Frontiers in gastroenterology (Lausanne, Switzerland)最新文献

{"title":"Higher fibrosis-4 index is associated with 2-year cardiovascular events in Vietnamese adults with type 2 diabetes mellitus: a prospective cohort study.","authors":"Quoc Bao Vu, Hong Minh Cong Vo, Xuan Linh Tran, Tuan Vu Nguyen, Thi Khanh Tuong Tran","doi":"10.3389/fgstr.2026.1973311","DOIUrl":"10.3389/fgstr.2026.1973311","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is a major extrahepatic outcome in type 2 diabetes mellitus (T2DM) and metabolic fatty liver disease, but prospective data integrating transient elastography and the fibrosis-4 index (FIB-4) with observed cardiovascular events remain limited in Southeast Asia.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of adults with T2DM consecutively recruited at a Vietnamese tertiary hospital from June 2023 through January 2025 and followed for up to 24 months. Hepatic steatosis and liver stiffness were assessed by FibroScan^©, and metabolic dysfunction-associated fatty liver disease (MAFLD) was defined using the Asian Pacific Association for the Study of the Liver framework. Expanded major adverse cardiovascular events (MACE) were the principal time-to-event outcome. Sparse-event associations were estimated with Firth-penalized Cox regression.</p><p><strong>Results: </strong>Of 452 patients screened, 301 consented and 284 entered the baseline cohort; 280 contributed follow-up. At baseline, MAFLD was present in 72.5% and significant liver fibrosis (liver stiffness measurement ≥7.0 kPa) in 23.9%. During 544.92 person-years, 11 expanded MACE and 5 conventional MACE occurred, corresponding to incidence rates of 20.19 (95% CI 10.08-36.12) and 9.18 (95% CI 2.98-21.41) per 1,000 person-years. In the main Firth model adjusted for age and MAFLD, each increase of 1 interquartile range (IQR; 0.696 units) in FIB-4 was associated with expanded MACE (adjusted hazard ratio 1.56, 95% CI 1.09-1.99; p = 0.022), whereas MAFLD was not statistically significant (adjusted hazard ratio 3.51, 95% CI 0.79-33.09; p = 0.105); the point estimate was above unity but imprecise because of the limited number of events.</p><p><strong>Conclusion: </strong>Higher FIB-4 was associated with short-term cardiovascular events in adults with T2DM. Given the small number of events, these findings require confirmation in larger multicenter cohorts.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1973311"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Lithium-induced bradycardia triggered by cecal volvulus: a case of obstruction-associated drug accumulation.","authors":"Akram Alnounou, Henry Zou, Madison Laird, Christopher Visak, Sage Bilsland, Sophie Numbers, Neil Hughes","doi":"10.3389/fgstr.2026.1728396","DOIUrl":"10.3389/fgstr.2026.1728396","url":null,"abstract":"<p><strong>Background: </strong>Lithium toxicity can rarely manifest as cardiac arrhythmias, often initially presenting as bradycardia. Bowel obstruction is a rare cause of acute lithium toxicity. We present a case of lithium-induced symptomatic bradycardia induced by cecal volvulus.</p><p><strong>Case report: </strong>An 84-year-old female with a history of bipolar 1 disorder on chronic lithium therapy was admitted for symptomatic bradycardia and abdominal pain. She also presented with myoclonus, polydipsia, and encephalopathy. Laboratory evaluation revealed lithium toxicity in the setting of renal impairment, and abdominal imaging findings indicated large bowel obstruction secondary to cecal volvulus. Lithium was discontinued, and the patient was managed supportively. Despite declining lithium levels, the patient's symptomatic bradycardia persisted until surgical correction of the volvulus, after which cardiac and neurological function markedly improved.</p><p><strong>Significance: </strong>This case highlights the potential role of gastrointestinal obstruction in exacerbating lithium-induced bradycardia by impairing its clearance and inducing a vagal response triggered by abdominal distension.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1728396"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategy for early diagnosis of pancreatic cancer.","authors":"Ravi Kumar Sharma, Alpa Singh, Gaurav Sharma, Saurabh Dawra, Surinder Singh Rana","doi":"10.3389/fgstr.2026.1731223","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1731223","url":null,"abstract":"<p><p>Exocrine pancreatic cancer, particularly Pancreatic Ductal Adenocarcinoma, is regarded as one of the most aggressive cancers with a poor prognosis. Its bleak outlook mainly results from its silent progression, late diagnosis, and unreliable early detection methods. Globally, PC ranks among the leading causes of cancer-related deaths, and