Frontiers in gastroenterology (Lausanne, Switzerland)最新文献

{"title":"Symptom clusters and core symptoms in early postoperative esophageal cancer patients.","authors":"Menglan Zhong, Changhong Wang, Xiaoqi Liu, Yan Wang, Xiaona Qi, Shaohua Xie","doi":"10.3389/fgstr.2026.1766306","DOIUrl":"10.3389/fgstr.2026.1766306","url":null,"abstract":"<p><strong>Purpose: </strong>Patients undergoing esophagectomy frequently experience diverse and complex symptoms. This study aimed to identify clusters of early postoperative symptoms and determine core symptoms among these patients, to facilitate targeted symptom management strategies.</p><p><strong>Methods: </strong>This prospective cohort study included 361 patients who underwent esophageal cancer surgery at a tertiary Grade A hospital in Harbin between 2023 and 2024. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) and the Esophageal Cancer-Specific Module (QLQ-OES18) were used to assess 18 symptoms one month postoperatively. Exploratory factor analysis and network analysis were conducted to identify symptom clusters and core symptoms, respectively. A 1-month landmark survival analysis was performed to examine their associations with 1-year postoperative survival, using a parsimonious multivariable Cox regression model.</p><p><strong>Results: </strong>Five distinct symptom clusters were identified: eating-related (eating difficulty, reflux, choking, appetite loss, nausea, vomiting, dysphagia; prevalence 49.0%), breathing-related (cough, dyspnea, insomnia; prevalence 47.0%), pain-related (esophageal pain, generalized pain; prevalence 48.0%), fatigue-speech related (fatigue, dry mouth, trouble talking; prevalence 51.0%), and excretion-related (constipation, diarrhea; prevalence 50.0%). Network analysis identified fatigue (relative strength [rS] = 2.83), pain (rS = 1.69), and insomnia (rS = 1.58) as core symptoms, with fatigue serving as the key bridge symptom. In the 1-month landmark analysis, no statistically significant association was detected between symptom clusters or core symptoms and 1-year postoperative survival.</p><p><strong>Conclusion: </strong>This study identified distinct symptom clusters and core symptoms one month post-esophagectomy that merit clinical attention during postoperative follow-up. Specifically, fatigue represents a key therapeutic target for developing intervention strategies.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1766306"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119282","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":"Comparative outcomes of advanced medical rescue therapies in steroid-refractory acute severe ulcerative colitis: a systematic review and network meta-analysis.","authors":"Mohamad Yousef Alabdallat, Omar Al Ta'ani, Tarek Bakain, Ahmad Al-Dwairy, Mohammad Ghannam, Abdulrahman Atasi, Fares Mashal, Khaled Moghib, Nader Bakheet, Javed G Jagroo, Rohan Hehr, Ahmed Salem, Derrick Cheung","doi":"10.3389/fgstr.2026.1937925","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1937925","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Steroid-refractory acute severe ulcerative colitis is a medical emergency associated with a substantial risk of colectomy. Although infliximab and calcineurin inhibitors are established rescue treatments, comparative evidence regarding alternative drugs, infliximab dosing strategies, and newer small-molecule therapies remains limited. We conducted a systematic review and network meta-analysis to compare the efficacy and safety of available medical rescue strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception through June 30, 2026. Randomized controlled trials and comparative observational studies enrolling adults hospitalized with steroid-refractory acute severe ulcerative colitis were eligible. Separate frequentist random-effects network meta-analyses were conducted for colectomy at approximately 12-14 weeks, colectomy during hospitalization or within 30 days, colectomy at approximately 12 months, and serious adverse events. Effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Risk of bias was assessed using RoB 2 and ROBINS-I.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 5, 498 records identified, 18 studies involving 1, 529 participants met the eligibility criteria, including three randomized trials and 15 observational studies. At approximately 12-14 weeks, ciclosporin was associated with higher odds of colectomy than standard-dose infliximab (OR 2.19, 95% CI 1.17-4.12). Neither high-dose infliximab (OR 2.92, 95% CI 0.42-20.26) nor accelerated infliximab (OR 4.57, 95% CI 0.88-23.75) differed significantly from standard-dose infliximab. Ciclosporin was also associated with higher odds of early colectomy (OR 3.05, 95% CI 1.38-6.77) and 12-month colectomy (OR 3.65, 95% CI 1.98-6.72) than standard-dose infliximab. Tacrolimus and accelerated infliximab did not differ significantly from standard-dose infliximab at either time point. Serious adverse events were similar between ciclosporin and infliximab (OR 0.94, 95% CI 0.54-1.63). The networks contained no closed loops, and most observational studies were judged to have a serious risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the combined randomized and observational evidence, standard-dose infliximab was associated with lower colectomy odds than ciclosporin, without a