Frontiers in gastroenterology (Lausanne, Switzerland)最新文献

{"title":"Quantitative classification of pancreatic atrophy: the İstanbul morphometric pancreatic atrophy classification based on CT and MRI measurements.","authors":"Fatih Öner Kaya, Esra Ümmühan Mermi, Alev Öztürk Günaldı, Haydar Kaan Karataş, Uğur Can Demir, Pınar Mert, Hüseyin Öztürk, Şule Sena Mazlum, Çağdaş Enginoğlu","doi":"10.3389/fgstr.2026.1735281","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1735281","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic atrophy (PA) is a progressive reduction in pancreatic parenchymal volume, accompanied by acinar cell loss, fibrosis, and fatty infiltration. It is an important radiological marker of glandular damage associated with physiological aging, chronic inflammatory diseases, and metabolic disturbances, such as diabetes mellitus and obesity. However, PA is still reported mainly using subjective terms, which leads to inter-observer variability and limits reliable clinical correlation and longitudinal follow-up.</p><p><strong>Purpose: </strong>This study aimed to introduce and validate the İstanbul Morphometric Pancreatic Atrophy Classification (IM-PAC), a four-tier morphometric grading system based on CT and MRI measurements, and to evaluate its association with graded CP severity features (CP).</p><p><strong>Methods: </strong>In this retrospective single-center study, 280 abdominal CT and MRI examinations performed in 2023 were analyzed. Pancreatic head, body, and tail thicknesses were measured at standardized anatomical landmarks. Chronic pancreatitis (CP)-related imaging features were graded using predefined ordinal severity scales for ductal abnormalities and MRI-defined fibrosis. Analyses used true modality-specific denominators (CT n = 168; MRI n = 112). Inter-observer reproducibility was assessed using intra-class correlation coefficients (ICC) and quadratic weighted Cohen's kappa.</p><p><strong>Results: </strong>IM-PAC grades were distributed as Grade 0 (n = 54, 19.3%), Grade 1 (n = 119, 42.5%), Grade 2 (n = 93, 33.2%), and Grade 3 (n = 14, 5.0%). Increasing IM-PAC grade was significantly and monotonically associated with ductal abnormality severity (Spearman ρ = 0.52, p < 0.001) and MRI-defined fibrosis severity (ρ = 0.48, p < 0.001). Calcifications assessed in the CT subgroup (n = 168) showed progressive enrichment across grades (p < 0.001). Inter-observer agreement was excellent for thickness measurements (ICC = 0.89; 95% CI: 0.84-0.92) and substantial for ordinal ductal and fibrosis grading (weighted κ = 0.81 and 0.78, respectively).</p><p><strong>Conclusion: </strong>By integrating severity-based CP grading, IM-PAC provides a reproducible and clinically relevant morphometric framework for quantifying pancreatic atrophy.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1735281"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846583","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":"The challenging diagnosis of sinistral portal hypertension in a patient with liver cirrhosis: a case report and literature review.","authors":"Natalia Altarsha, Adrian Raoul Kobe, Emanuel Burri, Magdalena Filipowicz Sinnreich","doi":"10.3389/fgstr.2026.1729501","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1729501","url":null,"abstract":"<p><strong>Background: </strong>Left-sided portal hypertension (LSPH) is commonly associated with pancreatic disease and typically manifests with gastrointestinal bleeding, but not with ascites or hypoalbuminemia. The coexistence of LSPH with liver cirrhosis complicates diagnosis and management, as standard imaging often fails to identify the underlying cause of portal hypertension-related complications.</p><p><strong>Case presentation: </strong>We report a case of a 59-year-old man with decompensated alcohol-related cirrhosis and prior pancreatic surgery, who presented with recurrent gastrointestinal bleeding, severe hypoalbuminemia, and treatment-refractory ascites, all of which persisted despite placement of a transjugular intrahepatic portosystemic shunt (TIPS). Diagnostic work-up included repeated imaging and hemodynamic measurements. Importantly, invasive splenoportography was the only approach that allowed the detection of a hemodynamically significant splenic vein stenosis, and subsequent percutaneous transluminal angioplasty (PTA) led to rapid clinical improvement.</p><p><strong>Key finding: </strong>Standard imaging failed to detect a splenic vein stenosis, which was identified only by invasive phlebography performed via the already placed TIPS. Following PTA, ascites resolved, serum albumin normalized, and no further gastrointestinal bleeding occurred. To our knowledge, this is the first case report describing the full reversal of such a constellation of symptoms after treatment of splenic vein stenosis.</p><p><strong>Conclusion: </strong>This case demonstrates that splenic vein stenosis can cause both hemorrhagic and non-hemorrhagic complications in patients with cirrhosis. Recognition and interventional treatment of LSPH may reverse refractory ascites and hypoalbuminemia, highlighting the importance of high clinical suspicion and invasive evaluation in complex portal hypertension cases.