Frontiers in gastroenterology (Lausanne, Switzerland)最新文献

{"title":"Deep learning analysis of capillary refill dynamics in ischemic colitis: differentiating reversible vs. gangrenous mucosa.","authors":"Zarqa Yasin, Hamza Sajid, Noor Ul Ain Saleem, Ursula Abu Nahla","doi":"10.3389/fgstr.2026.1782255","DOIUrl":"10.3389/fgstr.2026.1782255","url":null,"abstract":"<p><p>Ischemic colitis remains a diagnostic challenge, as endoscopic grading of mucosal ischemia is subjective and insensitive for transmural infarction. While the majority of non-gangrenous cases are resolved conservatively, gangrenous mucosa necessitates immediate resection. The current reliance on visual signals, such as color and bleeding, results in misclassification and variability. We propose a novel deep learning approach to quantify micro-capillary refill dynamics from colonoscopy video. The technology produces objective perfusion measures and real-time viability classification by examining frame-by-frame color recovery following temporary mucosal blanching. This approach makes use of recent developments in AI-assisted colonoscopy, annotated datasets, and endoscopic hardware. By incorporating capillary refill analysis, operational decision-making might be improved, interobserver variability could be decreased, and unnecessary colectomy and delayed gangrene treatment could be avoided. Pilot studies are warranted to validate this concept and establish its role in guiding therapy for ischemic colitis.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1782255"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610733","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":"<i>Helicobacter pylori</i> eradication: a narrative review.","authors":"Tarig Fadelelmoula, Hamdi Al Mutori, Khalid Mohammed, Mazin Saleh, Ali Al Reesi","doi":"10.3389/fgstr.2026.1823571","DOIUrl":"10.3389/fgstr.2026.1823571","url":null,"abstract":"<p><strong>Background: </strong><i>Helicobacter pylori</i> (<i>H. pylori</i>) is one of the most common chronic infections worldwide and a primary cause of peptic ulcer disease and gastric cancer. Increasing antibiotic resistance has made eradication more difficult, emphasizing the need for new strategies. This narrative review summarizes the current evidence on <i>H. pylori</i> eradication, focusing on epidemiology, resistance, treatment regimens, adjunctive therapies, cancer prevention, and extra-gastric outcomes.</p><p><strong>Evidence and methods: </strong>We conducted a narrative literature search to identify current evidence on strategies for eradicating <i>H. pylori</i>. Both first-line and salvage regimens were considered, as well as adjunctive and novel approaches. The evidence was organized thematically.</p><p><strong>Results: </strong>Over half of the world's population is infected with <i>H. pylori</i>, with the highest prevalence observed in Africa, South America, and Asia. Clarithromycin resistance exceeds 15%-20% in most regions, which diminishes the effectiveness of standard triple therapy. Current recommendations for first-line treatments in areas with high resistance include bismuth quadruple and concomitant regimens, which achieve eradication rates above 85%. Vonoprazan-based and high-dose dual therapies also show promise as alternative options. For second-line therapy, levofloxacin- and bismuth-based regimens remain effective, while rifabutin and susceptibility-guided approaches offer salvage options. Additionally, probiotics and N-acetylcysteine have been found to improve eradication rates and treatment tolerability. Successful eradication reduces the risk of gastric cancer, particularly in East Asia, and provides benefits for extra-gastric conditions such as iron deficiency anemia, idiopathic thrombocytopenic purpura, and pregnancy-related complications.</p><p><strong>Conclusion: </strong>Eradicating <i>H. pylori</i> is crucial for preventing gastric cancer and enhancing gastrointestinal and systemic health. Achieving success necessitates adapting treatment to resistance patterns, employing adjunctive strategies, using molecular antimicrobial sensitivity testing, and implementing eradication programs in areas with high prevalence.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1823571"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581405","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":"Percutaneous endoscopic gastrostomy insertion in patients with neuromuscular disease-a single centre experience of a novel technique.","authors":"Anissa Faher, Melanie Gunn, Timothy L Williams, Christian Dipper, Lindsay McGowan, Catherine Rimmer, Ben Messer","doi":"10.3389/fgstr.2026.1814988","DOIUrl":"10.3389/fgstr.2026.1814988","url":null,"abstract":"<p><strong>Background: </strong>Neuromuscular diseases (NMD) are often complicated by bulbar dysfunction limiting nutritional intake, and ventilatory failure requiring non-invasive ventilation (NIV). Although nutritional difficulties can be overcome with gastrostomy insertion, this has its own challenges since percutaneous endoscopic gastrostomy (PEG) requires endoscope access via the oral cavity with air leak-associated risk of hypoventilation and respiratory complications in patients with NIV-dependent NMD. Developing a mechanism for PEGs under sedation with concurrent NIV use has remained a clinical challenge.</p><p><strong>Aim: </strong>We report a change in practice in our hospital with the introduction of the endoscopy elbow (EE), an adjunct device enabling simultaneous use of NIV during PEG with minimal air leak.