detectable difference in serious adverse events. No consistent advantage was demonstrated for accelerated or high-dose infliximab. Because the apparent efficacy advantage of infliximab was driven predominantly by observational studies, whereas randomized trials showed comparable outcomes, the findings should be interpreted cautiously. Further adequately powered randomized comparisons incorporating contemporary biologic-exposed populations and newer small-molecule therapies are required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Systematic review registration: &lt;/strong&gt;https://www.crd.york.ac.uk/prospero/, identifier CRD4","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1937925"},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119166","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":"Role of prokinetic drugs prior to endoscopy in acute upper gastrointestinal bleeding: a systematic review and meta-analysis.","authors":"Mohamad Yousef Alabdallat, Tarek Bakain, Abdulrahman Atasi, Omar A Oudit, Mohammad Ghannam, Zaid AlRashid, Khaled Moghib, Emeka Stanley Obi, Muhammad Sarfaraz, Chidiebele Emmanuel Omaliko, Derrick Cheung","doi":"10.3389/fgstr.2026.1930145","DOIUrl":"https://doi.org/10.3389/fgstr.2026.1930145","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency in which retained blood and clots may impair endoscopic visualization, delay diagnosis, and increase the need for repeat endoscopy. Pre-endoscopic prokinetic therapy, particularly erythromycin, may improve gastric clearance before endoscopy, but its effects on clinical outcomes remain uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the efficacy and safety of pre-endoscopic prokinetic therapy in adults with acute UGIB, with attention to the strength of evidence for erythromycin and metoclopramide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis of randomized controlled trials evaluating pre-endoscopic prokinetic therapy in adults with acute UGIB. The primary outcome was adequate gastric emptying or adequate endoscopic visualization. Secondary outcomes included repeat endoscopy, mortality, endoscopy duration, blood transfusion requirement, length of hospital stay, endoscopic visualization score, bleeding-source identification, rebleeding, and adverse events. Dichotomous outcomes were pooled as odds ratios (ORs), and continuous outcomes as mean differences (MDs). Because visualization scores were measured using different scales, this outcome was pooled using standardized mean difference (SMD). Certainty of evidence was assessed using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ten randomized trials including 1,077 participants were included. Eight trials evaluated erythromycin and two evaluated metoclopramide. Pre-endoscopic prokinetic therapy improved adequate gastric emptying or endoscopic visualization (OR 3.68, 95% CI 2.06-6.60; p &lt; 0.0001; I&lt;sup&gt;2&lt;/sup&gt; = 59.9%) and reduced repeat endoscopy (OR 0.54, 95% CI 0.37-0.79; p = 0.0015; I&lt;sup&gt;2&lt;/sup&gt; = 20.8%). Continuous endoscopic visualization scores also favored prokinetic therapy when analyzed using SMD (SMD 0.47, 95% CI 0.21-0.72; p = 0.0003; I&lt;sup&gt;2&lt;/sup&gt; = 62.1%). No clear benefit was demonstrated for mortality (OR 0.59, 95% CI 0.32-1.09), rebleeding (OR 1.12, 95% CI 0.64-1.97), blood transfusion requirement (MD -0.64 units, 95% CI -1.44 to 0.15), or endoscopy duration (MD -1.67 minutes, 95% CI -5.59 to 2.25) under random-effects models. Length of hospital stay was shorter with prokinetic therapy (MD -1.30 days, 95% CI -2.11 to -0.49), although this outcome may be influenced by healthcare-system factors. Safety reporting was limited and inconsistent; no consistent serious safety signal was identified, but the trials were not powered to detect uncommon adverse events such as QT prolongation, arrhythmia, or extrapyramidal reactions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Pre-endoscopic prokinetic therapy, supported mainly by erythromycin-based randomized evidence, improves gastric emptying/endoscopic visualization and probably reduces repeat endoscopy in adults with acute UGIB. These findings should be interpreted primarily as procedural benefits r","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1930145"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119309","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":"Chronic liver disease impacting the severity of acute pancreatitis: a detailed narrative review of the literature.","authors":"Abdul Basit, Muhammad Ashhad Usman, Syed Muhammad Ali, Abdul Mabood Basil","doi":"10.3389/fgstr.2026.1921741","DOIUrl":"10.3389/fgstr.2026.1921741","url":null,"abstract":"<p><p>Chronic Liver Disease (CLD) and Acute Pancreatitis (AP) are significant global health burdens, often coexisting in clinical settings. This narrative review explores the complex interplay between CLD and the severity of AP. CLD contributes to immune dysregulation, hemodynamic instability, and metabolic disturbances, which may amplify the inflammatory and systemic effects of AP. The review discusses overlapping pathophysiological mechanisms, including cytokine-driven inflammation, portal hypertension, and impaired hepatic detoxification. It also highlights diagnostic challenges due to overlapping clinical features and limitations in conventional markers. Evidence