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1729501"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846772","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: Hepatitis and autoimmune hemolytic anemia induced by EBV-associated infectious mononucleosis.","authors":"Akram Alnounou, Henry Zou, Madison C Laird, Sophie Numbers, Christopher Visak, Sage Bilsland, Neil Hughes, Eric Martin Sieloff","doi":"10.3389/fgstr.2026.1720586","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1720586","url":null,"abstract":"<p><p>Epstein-Barr virus (EBV) typically causes infectious mononucleosis, but in rare cases, it may lead to complications such as autoimmune hemolytic anemia (AIHA) and hepatitis. We report the case of an 18-year-old previously healthy female who presented with jaundice, red urine, and arthralgia. Laboratory workup revealed direct hyperbilirubinemia, elevated transaminases, and a direct antiglobulin test positive for IgG (negative for C3d), consistent with warm autoimmune hemolytic anemia in the context of EBV infection. Imaging ruled out biliary obstruction. The patient was managed conservatively, with cautious steroid use, and demonstrated clinical improvement without progression to hepatic failure. This case underscores the importance of recognizing atypical hepatic presentations of EBV and carefully managing overlapping autoimmune complications.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1720586"},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824337","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":"Primary prevention in liver cirrhosis patients with esophageal varicesa: a systematic review and network meta-analysis.","authors":"Feng Li, Xiaoyi- Zhang, Jia-Li Chi, Xuemei Zhang, Yu-Jing Zhou, Han-Fang Xu, Kai Zhang, Yi-Jing Ren, Xiu-Yan Wei","doi":"10.3389/fgstr.2026.1754027","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1754027","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and safety of different primary preventive measures for esophageal variceal bleeding using a network meta-analysis.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) on primary prevention were retrieved from PubMed, Cochrane Library, Embase, and Web of Science. Primary outcomes were the incidence of variceal bleeding, all-cause mortality, All-Cause Bleeding and Bleeding-Related Mortality. Secondary outcomes included adverse events and other decompensation events. Study quality was assessed with the Cochrane Risk of Bias tool. Data were analyzed using Revman 5.4 and Stata 16.0.</p><p><strong>Results: </strong>A total of 50 RCTs (6510 patients) evaluating 16 interventions were included. For reducing bleeding incidence, the combinations Midodrine + Propranolol (Mido+PPL), Carvedilol + Endoscopic Variceal Band Ligation (Carv+EVBL), and Fuzheng Huayu Capsule + Propranolol (FZHYJN+PPL) were superior. For lower all-cause mortality, Carv+EVBL, Mido+PPL, and Nadolol + Isosorbide Mononitrate (Nado+ISMN) were favorable. Carv+EVBL, EVBL, and Endoscopic Injection Sclerotherapy (EIS) were better for reducing bleeding-related mortality. Regarding safety, Mido+PPL, Nadolol (Nado), and Carvedilol (Carv) had fewer general adverse events, while Isosorbide Mononitrate (ISMN), Mido+PPL, and Carv had lower rates of other decompensation events.</p><p><strong>Conclusion: </strong>Based on low-certainty evidence, Mido+PPL demonstrated a favorable balance of efficacy and safety and is recommended as a preferred option. Mido+PPL, Carv+EVBL, and FZHYJN+PPL are recommended for primary prophylaxis in cirrhosis. For Child-Pugh A/B patients, Mido+PPL, Carv+EVBL, and FZHYJN+PPL are suggested, with EVBL as an alternative for those intolerant to drugs. EVBL may be considered for Child-Pugh C patients. Mido+PPL is recommended for prophylaxis within one year, FZHYJN+PPL for up to two years, and Carvedilol (alone or with EVBL) for long-term management beyond two years. Carvedilol and Propranolol showed superior net clinical benefit over Nadolol and Timolol. Although Nadolol (alone or with ISMN) may reduce mortality, its higher adverse event rate precludes it as a first-line strategy. FZHYJN, while effective, may increase the risk of other decompensation events.