were cross-sectional studies, 7 were cohort studies, and only one was a case-control study. No study from the remaining countries met our inclusion criteria. Among 4740 participants, the pooled seroprevalence of CD was 13% (95% CI: 0.10-0.15, I2 = 84%) and the biopsy-confirmed pooled prevalence was 7% (95% CI: 0.05-0.09, I2 = 42%). Pooled prevalence was higher for those with longer mean duration of T1D. Higher prevalence was observed in Saudi T1DM children. Study quality was generally low to moderate, and there was no publication bias in estimates. Overall certainty of evidence was graded as moderate for CD biopsy and low for seroprevalence.</p><p><strong>Conclusions: </strong>CD prevalence in pediatric T1D in the EMR is substantially higher than population baselines, as 1 in 8 in T1DM seropositive children compared to 1 in 14 in biopsy-confirmed T1DM children. The prevalence varied across countries, supporting routine, repeated region-adapted screening.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-based differences and associated clinical manifestations and symptom severity of celiac disease: a 10-year retrospective study in a tertiary care center in Lebanon.","authors":"Hussein Fayyad-Kazan, Fatima Shaalan, Fatima Kdouh, Zainab Al-Hawraa Mchaymech, Youssef Alawieh, Mahdi Tarhini, Abdallah Medlej","doi":"10.1016/j.ajg.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.08.001","url":null,"abstract":"<p><strong>Background and study aims: </strong>Celiac Disease (CD) is a systemic, immune-mediated disease triggered by dietary gluten in genetically predisposed individuals. It primarily affects the proximal small intestine and is accompanied by severe gastrointestinal and/or extra-intestinal manifestations. This study aimed to examine the frequency of clinical manifestations associated with CD, assess adherence rates to GFD and its effects on symptoms' resolution and overall improvement, and finally, to determine factors associated with disease symptom severity.</p><p><strong>Patients and methods: </strong>We conducted a 10-year retrospective analysis (2015-2024) of 1779 patients who presented to SRHUH with celiac disease symptoms, among whom 51 were biopsy-confirmed celiac disease cases. Data were collected from a comprehensive patient-completed questionnaire. Symptom severity was classified as Mild, Moderate, or Severe.</p><p><strong>Results: </strong>Among the biopsy-confirmed CD patients, 27.5% showed severe symptoms, and 82.4% were classified as Marsh 3C. While gastrointestinal manifestations were the most prevalent, CD patients also reported dental, neurological, musculoskeletal, cardiac, and psychiatric manifestations. Female patients showed significantly higher rates of nutritional supplement use, persistent symptoms after diagnosis, complications, anemia, and deficiencies in iron and vitamin D compared to males. In contrast, growth problems were significantly more common in males. In CD women, symptom severity was associated with medication use, headaches, peripheral neuropathy, bone/joint pain, muscle cramps, quality of life, and psychological state. Histologic severity (partial vs total villous atrophy) and anemia were not associated with symptom severity.</p><p><strong>Conclusion: </strong>In this Lebanese tertiary-care cohort, CD predominantly affected adult females, with high rates of malabsorption-related complications and extra-intestinal complaints. Early diagnosis and dietary management may help mitigate disease progression and improve clinical outcomes.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial resistance, bacterial density, and eradication outcomes of Helicobacter pylori infection in Egyptian patients: A prospective cohort study.","authors":"Saad Zaky, Nariman Zaghloul, Helal F Hetta, Dalia M Badary, Hager Hamdy Sayed, Khaled Abobakr Khalaf Ali","doi":"10.1016/j.ajg.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.08.002","url":null,"abstract":"<p><strong>Background and study aims: </strong>Helicobacter pylori is a widespread pathogen linked to gastritis, peptic ulcers, and gastric cancer. Increasing antimicrobial resistance is making eradication more difficult. The aim is tostudy how clinical symptoms, endoscopic and histopathological findings, bacterial density, and antimicrobial resistance patterns of H. pylori are related in Egyptian patients.</p><p><strong>Patients and methods: </strong>In our study, 100 treatment-naïve patients with gastrointestinal symptoms suggestive of H. pylori infection and positive stool antigen tests underwent endoscopy, gastric biopsy, histopathology, and culture with antimicrobial susceptibility testing. All patients received 14-day levofloxacin-based triple therapy. Treatment response was assessed clinically and by stool antigen testing..</p><p><strong>Results: </strong>Epigastric pain was the most common symptom, reported by 83% of patients, followed by nausea and vomiting in 58%. Weight loss and pallor were less frequent, at 24% and 18%, respectively. Abnormal upper gastrointestinal endoscopy findings were present in 97% of patients, with 53% showing erosive or ulcerative lesions, indicating significant mucosal involvement. Higher H. pylori bacterial density was associated with gastric ulcers, erosions, mucosal atrophy, and duodenal lesions (p < 0.001). Higher bacterial density was significantly associated with severe mucosal lesions and increased the risk of ulcerative disease, resulting in more severe epigastric pain and gastrointestinal bleeding. Histopathology revealed chronic inflammation in 95% of patients and active inflammation in 80%, indicating ongoing mucosal activity. Treatment failed in 43% of cases and was closely associated with higher bacterial density, confirming the impact of bacterial load on treatment outcomes. Antimicrobial testing showed high resistance to common first-line drugs, including amoxicillin (53.5%), clarithromycin (46.5%), and amoxicillin-clavulanic acid (50.7%). In contrast, meropenem, doxycycline, and rifampicin showed no detected resistance, indicating potential utility against infections with resistance.