suggests that CLD worsens AP outcomes, increasing risks of pancreatic necrosis, organ failure, and mortality. The influence of liver disease etiology, such as alcoholic or viral origins, further modifies AP severity. The evidence base is dominated by retrospective cohorts, single-center series, and administrative database analyses, with almost no prospective data. Definitions of CLD vary considerably between studies, adjustment for confounders such as ongoing alcohol use, sarcopenia, and baseline infection is inconsistent, and the reported effect sizes differ more widely than the uniformity of the published conclusions would suggest. The review also examines why conventional severity scores may perform sub optimally in this population and where liver-specific scores may add value. Enhanced understanding of these interactions is essential for early diagnosis, risk stratification, and tailored management strategies. This review underscores the need for integrated clinical approaches in patients affected by both hepatic and pancreatic disorders, and identifies the specific evidence gaps whose resolution would most change practice.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1921741"},"PeriodicalIF":0.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042344","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":"Gastrointestinal complications of cocaine use: a narrative literature review.","authors":"Abeer Qasim, Saran Lal Ajai Mokan Dasan, Fnu Veena, Sameer Kandhi, Harish Patel","doi":"10.3389/fgstr.2026.1907090","DOIUrl":"10.3389/fgstr.2026.1907090","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cocaine is the second most widely used illicit substance worldwide and exerts potent sympathomimetic effects by inhibiting the reuptake of norepinephrine, dopamine, and serotonin. While cardiovascular and neurological complications are well recognized, gastrointestinal (GI) manifestations are increasingly reported. These arise from multifactorial mechanisms including vasospasm, endothelial dysfunction, thrombosis, ischemia, and direct mucosal toxicity, often with severe clinical consequences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This narrative review summarizes the mechanisms, pharmacokinetics, pharmacodynamics, routes of use, and spectrum of GI complications associated with cocaine exposure, with emphasis on ischemic, ulcerative, hemorrhagic, inflammatory, fibrotic, hepatobiliary, and pancreatic sequelae; provides a differential-diagnosis and diagnostic algorithm; and critically appraises the strength of the supporting evidence and its principal confounders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed/MEDLINE, Embase, and Scopus were searched from January 1, 1987 through July 17, 2026, using the Boolean strings detailed in the Methods section. Case reports, case series, retrospective cohort/case-control studies, and systematic reviews published in English were eligible; both abstract and, where accessible, full text were screened. Reference lists of retrieved articles were hand-searched (snowballing) for additional citations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Cocaine induces GI injury through vasoconstriction, pro-thrombotic effects, microvascular dysfunction, and direct cytotoxicity. Reported complications span ischemic/vascular disease (mesenteric ischemia/infarction, colonic ischemia, ischemic/hemorrhagic colitis, vascular thrombosis), ulcerative/perforative disease (peptic ulcer disease; gastric, duodenal, small-, and large-bowel perforation), inflammatory/fibrotic disease (enteritis, enterocolitis, strictures, retroperitoneal fibrosis), hepatobiliary and pancreatic injury, splenic infarction/hematoma/rupture, and other presentations including gastric antral vascular ectasia, an inflammatory bowel disease (IBD)-mimicking phenotype, and, rarely, acalculous cholecystitis. A systematic review of 53 studies (69 patients) found broadly similar mortality and surgical rates across routes of cocaine use, and two hybrid cohort/case-control studies of cocaine-associated ischemic colitis reported substantially higher mortality and surgical intervention rates than non-cocaine-related ischemic colitis. Polysubstance use - particularly concurrent alcohol (via the metabolite cocaethylene) and tobacco - and pre-existing vascular disease are common but incompletely characterized confounders. Notably, the evidence base underlying nearly every complication described here remains dominated by single case reports and small case series rather than comparative studies, a limitation that should temper the strength of any causal inference drawn","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1907090"},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009350","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":"Advances in the application of insulin resistance-related indicators in the clinical evaluation of metabolic dysfunction-associated steatotic liver disease.","authors":"Yi Li, Huan Li, Bolun Zhang, Qingming Wu, Hui Long","doi":"10.3389/fgstr.2026.1859647","DOIUrl":"10.3389/fgstr.2026.1859647","url":null,"abstract":"<p><p>Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has become the most common chronic liver disease worldwide, and its core pathophysiological mechanism is closely related to insulin resistance. This literature review aims to systematically summarize the application progress of insulin resistance-related indicators in the clinical assessment of MASLD, points out the limitations of existing indicators in clinical application, and looks forward to future research directions, including the development of more accurate and non-invasive biomarkers, exploration of multi-omics integration models, and promotion of individualized diagnosis and treatment strategies, with the expectation of optimizing the clinical management of MASLD and improving patient prognosis.