its incidence continues to increase. Because the pancreas is situated deep within the abdomen, early symptoms such as mild abdominal pain, fatigue, or weight loss are often vague. Most patients are only diagnosed after the disease has spread beyond the point where curative treatment is possible. Although surgery provides the best chance for long-term survival, only a small number of patients qualify for it at the time of initial diagnosis. Several factors increase the risk of developing PC, including chronic pancreatitis, smoking, obesity, inherited genetic mutations (like BRCA1/2), and new-onset diabetes (NOD), which has recently gained attention as a possible early warning sign. However, widespread screening for PC isn't yet practical because the disease is relatively uncommon and there are no highly accurate, non-invasive biomarkers. The most widely used blood test, CA 19-9, often gives unreliable results, while newer molecular approaches-like circulating tumor DNA, exosomal markers, microRNAs, and metabolomic profiles-are still being refined. Recent advances in imaging technology, artificial intelligence, and targeted screening for high-risk individuals hold promise for catching pancreatic cancer earlier. As we advance, combining multi-omics biomarkers with precision imaging may finally make earlier diagnosis-and improved survival-a reality for this devastating disease.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1731223"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-fat diet and portal hypertension: a triangulation approach combining Mendelian randomization with retrospective clinical analysis.","authors":"Yu Xu, Siqi Yang, Yuying Li, Quanfa Han, Weixing Wang","doi":"10.3389/fgstr.2026.1927449","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1927449","url":null,"abstract":"<p><strong>Background: </strong>Portal hypertension is a major complication of chronic liver disease, but the causal role of dietary factors, particularly high-fat diet, remains unclear due to confounding in observational studies. This study aimed to investigate the relationship between high-fat diet and portal hypertension using a triangulation approach combining Mendelian randomization (MR) and retrospective clinical analysis.</p><p><strong>Methods: </strong>We conducted a two-sample Mendelian randomization analysis using summary-level genome-wide association study (GWAS) data for dietary fat intake (n = 268,922) and portal hypertension-related traits. Eighteen independent SNPs served as genetic instruments (mean F-statistic = 34.2, collectively explaining 2.8% of phenotypic variance). Inverse variance weighted (IVW), weighted median, MR-Egger regression, and mode-based methods were employed. Sensitivity analyses included MR-Egger intercept test, Cochran's Q statistic, MR-PRESSO, and leave-one-out analysis. Additionally, a retrospective cross-sectional clinical study was conducted on 72 patients with portal hypertension who underwent hepatic venous pressure gradient (HVPG) measurement.</p><p><strong>Results: </strong>MR analysis provided evidence consistent with a causal association between genetically predicted high-fat diet and increased risk of portal hypertension (IVW OR = 1.28 per SD increase, 95% CI: 1.15-1.42, p = 1.0 × 10^-5). Results were consistent across multiple MR methods. Sensitivity analyses showed no evidence of directional pleiotropy (MR-Egger intercept p = 0.178), significant heterogeneity (Cochran's Q p = 0.241), or MR-PRESSO-detected outliers (global test p = 0.312). In the clinical cohort, high-fat diet score was positively correlated with HVPG (r = 0.700, p < 0.001), and this association remained significant after multivariate adjustment (β = 0.85, 95% CI: 0.52-1.18, p < 0.001).</p><p><strong>Conclusion: </strong>Using a triangulation approach, we found consistent evidence from both Mendelian randomization and retrospective clinical analysis that a high-fat diet is linked to increased portal pressure. These complementary findings strengthen the overall evidence base and highlight the potential importance of dietary fat modification in portal hypertension management.