Gastroenterology Report最新文献

{"title":"Beyond triglyceride clearance: rethinking hypertriglyceridemia-associated acute pancreatitis in the apoC-III era.","authors":"Serge Chooklin, Serhii Chuklin","doi":"10.1093/gastro/goag107","DOIUrl":"10.1093/gastro/goag107","url":null,"abstract":"<p><p>Hypertriglyceridemia-associated acute pancreatitis (HTG-AP) requires causal attribution rather than reliance on a single triglyceride (TG) threshold. Early TG measurement and assessment of competing or coexisting causes are essential because fasting, fluids, and correction of metabolic stress can produce substantial early TG decline. Severity should be determined by serial organ-function assessment using revised Atlanta and Modified Marshall criteria rather than TG concentration alone. Acute management should prioritize standard pancreatitis care, moderate crystalloid resuscitation, analgesia, early oral or enteral nutrition, and correction of genuine metabolic drivers. Intravenous insulin is appropriate for diabetic ketoacidosis, uncontrolled diabetes, marked hyperglycemia, or clinically important insulin deficiency, but current evidence does not support routine insulin solely for TG lowering in insulin-sufficient patients. Heparin should not be used for TG lowering. Therapeutic plasma exchange (TPE) produces rapid biochemical TG clearance, but randomized and adjusted observational evidence has not established improvement in organ failure, pancreatic necrosis, hospital stay, or mortality. TPE should therefore not be used as routine or rescue TG-lowering therapy; exceptional multidisciplinary deliberation may occur only in narrowly defined circumstances and should not be interpreted as an evidence-based indication or recommendation. After recovery, phenotype-directed assessment using fasting lipids, apolipoprotein B, evaluation of secondary drivers, and selective genetic testing can distinguish familial from multifactorial chylomicronemia and guide prevention. Hepatic apolipoprotein C-III (apoC-III) inhibition currently has the strongest randomized evidence for reducing pancreatitis events in relevant chylomicronemia populations. Management should prioritize prevention of organ injury during the acute episode and prevention of subsequent pancreatitis rather than the fastest possible TG decline.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag107"},"PeriodicalIF":4.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076486","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":"Navigating TIPS in the era of ageing and metabolic comorbidity: a contemporary narrative review of risk, resilience, and outcomes.","authors":"Davide Roccarina, Dario Saltini, Chiara Mangini, Antonio Piscopo, Alessio Mastro, Alessandra Barbera, Andrea Salomè Velasco Mayorga, Alessandra Avossa, Lucia Ragozzino, Margherita Falcini, Martina Rosi, Alfredo Vozza, Gianmarco Falcone, Fabrizio Fanelli, Fabio Marra, Sara Montagnese, Filippo Schepis, Francesco Vizzutti","doi":"10.1093/gastro/goag103","DOIUrl":"10.1093/gastro/goag103","url":null,"abstract":"<p><p>The ageing of the cirrhotic population, together with the epidemiological shift toward metabolic dysfunction-associated steatohepatitis, is redefining the profile of patients referred for transjugular intrahepatic portosystemic shunt (TIPS). Although TIPS remains a cornerstone in the management of complications of portal hypertension, its abrupt hemodynamic and metabolic effects challenge the physiological reserve of multiple organ systems. Age-related cardiovascular remodeling, cirrhotic cardiomyopathy, impaired renal function and autoregulation, and reduced neurocognitive reserve interact with the hyperdynamic circulatory state of cirrhosis increasing the susceptibility to heart failure, acute kidney injury (AKI), and hepatic encephalopathy following TIPS. This vulnerability is further amplified by metabolic comorbidities, obesity, sarcopenia, frailty, and age-related alterations of the gut microbiota and gut-liver axis, which collectively promote systemic inflammation, immune dysregulation, endothelial dysfunction, and reduced metabolic adaptability. Rather than independently, these factors shape an interconnected heart-liver-kidney-brain network in which dysfunction in one domain may rapidly propagate to others. This review summarizes how ageing influences the cardiovascular, renal, neurological, and metabolic response to TIPS, critically appraises current strategies for pre-procedural risk assessment, and discusses approaches to improve patient selection and peri-procedural management. Because chronological age alone inadequately reflects procedural risk and clinical outcomes, TIPS evaluation should incorporate a structured assessment of biological ageing, including cardiovascular and renal reserve, neurocognitive vulnerability, sarcopenia, frailty, body-composition phenotype, and metabolic burden. Integrating these domains into pre-procedural assessment may improve patient selection, inform shunt sizing, and ultimately optimize outcomes in this rapidly evolving patient population.