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1859647"},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009353","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":"Where healthcare systems fall short in long-term ostomy care: implications for quality of life, healthcare utilization, and sustainable care pathways.","authors":"Judith A Hargreaves, Diego Schaps, Beata Buchelt","doi":"10.3389/fgstr.2026.1920507","DOIUrl":"10.3389/fgstr.2026.1920507","url":null,"abstract":"<p><strong>Introduction: </strong>Ostomy surgery, most commonly following colorectal cancer, can create a lifelong self-management burden affecting physical health, psychological well-being, and daily functioning. This narrative review synthesizes evidence on long-term ostomy self-management, its multidimensional burden, and interventions and care pathway designs that support sustainable patient-centered outcomes.</p><p><strong>Methods: </strong>This narrative review was informed by a structured literature search across PubMed/Medline, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, ICTRP, and Google Scholar (2020-2026), supplemented by ostomy organization resources and some foundational pre-2020 studies. Literature considered for inclusion were observational, cohort, cross-sectional, qualitative and mixed-methods studies, systematic reviews, meta-analyses, and registry analyses.</p><p><strong>Results: </strong>92 primary studies met the eligibility criteria. Nine thematic domains were identified: self-management burden, quality of life (QoL), healthcare utilization, intervention effectiveness, predictive factors, long-term adaptation, lived experience, economic burden, and environmental sustainability. Ostomy complication rates are high: peristomal skin lesions affect 52-75% of patients, and leakage is reported by 27-58%. Structured education pathways increased independent self-care from 8% to 68% at discharge and reduced home nursing reliance from 80% to 50%. Telehealth and continuing care interventions reduced 30-day readmissions from 29% to 14%. Ostomy-related complications are associated with a substantial, long-term economic burden encompassing both direct (hospitalization and outpatient services) and indirect costs (productivity losses). Body image concerns and sexual dysfunction persist among long-term survivors, and real lived experience research identifies continuous cognitive, emotional, and practical burdens that clinical metrics alone do not capture. Environmental sustainability is an emerging dimension of ostomy care, and ostomy-specific evidence remains limited.</p><p><strong>Conclusion: </strong>Longitudinal, patient-centered care pathways integrating education, specialist follow-up, psychosocial support, and digital tools have been associated with improved self-management and QoL and with reductions in complications and unplanned healthcare use; these approaches may also help lower the economic and environmental burden of long-term ostomy care.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1920507"},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946015","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":"Glucagon like peptide 1 receptor agonists in patients with inflammatory bowel disease: safety, clinical effectiveness and anti-inflammatory mechanisms.","authors":"Shannon Fernando, Joy Zhao, Kevan Josloff, Nida Zubair, Aakash Desai, Raina Shivashankar, Patricia L Kozuch, Cuckoo Choudhary, Gary Lichtenstein, Priya Sehgal","doi":"10.3389/fgstr.2026.1864456","DOIUrl":"10.3389/fgstr.2026.1864456","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of obesity among patients with inflammatory bowel disease (IBD) continues to rise and is associated with adverse IBD outcomes and diminished treatment response. This study reviews the clinical safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with IBD and comorbid obesity and explores their theorized anti-inflammatory mechanisms.</p><p><strong>Methods: </strong>Published articles through July 2026 were identified via a PubMed search for a narrative review using terms related to GLP-1RA, IBD, safety, effectiveness, and outcomes. Data extraction focused on GLP-1RA intervention details, IBD-related outcomes and inflammatory markers, and proposed anti-inflammatory mechanisms.</p><p><strong>Results: </strong>GLP-1RA therapy promotes weight loss in patients with IBD comparable to the general population (about 16 pounds over 18 months). The most frequently reported adverse effects are gastrointestinal, often limiting treatment continuity. Most studies report no significant differences in hospitalization, surgery, steroid use or IBD medication adjustments, and some reported improvement in these outcomes. Data on endoscopic disease activity is limited. Inconsistent effects of GLP-1RA on inflammatory serum biomarkers were noted, with reductions in CRP but no consistent changes in fecal calprotectin.