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1754027"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824348","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: A rare presentation of gastrointestinal amyloidosis: unmasking the hidden culprit of chronic epigastric pain and weight loss.","authors":"Fnu Veena, Muhammad Rizwan Akram, Mohamed Farag, Priscilla Lajara Hallal, Elona Shehi","doi":"10.3389/fgstr.2026.1742374","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1742374","url":null,"abstract":"<p><p>Amyloidosis is a rare, heterogeneous condition characterized by extracellular deposition of misfolded protein fibrils, resulting in organ dysfunction. Gastrointestinal amyloidosis (GIA), an uncommon manifestation, is often underdiagnosed due to its nonspecific symptoms, such as weight loss, abdominal pain, and diarrhea. Early recognition and accurate amyloid typing are crucial, as treatment strategies depend on the specific subtype involved. We report a case of a 42-year-old African male presenting with chronic epigastric pain, significant weight loss (BMI: 17.1), and a history of GERD. He had recently traveled to Equatorial Guinea. His symptoms, including nausea, decreased appetite, constipation, and persistent epigastric pain, were unresponsive to proton pump inhibitors. On examination, he was hypotensive and tachycardic. Laboratory workup revealed hyponatremia and elevated troponin T. Imaging showed fecal impaction and pyloric edema. Upper endoscopy and colonoscopy with biopsies confirmed amyloid deposition in the stomach, duodenum, ileum, and colon. Congo red staining demonstrated classic apple-green birefringence under polarized light. Cardiac evaluation revealed reduced global longitudinal strain. Serum studies showed elevated free lambda light chains and an IgG-lambda monoclonal band, while the urine protein/creatinine ratio was 361 mg/g, consistent with proteinuria. Chronic hepatitis B infection with detectable HBV DNA and elevated gamma/delta T cells on the lymphoma panel raised concerns for an underlying T-cell lymphoproliferative disorder. This case highlights the diagnostic complexity of gastrointestinal amyloidosis with multisystem involvement. The patient's presentation, along with elevated free light chains and monoclonal gammopathy, raised suspicion for AL amyloidosis, though chronic hepatitis B and possible lymphoproliferative disease kept AA amyloidosis in the differential. Consistent with the literature, vague gastrointestinal (GI) symptoms often delay diagnosis, underscoring the role of Congo red staining and mass spectrometry for confirmation and subtype identification. Recent trials support daratumumab for AL and patisiran/inotersen for ATTR amyloidosis. Early, accurate diagnosis is key to initiating appropriate therapy and improving outcomes, with multidisciplinary involvement crucial for optimal care.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1742374"},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790895","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":"Tangled contacts: mitochondrial interactions with cellular organelles in acute pancreatitis.","authors":"Serge Chooklin, Serhii Chuklin","doi":"10.3389/fgstr.2026.1802268","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1802268","url":null,"abstract":"<p><strong>Objective: </strong>Mitochondria in pancreatic acinar cells function as central hubs integrating calcium signaling, ATP production, redox balance, autophagy, secretion, and cell-death regulation through dynamic interactions with other organelles.</p><p><strong>Aim: </strong>To summarize current evidence on mitochondria-organelle interactions in pancreatic acinar cells and their relevance to acute pancreatitis.</p><p><strong>Methods: </strong>We performed a narrative review of experimental and translational studies addressing mitochondrial interactions with the endoplasmic reticulum, lysosomes, autophagosomes, peroxisomes, the cytoskeleton, plasma membrane, nucleus, lipid droplets, and secretory granules in pancreatic acinar cells and experimental acute pancreatitis.</p><p><strong>Results: </strong>Mitochondria-endoplasmic reticulum contacts emerged as major determinants of pathological Ca²⁺ transfer, mitochondrial depolarization, and ATP depletion. Impaired crosstalk with lysosomes and autophagosomes disrupted mitophagy and favored the persistence of dysfunctional mitochondria, defective vacuolar processing, and inflammatory amplification. Altered functional coupling with peroxisomes and lipid droplets intensified oxidative stress, fatty-acid disequilibrium, and lipotoxic injury, particularly in metabolically unfavorable settings. Disturbed interactions with the cytoskeleton and plasma membrane impaired mitochondrial positioning, local Ca²⁺ buffering, and the spatial organization of stimulus-secretion coupling. Mitochondria-to-nucleus signaling promoted stress-responsive and proinflammatory transcriptional programs, while mitochondrial failure in the apical secretory region indirectly facilitated defective exocytosis and premature zymogen activation. Collectively, these alterations shifted acinar cells from adaptive stress responses toward necrosis, local pancreatic damage, systemic inflammation, and organ failure.</p><p><strong>Conclusions: </strong>Mitochondria-associated inter-organellar networks are integral to acinar-cell homeostasis and critically influence the initiation and progression of acute pancreatitis. Their selective stabilization may represent a mechanistically grounded therapeutic direction.