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1927449"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NMA plus antitumor therapy versus antitumor therapy alone in patients with BCLC stage B or C hepatocellular carcinoma and pre-cachexia or cachexia: protocol for a prospective, multicenter, randomized, open-label phase II trial.","authors":"Ruihong Dai, Facheng Lu, Weibing Leng, Qing He, Wenhao Guo, Tao Hai, Chang Liu","doi":"10.3389/fgstr.2026.1926294","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1926294","url":null,"abstract":"<p><strong>Background: </strong>Cancer anorexia-cachexia syndrome (CACS) is prevalent among patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C hepatocellular carcinoma (HCC) and is strongly associated with poor prognosis, reduced treatment tolerance, and impaired quality of life. Megestrol acetate (MA) has demonstrated efficacy in improving appetite and body weight; however, conventional formulations are limited by variable bioavailability. This trial will evaluate the efficacy and safety of nanocrystalline megestrol acetate (NMA) in patients with BCLC stage B or C HCC and pre-cachexia or cachexia receiving systemic therapy combined with transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC).</p><p><strong>Methods: </strong>This multicenter, randomized, open-label, parallel-group Phase II trial protocol will enroll 68 adults aged 18-75 years with BCLC stage B or C HCC and pre-cachexia or cachexia. Participants will be stratified according to BCLC stage and weight loss during the previous 6 months and then randomized in a 1:1 ratio to receive either NMA (625 mg/day for 12 weeks) plus antitumor therapy (systemic therapy combined with transarterial chemoembolization [TACE] or hepatic arterial infusion chemotherapy [HAIC]) or antitumor therapy alone. Antitumor therapy will comprise systemic therapy combined with TACE or HAIC. The co-primary endpoints are the proportions of Anorexia/Cachexia Subscale-12 (A/CS-12) responders and body mass index (BMI) responders at Week 12. Secondary endpoints include objective response rate, progression-free survival, changes in the L3 skeletal muscle index (L3 SMI), and the incidence of adverse events. Exploratory endpoints will evaluate inflammatory and nutritional biomarkers as well as quality of life, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30).</p><p><strong>Discussion: </strong>This trial will provide preliminary comparative data on NMA plus antitumor therapy versus antitumor therapy alone in patients with BCLC stage B or C HCC and pre-cachexia or cachexia.</p><p><strong>Ethics: </strong>The study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University (IRB No. 2025-2539). The trial is registered at ClinicalTrials.gov NCT07356037.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1926294"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal endoscopic diagnosis in biliary oncology: integrating EUS-guided tissue acquisition and cholangioscopy for personalized cancer care.","authors":"Petko Karagyozov, Nadica Male, Kalina Panova, Stela Nikolova","doi":"10.3389/fgstr.2026.1924535","DOIUrl":"10.3389/fgstr.2026.1924535","url":null,"abstract":"<p><p>The diagnosis of biliary malignancies remains challenging because of the heterogeneous growth patterns of cholangiocarcinoma, the limited sensitivity of conventional tissue acquisition techniques, and the growing need for molecular profiling in the era of precision oncology. Over the past decade, endoscopic ultrasound (EUS) and digital single-operator cholangioscopy have transformed the diagnostic approach by providing complementary information. EUS enables high-resolution imaging, locoregional staging, and tissue acquisition from primary tumors and regional lymph nodes, while cholangioscopy offers direct intraductal visualization and targeted biopsy of suspicious biliary lesions. This review summarizes the current evidence on the diagnostic performance, strengths, and limitations of EUS-guided tissue acquisition and cholangioscopy, emphasizing their complementary role within contemporary diagnostic algorithms. We also discuss emerging technologies, including molecular profiling, next-generation sequencing, artificial intelligence, radiomics, digital pathology, and liquid biopsy, which are shaping the future of biliary oncology. In addition to the available evidence, we present our institutional experience comparing EUS-guided tissue acquisition and cholangioscopy-directed biopsy in patients with suspected malignant biliary strictures. Our institutional experience supports the complementary use of EUS-guided tissue acquisition and cholangioscopy within a multimodal diagnostic approach. In the subgroup of patients who underwent both procedures, we observed high diagnostic sensitivity while maintaining an acceptable safety profile, supporting the potential value of a multimodal diagnostic approach. Integrating advanced endoscopic techniques with precision diagnostics is likely to optimize diagnostic accuracy and guide personalized management of biliary malignancies.