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag103"},"PeriodicalIF":4.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065891","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":"Endoscopic ultrasound-guided hepaticogastrostomy with a 22-G needle and novel double-lumen catheter after pancreaticoduodenectomy.","authors":"Toru Kaneko, Mitsuhiro Kida, Takahiro Kurosu, Yuta Sakabe, Shiori Koyama, Hisashi Hidaka, Chika Kusano","doi":"10.1093/gastro/goag097","DOIUrl":"10.1093/gastro/goag097","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag097"},"PeriodicalIF":4.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009514","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":"A rare cause of liver cirrhosis in an adult.","authors":"Shuxiang Li, Weijia Duan, Guanhua Zhang, Xiaojuan Ou, Jidong Jia, Xinyan Zhao","doi":"10.1093/gastro/goag069","DOIUrl":"10.1093/gastro/goag069","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag069"},"PeriodicalIF":4.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992325","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":"Is high-quality robotic surgery a solo performance by the console surgeon?","authors":"Jun Lu, Junwei Zou, Youdong Liu, Fenglin Liu","doi":"10.1093/gastro/goag102","DOIUrl":"https://doi.org/10.1093/gastro/goag102","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag102"},"PeriodicalIF":4.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992273","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":"Real-time AI assistance improves adherence to standardized biliopancreatic EUS examination: a real-world comparative study.","authors":"Chenxia Zhang, Jun Zhang, Wei Tan, Xiao Tao, Wei Zhou, Bing Xiao, Honggang Yu","doi":"10.1093/gastro/goag078","DOIUrl":"10.1093/gastro/goag078","url":null,"abstract":"<p><strong>Background: </strong>Biliopancreatic endoscopic ultrasound (EUS) is highly operator-dependent, and adherence to standardized examination pathways may vary in routine practice. Evidence on whether real-time artificial intelligence (AI) assistance improves adherence to standardized biliopancreatic EUS examination in real-world settings remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective comparative cohort study at a tertiary referral center to evaluate the real-world implementation of a real-time AI assistance system during biliopancreatic EUS. Examinations from the pre-AI period were compared with those from the post-AI period after a washout interval. Propensity score matching and interrupted time-series analysis were used to reduce baseline imbalance and assess temporal changes. The primary outcome was adherence to the standardized examination protocol, operationalized as total documentation completeness across eight predefined anatomical stations. Secondary outcomes included station-level adherence and lesion detection, with prespecified evaluation of pancreatic masses smaller than 2 cm.</p><p><strong>Results: </strong>Among 1,465 eligible examinations, 854 matched examinations (427 per group) were analyzed. Adherence to the standardized eight-station examination was higher in the post-AI group, reflected by greater total documentation completeness (89.93% vs 81.29%, adjusted absolute difference 8.65%, 95% confidence interval [CI] 6.58-10.71, <i>P </i>< 0.001). Detection of pancreatic masses smaller than 2 cm was also higher after AI implementation (11.48% vs 6.56%, adjusted odds ratio 1.82, 95% CI 1.13-3.01, <i>P </i>= 0.016).</p><p><strong>Conclusions: </strong>In this real-world comparative study, real-time AI assistance was associated with greater adherence to a standardized biliopancreatic EUS examination protocol and a higher observed detection rate of pancreatic masses smaller than 2 cm. These findings suggest that real-time AI assistance may facilitate more standardized biliopancreatic EUS examination in routine practice.