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1802268"},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790890","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: Endoscopic anal papillectomy combined with ligation: a new approach for the treatment of grade IV hemorrhoids (with video).","authors":"Xiaopan Lv, Mingli Zhu, Xianzhong Zeng, Zheng Li, Kaitong Jiang, Xuemin Yuan","doi":"10.3389/fgstr.2026.1681972","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1681972","url":null,"abstract":"<p><strong>Background and aims: </strong>Hemorrhoids represent the most prevalent anorectal disorder globally. They are categorized into three types based on location: internal, external, and mixed hemorrhoids. Furthermore, internal hemorrhoids are classified from I to IV, depending on their appearance and degree of prolapse. Surgical intervention is frequently required for Grade III-IV and mixed hemorrhoids, which exhibit complex and severe symptoms. The challenges of these surgical procedures include extensive incisions, substantial intraoperative bleeding, intense postoperative pain, and a heightened risk of complications. Consequently, the exploration of alternative therapies continues.</p><p><strong>Methods: </strong>This report introduces an innovative endoscopic technique employed to treat a female patient suffering from Grade IV hemorrhoids for three years. Utilizing an endoscope, the prolapsed hemorrhoid and hypertrophic anal papillae were progressively excised with a snare, followed by the application of a ligator to ligate the lax mucosa above the dentate line at multiple sites, thereby preventing future prolapse.</p><p><strong>Results: </strong>The procedure resulted in minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up.</p><p><strong>Conclusion: </strong>This technique is particularly innovative as endoscope facilitates a clearer surgical view and more precise manipulation, thus minimizing damage to the rectal mucosa and anal skin. Furthermore, this technique can be utilized to concurrently remove hemorrhoids during gastrointestinal endoscopy, which will alleviate the patient's multiple suffering and save money and time. This method offers a new direction for treating Grade IV hemorrhoids. Longer follow-up periods and larger sample size comparative studies are needed in the future to verify its safety and efficacy.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1681972"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790879","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":"The importance of <i>Helicobacter pylori</i> eradication: a narrative review.","authors":"Orlaith Casey, Marta Dobric, Orlaith Kelly, Colm Antoine O'Morain","doi":"10.3389/fgstr.2026.1740221","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1740221","url":null,"abstract":"<p><strong>Background: </strong><i>Helicobacter pylori (H. pylori)</i> is a gram-negative bacterium infecting over 40% of the global population, with highest prevalence in low- and middle-income regions. Chronic infection leads to persistent gastritis and can result in peptic ulcer disease, dyspepsia and gastric adenocarcinoma. Despite its high pathogenic potential, population-based screening and eradication programmes remain limited, particularly in Europe.</p><p><strong>Methods: </strong>This narrative review summarisescurrent evidence on the epidemiology, clinical burden and eradication strategies for <i>H. pylori</i>. A literature search of PubMed, Embase and the Cochrane Database was performed to identify recent publications relating to <i>H. pylori</i> infection, consequences and screening approaches.</p><p><strong>Results: </strong><i>H. pylori</i> has been classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen and is the leading cause of infection-attributable cancer worldwide, accounting for approximately 850,000 gastric cancer cases annually. Robust evidence demonstrates that eradication of <i>H. pylori</i> reduces the risk of peptic ulcer recurrence, dyspepsia, and gastric cancer incidence, with recent meta-analyses reporting a pooled relative risk reduction of up to 44%. Population-based eradication initiatives, such as the Matsu Islands study, have shown dramatic declines in <i>H. pylori</i> prevalence, peptic ulceration, and gastric cancer incidence. Current international guidelines, including the Maastricht VI/Florence and 2025 Taipei Global Consensus reports, now recommend universal eradication of confirmed infections and support population-level or family-based screening in high-risk regions. Ongoing European pilot studies, including the TOGAS initiative, aim to inform the implementation of gastric cancer screening programs. Concerns regarding antibiotic resistance remain, though recent evidence suggests that the risks are manageable with appropriate antibiotic stewardship.</p><p><strong>Conclusion: </strong>Population-based <i>H. pylori</i> screen-and-treat strategies represent a cost-effective and evidence-based approach to preventing gastric cancer. Further large-scale European studies are warranted to guide optimal implementation, timing, and cost-effectiveness of such programs.