</p><p><strong>Conclusion: </strong>Bacterial density is an important predictor of mucosal damage and treatment failure. The high rate of resistance to standard first-line antibiotics highlights the need for new treatment strategies and region-specific guidelines.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of fluorescence ROSE quantitative detection of Helicobacter pylori and traditional histopathological method.","authors":"Lin Zhang, Yanhong Hou, Binghui Li, Kai Wu, Jing Zhang, Mi Yang","doi":"10.1016/j.ajg.2026.07.007","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.07.007","url":null,"abstract":"<p><strong>Background and study aims: </strong>To establish a quantitative and viable-nonviable differentiation system for Helicobacter pylori (Hp) in gastric mucosal biopsy specimens using fluorescence rapid on-site evaluation (F-ROSE), to determine the minimum bacterial count threshold for histopathological positivity, to reveal the bacterial load mechanism underlying the high specificity, low sensitivity, and high false-negative rate of traditional histopathology, and to provide an objective basis for real-time quantitative diagnosis and precise stratification of Hp infection under endoscopy.</p><p><strong>Patients and methods: </strong>A total of 160 gastroscopic biopsy specimens were enrolled and simultaneously examined by F-ROSE quantitative assay and traditional histopathological staining. F-ROSE used acridine orange-ethidium bromide (AO-EB) dual staining to count total, viable, and nonviable bacteria under ×400 high-power field (HPF). Histopathological results were interpreted in a double-blind manner. No traditional gold standard was set; the latent true infection status was inferred by latent class analysis (LCA) combined with Bayesian model, based on which diagnostic efficacy was calculated and the critical bacterial count for histopathological positivity was determined.</p><p><strong>Results: </strong>A total of 102 true positive and 58 true negative cases were inferred. The positive rate of F-ROSE (61.25%) was significantly higher than that of histopathology (41.88%, P < 0.001). Using true infection status as the reference, F-ROSE showed a sensitivity of 94.1%, specificity of 93.1%, and AUC of 0.943; histopathology showed a sensitivity of 65.7%, specificity of 89.7%, and AUC of 0.782. The mean total bacterial count in F-ROSE was (42.6 ± 9.3)/HPF in histopathologically positive specimens, significantly higher than that in true-positive but histopathologically negative specimens (P < 0.001). A total bacterial count ≥22/HPF was the critical value for histopathological positivity, below which the histopathological positive rate was only 9.3%. Traditional histopathology could not distinguish viable from nonviable bacteria and its positivity was related only to total bacterial count, not to bacterial viability. Patients with a viable bacterial ratio > 60% had significantly more severe dyspeptic symptoms.</p><p><strong>Conclusion: </strong>Traditional histopathology has high specificity but low sensitivity; it reliably detects Hp only at a bacterial load ≥22/HPF and misses most low-level infections, while being unable to differentiate viable and nonviable bacteria. F-ROSE enables real-time quantification, viability differentiation, and detection of low-level infection, showing promising preliminary diagnostic performance in this single-center Phase I study. These findings require validation in larger multicenter trials with independent reference standards before clinical implementation.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic changes in non-invasive fibrosis scores as early predictors of deterioration in chronic hepatitis B.","authors":"Muhammet Salih Tarhan","doi":"10.1016/j.ajg.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.ajg.2026.07.009","url":null,"abstract":"<p><strong>Background and study aims: </strong>Non-invasive scores such as APRI, FIB-4, GPR and ALBI are commonly used to evaluate liver fibrosis and functional reserve in patients with chronic hepatitis B (CHB). However, interpretation has predominantly focused on single-time measurements, and the prognostic value of short-term changes (delta scores) remains uncertain. This study evaluated whether one-year changes in these scores are associated with laboratory-based composite deterioration during routine follow-up of CHB patients.</p><p><strong>Patients and methods: </strong>This retrospective cohort included adult CHB patients with two laboratory assessments approximately 12 months apart. APRI, FIB-4, GPR and ALBI were calculated at baseline (T₀) and follow-up (T₁); delta values were defined as ΔScore = T₁ - T₀. Laboratory-based composite deterioration was defined as meeting ≥1 criterion based on albumin, total bilirubin, INR, or platelet count. Logistic regression models, adjusted for age, gender, HBV-DNA level, HBeAg status, and antiviral therapy assessed associations between delta scores and deterioration. ROC analysis evaluated discriminative performance.</p><p><strong>Results: </strong>A total of 297 patients were included (56.9% male; median age 45 years). Laboratory-based composite deterioration occurred in 23.6%. Baseline non-invasive scores were not associated with deterioration, while ΔAPRI, ΔFIB-4 and ΔGPR were significant predictors. In multivariable analyses, each 0.1-unit increase corresponded to higher risk: ΔAPRI (aOR 1.55; p = 0.004), ΔFIB-4 (aOR 1.29; p < 0.001) and ΔGPR (aOR 1.86; p = 0.001). When standardized, ΔFIB-4 demonstrated the strongest association (aOR 7.32 per 1-SD increase). ΔFIB-4 also showed the best discrimination (AUC 0.730).</p><p><strong>Conclusion: </strong>One-year dynamic changes in non-invasive scores, particularly ΔFIB-4, provide additional and clinically relevant prognostic information for identifying early deterioration during routine follow-up. Incorporating delta score monitoring into clinical practice may help to detect laboratory-based deterioration at an earlier stage.</p>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}