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1924535"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irritable bowel syndrome-like symptoms are associated with increased healthcare utilization in patients with inflammatory bowel disease.","authors":"Sophie Montgomery, Alessandra Saraga, Nathan David Vanshelboym Rothschild, Mostafa A Soliman, Audrey N Kim, Isabella Midura, Rishita Tikkala, Lina Zhang, Shana Rakowsky, Loren Rabinowitz, Konstantinos Papamichael, Adam S Cheifetz, Sarah Ballou","doi":"10.3389/fgstr.2026.1924176","DOIUrl":"10.3389/fgstr.2026.1924176","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with Inflammatory Bowel Disease (IBD) experience Irritable Bowel Syndrome (IBS)-like symptoms more frequently than the general population. The impact of IBS-like symptoms on the clinical course of IBD remains uncertain.</p><p><strong>Methods: </strong>In a prospective cohort of patients with quiescent IBD, as defined by endoscopic remission, IBS-like symptoms were measured using the IBS-Symptom Severity Scale (IBS-SSS) at the time of endoscopy to define IBD patients with no IBS-like symptoms (IBS-SSS <75), mild IBS-like symptoms (IBS-SSS 75-175), and moderate-severe IBS-like symptoms (IBS-SSS >175). The primary outcome was total IBD-related healthcare utilization (HCU), while secondary outcomes included time to unscheduled/acute HCU and treatment failure among patients on biologics.</p><p><strong>Results: </strong>Among 114 patients with quiescent IBD, 53 had no IBS-like symptoms, 43 had mild IBS-like symptoms, and 18 had moderate-severe IBS-like symptoms. The median follow-up time was 3.5 years and was comparable among groups (p=0.330). Patients with mild or moderate-severe IBS-like symptoms had a higher total number of HCU events than patients without IBS-like symptoms (median (IQR): 8 (6-13) vs. 12 (9-15) vs 7 (5-11), respectively, p=0.042). After adjusting for IBD type and biologic therapy at baseline multivariable Cox proportional hazards regression analysis identified mild (HR: 3.6; 95%CI): 1.1-11.7; p=0.029) and moderate/severe (HR: 6.2; 95%CI: 1.8-21.3, p=0.004) IBS-like symptoms associated with unscheduled/acute HCU. Treatment failure did not differ by presence of IBS-like symptoms.</p><p><strong>Discussion: </strong>IBS-like symptoms in IBD are associated with increased HCU but not treatment failure. These findings suggest that IBS-like symptom burden in IBD is clinically meaningful, may drive healthcare seeking, and warrants targeted treatment within IBD care models.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1924176"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purinergic signaling in the gut neuro-glial-immune axis: mechanisms of homeostasis, inflammation, and gastrointestinal dysfunction.","authors":"Eduardo E Valdez-Morales, Andrómeda Liñán-Rico, Raquel Guerrero-Alba","doi":"10.3389/fgstr.2026.1954794","DOIUrl":"10.3389/fgstr.2026.1954794","url":null,"abstract":"<p><p>The gastrointestinal (GI) tract contains a highly integrated network composed of the enteric nervous system (ENS), epithelial cells, resident immune populations, and intestinal microbiota. Communication among these components is essential for maintaining intestinal homeostasis and coordinating responses to environmental and inflammatory stimuli. Purinergic signaling regulates synaptic transmission, neuronal excitability, enteric neuron-glia communication, intestinal motility, and epithelial secretion. In parallel, purinergic receptors expressed by epithelial and immune cells modulate barrier integrity, cytokine production, leukocyte recruitment, immune tolerance, and tissue repair. Growing evidence indicates that dysregulated purinergic pathways contribute to neuroinflammation, enteric neuronal loss, intestinal dysmotility, visceral hypersensitivity, and inflammatory bowel disease (IBD). Among purinergic receptors, P2X7 has been strongly implicated in neuroimmune inflammatory responses, particularly in experimental models of IBD, whereas adenosine receptors generally exert immunomodulatory and tissue-protective effects, although these actions are highly context- and cell-dependent. This review summarizes current knowledge on purinergic signaling within the intestinal neuro-glial-immune network, highlighting its roles in gastrointestinal homeostasis and disease. We also discuss emerging therapeutic opportunities targeting purinergic receptors and ectonucleotidases to restore intestinal function and limit chronic inflammation.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1954794"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of ustekinumab in Crohn's disease between biologic-naïve and biologic-experienced.","authors":"Kaifei Yuan, Xianhong Hu, Qi Fang, Siyuan Li, Ping Lin, Baijing Ding, Tongyuan Lin","doi":"10.3389/fgstr.2026.1926425","DOIUrl":"10.3389/fgstr.2026.1926425","url":null,"abstract":"<p><strong>Objective: </strong>This thesis investigates the differences in clinical efficacy of ustekinumab (UST) as a biologic-naïve or biologic-experienced for Crohn's Disease (CD) patients in terms of clinical manifestations and laboratory test indicators. It also explores the correlation between clinical response status and patients' quality of life, as well as their anxiety and depression levels.