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1740221"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700727","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":"Positioning double-balloon enteroscopy in the diagnostic algorithm for suspected small bowel Crohn's disease: a retrospective analysis of decision-making at a tertiary referral centre.","authors":"Thomas Sheehan, Cormac Hegarty, Roisin Connaughton, Barry Hall, Orlaith B Kelly","doi":"10.3389/fgstr.2026.1699553","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1699553","url":null,"abstract":"<p><strong>Background: </strong>Small bowel capsule endoscopy (SBCE) enables non-invasive mucosal assessment of the small bowel, while double-balloon enteroscopy (DBE) allows histological confirmation and therapeutic intervention. Appropriate patient selection is essential to maximise diagnostic yield and minimise unnecessary invasive procedures.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients referred for investigation of suspected small bowel Crohn's disease over a two-year period at a tertiary referral centre. Demographic data, prior investigations, SBCE findings, and subsequent DBE decisions were recorded. The primary outcome was the decision to proceed to DBE. Secondary outcomes included the diagnostic yields of SBCE and DBE. Multivariate logistic regression was used to identify factors associated with DBE referral.</p><p><strong>Results: </strong>Ninety-eight patients with complete data were included. SBCE was performed as the initial investigation in 90.8%, while 5.5% proceeded directly to DBE for therapeutic or histological indications. The SBCE-to-DBE conversion rate was 30.4%. SBCE alone established or excluded inflammatory bowel disease in 70% of patients. Among those undergoing DBE, Crohn's disease was confirmed in 21% and excluded in 79%. Increasing age (OR 1.04 per year; 95% CI 1.01-1.07) and diagnostic uncertainty on SBCE (OR 2.0; 95% CI 1.8-3.5) independently predicted DBE referral.</p><p><strong>Conclusion: </strong>SBCE is diagnostic in the majority of patients with suspected small bowel Crohn's disease and functions effectively as a triage tool. DBE should be reserved for cases requiring histological confirmation, clarification of indeterminate findings, assessment of proximal disease, or therapeutic intervention.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1699553"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700367","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":"Hepatoprotective effects of oyster-derived bioactive compounds in alcoholic liver disease: a systematic review.","authors":"Rui Chen, Yanan Qin, Ping Yu","doi":"10.3389/fgstr.2026.1737942","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1737942","url":null,"abstract":"<p><strong>Background: </strong>Alcoholic liver disease (ALD) is a major global cause of liver-related morbidity and mortality, driven by excessive alcohol consumption and characterized by oxidative stress, inflammation, disordered lipid metabolism, and gut-liver axis dysfunction. Oyster-derived bioactive compounds have shown hepatoprotective potential in experimental settings; however, their efficacy and role in ALD management remain unclear.</p><p><strong>Objective: </strong>To systematically evaluate and synthesize preclinical and clinical evidence on oyster-derived bioactive compounds for the prevention and treatment of ALD.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Scopus were searched for studies examining oyster-derived bioactives, including polysaccharides, peptides, protein hydrolysates, and related extracts, in alcohol-induced liver injury models. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the SYRCLE tool for animal studies and RoB 2.0 for human trials. Certainty of evidence was evaluated using the GRADE framework.</p><p><strong>Results: </strong>Eleven studies met the inclusion criteria, comprising ten animal studies and one randomized controlled trial. In animal models, oyster-derived interventions reduced alanine and aspartate aminotransferase levels by approximately 34-56%, increased antioxidant defenses (glutathione and superoxide dismutase increased by up to 45% and 40%, respectively), and decreased inflammatory mediators including TNF-α, IL-1β, and IL-6. Improvements in lipid metabolism and gut-liver axis markers were also reported in several studies. The single human trial demonstrated a modest reduction in γ-glutamyl transferase, with no significant changes in ALT or AST. Overall, the certainty of evidence ranged from very low to low, reflecting methodological heterogeneity, risk of bias, and limited human data.</p><p><strong>Conclusions: </strong>Oyster-derived bioactives consistently demonstrate hepatoprotective effects in preclinical models of ALD through antioxidant, anti-inflammatory, metabolic, and gut-mediated mechanisms. However, the current evidence base is preliminary, and well-designed, adequately powered clinical trials are required to determine their clinical efficacy, optimal formulation, and long-term safety.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251104584, identifier CRD420251104584.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1737942"},"PeriodicalIF":0.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596553","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}