</p><p><strong>Discussion: </strong>Addressing obesity in patients with IBD is an emerging clinical priority. GLP-1RA therapy demonstrates efficacy in promoting weight loss, improving glycemic control, and reducing systemic inflammation, which may benefit IBD disease activity. Longitudinal studies are required to clarify the long-term impact of GLP-1RA on clinical and endoscopic outcomes in IBD.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1864456"},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898386","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":"Risks of GI endoscopy in cancer patients with neutropenia and thrombocytopenia.","authors":"Clark Zhang, Xiaoyi Ma, Meghan Cloutier, Michael Farrell, Edward Tamale, Debduti Mukhopadhyay, Han Yu, Anoop Prabhu, Kevin Robillard","doi":"10.3389/fgstr.2026.1890947","DOIUrl":"10.3389/fgstr.2026.1890947","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the safety of endoscopic procedures in cancer patients with neutropenia and/or thrombocytopenia.</p><p><strong>Methods: </strong>We collected data on patients with neutropenia and/or thrombocytopenia who underwent endoscopy between 2012 and 2022 at Roswell Park Comprehensive Cancer Center. Neutropenia was defined as absolute neutrophil count (ANC) <1500 cells/µL, and thrombocytopenia was defined as platelet count <50 x 10³/µL. The development of infectious AEs (fever within 3 days or positive blood cultures within 7 days following endoscopy) in neutropenic patients and bleeding AEs (new overt GI bleeding within 3 days following endoscopy) in thrombocytopenic patients were the primary outcome measures; 30-day mortality was a secondary outcome measure. Univariate and multivariate analyses by logistic regressions were used to evaluate for risk factors.</p><p><strong>Results: </strong>A total of 234 patients who underwent 329 endoscopic procedures were identified. In neutropenic patients, 7.8% (8/103) developed infectious AEs. In thrombocytopenic patients, 5.8% (12/208) developed bleeding AEs. Use of granulocyte colony-stimulating factor (G-CSF) was associated with increased risk of infectious AEs (OR 5.79, <i>p</i> = 0.02). The severity of neutropenia or thrombocytopenia and risk level of endoscopy were not associated with AEs. Multivariate analyses showed that poor performance status (PS) was the greatest risk factor for increased 30-day mortality (OR 4.69, <i>p</i> = <0.01).</p><p><strong>Conclusions: </strong>Endoscopy in patients with neutropenia and thrombocytopenia is relatively safe and does not lead to significant morbidity. A careful risk-benefit analysis in cancer patients with poor PS should be conducted prior to endoscopy.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1890947"},"PeriodicalIF":0.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882298","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 typical, nearly missed jejunal gallstone ileus.","authors":"Chengyang Chen, Yushi Fan, Baoping Tian, Hui Shan, Nanxia Xuan, Linlin Du, Gensheng Zhang","doi":"10.3389/fgstr.2026.1870893","DOIUrl":"10.3389/fgstr.2026.1870893","url":null,"abstract":"<p><strong>Background: </strong>Gallstone ileus is a rare cause of mechanical intestinal obstruction, predominantly affecting older adults. The ileum and ileocecal valve are the most common sites of impaction, whereas jejunal involvement is considerably less frequent. Contrast-enhanced computed tomography (CT) is the primary imaging modality for diagnosis; however, minimally calcified ectopic stones are prone to being overlooked, leading to delayed surgical intervention.</p><p><strong>Case presentation: </strong>A 68-year-old woman presented with a 12-day history of abdominal pain, nausea, vomiting, and obstipation. She underwent two contrast-enhanced abdominal CT scans at different institutions, both of which demonstrated cholelithiasis, pneumobilia, and small bowel dilation, but failed to definitively identify an obstructive gallstone. Nevertheless, the combination of pneumobilia and small bowel obstruction-both components of Rigler's triad-along with a visible cholecystoduodenal fistula, made gallstone ileus highly suspected. Emergency exploratory laparotomy revealed a 3.0 × 2.5 cm rim-calcified stone lodged in the jejunum, 80 cm distal to the ligament of Treitz. Simple enterolithotomy was performed without fistula repair. The patient recovered gradually, though she developed transient postoperative atrial fibrillation with hypotension on Day 21, which was managed medically. She was discharged on Day 30. Retrospective re-evaluation of the CT images confirmed the subtle rim-calcified stone.</p><p><strong>Conclusions: </strong>Minimally rim-calcified stones are easily missed on contrast-enhanced CT. In patients with intestinal obstruction exhibiting two of the three signs of Rigler's triad, gallstone ileus should be strongly suspected even when no ectopic stone is clearly visible. Proactive clinician-radiologist communication and structured follow-up planning are essential to reduce diagnostic errors and manage recurrence risk.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1870893"},"PeriodicalIF":0.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876568","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}