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag078"},"PeriodicalIF":4.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957297","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":"Combination interleukin-23p19 inhibitor and Janus kinase inhibitor rescue for steroid-refractory acute severe ulcerative colitis in pregnancy complicated by primary sclerosing cholangitis.","authors":"Mohammed Nabil Quraishi, Nadeen Omar, Hatim Taha, Sherina AlShamshi, Menatullah Fadda, Zaher Koutoubi","doi":"10.1093/gastro/goag095","DOIUrl":"10.1093/gastro/goag095","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag095"},"PeriodicalIF":4.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13568818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957301","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":"Citation integrity in the AI era: a focused evidence map and layered verification framework for gastroenterology and hepatology publishing.","authors":"Eun-Ae Jung, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim","doi":"10.1093/gastro/goag098","DOIUrl":"10.1093/gastro/goag098","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag098"},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921937","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":"Protrusion of nasobiliary drainage catheter through the anus.","authors":"Dongrui Li, Yuanbo Bi, Shengxiong Chen, Tengfei Zhang, Yunfei Liang, Jiansheng Zhang","doi":"10.1093/gastro/goag086","DOIUrl":"10.1093/gastro/goag086","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag086"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914339","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":"Real-world management of SeHCAT-confirmed bile acid diarrhoea: response to colestyramine and predictors of treatment success.","authors":"Eduard Brunet-Mas, Andrea Peña-Rosado, Belen Garcia-Sagué, Luis Enrique Frisancho, Luigi Melcarne, Laura Patricia Llovet, Anna Puy, Maria José Ramírez-Lázaro, Antonio Rodriguez Revuelto, Alberto Villoria, Xavier Calvet, Sergio Lario","doi":"10.1093/gastro/goag090","DOIUrl":"10.1093/gastro/goag090","url":null,"abstract":"<p><strong>Background: </strong>Bile acid diarrhoea (BAD) is an increasingly recognized cause of chronic diarrhoea. The 75-selenium homocholic acid taurine (SeHCAT) test remains the gold standard for diagnosis. The primary pharmacological treatment involves bile acid-binding agents, most commonly colestyramine. This study aimed to review the management of BAD at our centre and to identify factors associated with response to colestyramine.</p><p><strong>Materials and methods: </strong>This single-centre retrospective study included all patients with an abnormal SeHCAT test (retention <15%) from 1 January 2020 to 31 December 2023 associated with chronic diarrhoea. Patients receiving empiric bile acid chelators without prior SeHCAT testing and those under 18 years of age were excluded. The primary endpoint was treatment success with colestyramine, defined as complete or partial clinical response without treatment discontinuation due to intolerance. Univariable comparisons and multivariable logistic regression were performed to identify factors independently associated with treatment success.</p><p><strong>Results: </strong>Ninety-seven patients were included; 72.2% were women, with a mean age of 54.4 ± 15.1 years. Severe BAD was observed in 60.8% of cases. Overall, 77.3% of patients responded to colestyramine (43.2% complete, 34.0% partial). In multivariable analysis, baseline higher number of bowel movements per day was independently associated with a lower probability of treatment success (odds ratio 0.79, 95% confidence interval 0.68-0.92; <i>P </i>= 0.003). Colestyramine failure was generally due to intolerance-related discontinuation (17.5% of the cohort) followed by lack of efficacy (5.1%). No severe adverse events were documented.</p><p><strong>Conclusion: </strong>Colestyramine appears to be an effective first-line therapy for BAD in routine clinical practice. However, treatment success in this study reflects both clinical response and tolerability, as treatment failure was more frequently related to intolerance than lack of efficacy.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":"14 ","pages":"goag090"},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892818","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}