</p><p><strong>Method: </strong>This study involved 61 CD patients treated with UST. We gathered clinical data, laboratory results, CDAI scores and SES-CD scores at 0, 8, and 32 week, and assessed quality of life and psychological state at baseline and week 32. Initially, patients were divided into biologic-naïve and biologic-experienced groups based on their previous biologic history. By analyzing the changes in laboratory indicators at weeks 0, 8, and 32, as well as the differences in the degree of these changes, the effectiveness of different treatment regimens was evaluated. At the end of the treatment (week 32), 61 patients were reclassified into the clinical response group and the non-response group based on the decrease in CDAI score. Subsequently, statistical methods were used to assess the differences in quality of life and psychological status between these two response groups.</p><p><strong>Results: </strong>There was no statistically significant difference in the baseline data between the biologic-naïve and biologic-experienced groups (<i>P</i> > 0.05). After treatment, the inflammatory and nutritional indicators in both groups improved. The inflammation decreased more significantly in the biologic-naïve group. At 32 week, the reduction in CDAI and SES-CD in the biologic-naïve group was better than that in the treated group (all <i>P</i> = 0.03), but there was no difference in clinical response and remission rate between the two groups. Regardless of whether there was clinical response, the IBDQ score of patients increased compared to the baseline. The improvement in IBDQ in the clinical response group was higher than that in the clinical non-response group (<i>P</i> = 0.001). Only the anxiety subscale (HADS-A) of the response group, significantly decreased (<i>P</i> = 0.02), while the depression score of HADS-D showed no significant improvement. There were no statistically significant differences in the anxiety subscale (HADS-A) and depression subscale (HADS-D) of the rnon-esponse group (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>UST can improve the inflammation and nutritional status of patients with CD who are biologic-naïve or biologic-experienced. The clinical and endoscopic improvement benefits for the biologic-naïve are more prominent. The quality of life of patients who achieved a clinical response has improved more significantly. Anxiety symptoms can be somewhat alleviated, while the depressive state has not shown any significant change.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1926425"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MASLD beyond the liver: decoding the gut-genetic-metabolic nexus.","authors":"Philippe Attieh, Maria Nassif, Mark Maghzal, Anthony Bedran, Jane Kassas, Mahmoud Othman, Francois Sahyoun, Frederic Harb, Sami Azar, Hilda E Ghadieh","doi":"10.3389/fgstr.2026.1824548","DOIUrl":"10.3389/fgstr.2026.1824548","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease, is the most prevalent chronic liver disorder globally and is tightly linked to obesity, diabetes, dyslipidemia, and metabolic syndrome. MASLD spans a continuum from simple steatosis to metabolic dysfunction-associated steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Its pathogenesis is driven by complex interactions among host genetics, metabolic stress, dietary factors, gut microbiota dysbiosis, immune dysregulation, and oxidative injury. The gut-liver axis plays a central role, with microbial metabolites and altered intestinal permeability driving hepatic inflammation and fibrogenesis. Genetic variants, including PNPLA3, TM6SF2, and MBOAT7, modulate disease susceptibility and metabolic pathways. Emerging therapies target interconnected mechanisms through lifestyle interventions, microbiome-directed strategies, bile acid signaling, incretin-based treatments, and antifibrotic approaches. Advances in omics technologies and biomarkers support precision medicine frameworks. Despite major advances in mechanistic understanding, resmetirom has recently become the first FDA-approved therapy for adults with non-cirrhotic MASH and moderate-to-advanced fibrosis. Nevertheless, effective treatment options remain limited, emphasizing the need for additional mechanism-based and personalized therapeutic strategies.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1824548"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}