</p><p><strong>Methods: </strong>This retrospective service evaluation analysed data of PEGs in NIV-dependent NMD in a tertiary referral hospital over a ten-year period measuring respiratory complications, critical care admissions, time from referral to procedure, hospital stay, and survival times.</p><p><strong>Results: </strong>The EE enabled a successful transition from PEGs conducted under general anaesthesia to PEGs with sedation and NIV in the endoscopy suite, with statistically significant reduction in respiratory complications and critical care admissions for all patients with NMD and improved six-month survival in patients with motor neurone disease. There was no improvement in length of time from referral to procedure, nor hospital stay.</p><p><strong>Conclusions: </strong>The EE provides a novel technique with improved outcomes for respiratory complications and critical care admissions. This technique may be applicable to other centres caring for similar patient cohorts, although local protocols and resources should be considered.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1814988"},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13357134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439030","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":"Editorial: Gastrointestinal infections in pediatric populations.","authors":"Sahil Khanna, Kanika Puri","doi":"10.3389/fgstr.2026.1893817","DOIUrl":"10.3389/fgstr.2026.1893817","url":null,"abstract":"","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1893817"},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426921","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":"Infliximab as <i>ultima ratio</i> in a case of refractory non-Crohn's disease complex fistula system: case report and mini-review of the literature.","authors":"Nada Agbariah, Matthias Kis, Christine Manser, Luc Biedermann, Gerhard Rogler","doi":"10.3389/fgstr.2026.1815049","DOIUrl":"10.3389/fgstr.2026.1815049","url":null,"abstract":"<p><p>Infliximab (IFX) has been a first-line treatment for perianal fistulizing Crohn's disease (CD) since 1999. However, its role in non-CD-related fistulas remains largely unknown, despite the established involvement of tumor necrosis factor (TNF) in both types of fistulas. A 76-year-old man with a history of prostate cancer presented in 2024 with recurrent fistulas and a presacral wound cavity with sepsis. He had been hospitalized approximately once a month over the past year due to fever and uncontrolled infection. The patient was initially treated with radiation in 2017. Despite this treatment, he developed increasing polyuria related to prostatic hyperplasia, which led to his first operation (prostatectomy) with accidental rectal injury, followed by multiple surgeries for complications and subsequent abscess formation. Histologically, there was no evidence of CD. Due to a lack of surgical options and failed endoscopic treatments, the patient was considered for exploratory IFX therapy. The patient received IFX induction therapy (5 mg/kg every 2 weeks for the first two doses) in May 2024, followed by maintenance therapy (5 mg/kg every 8 weeks). Within just 2 weeks, he reported the first significant clinical improvement. After 22 weeks of therapy with IFX, he reported feeling well, with no abdominal pain and a weight gain of 6 kg. At the 1-year follow-up, no further hospitalizations due to uncontrolled presacral infection with fever and anal pus discharge were reported, and the presacral wound cavity was found to be reduced on MRI from 37 mm × 43 mm × 62 mm (March 2024) to 23 mm × 22 mm × 45 mm (May 2025). Despite a history of recurrent urinary tract infections (UTIs) associated with mono-J catheters, the frequency of UTIs did not increase during therapy with IFX. This case indicates that infliximab may represent an effective therapeutic option for non-CD-related fistulas when there are no other therapeutic options available.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1815049"},"PeriodicalIF":0.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364036","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: Pancreatic toxoplasmosis: role of endoscopic ultrasound in diagnosis.","authors":"Cosmas Rinaldi A Lesmana, Randy Adiwinata, Jennifer Simca, Caroline Tanadi, Kevin Tandarto, Stella Marleen, Daniel Ruslim, Joyce Bratanata","doi":"10.3389/fgstr.2026.1763923","DOIUrl":"10.3389/fgstr.2026.1763923","url":null,"abstract":"<p><p>Toxoplasmosis can present as systemic disease affecting many organs, especially in immunocompromised patients. Most cases of toxoplasmosis present as encephalitis, while extracerebral toxoplasmosis is rare, particularly within the gastrointestinal tract. Here, we report the case of a 48-year-old patient with toxoplasmosis presenting as pancreatic nodules, chronic pancreatitis and encephalitis. He was referred to our hospital for the evaluation of pancreatic lesions. The patient had been previously hospitalized due to hemiparesis and dizziness. Contrast-enhance brain magnetic resonance imaging (MRI) revealed a space-occupying lesion in the cerebellum with surrounding edema. Positron emission tomography (PET) scan demonstrated focal hypermetabolic sign in the head and body of pancreas, raising suspicion for primary pancreatic malignancy. Serum lipase was mildly elevated to less than twice the upper limit of normal. Meanwhile, amylase, Ca 19-9, and CEA levels were within normal limits. Endoscopic ultrasound (EUS) was subsequently performed and revealed multiple hypoechoic nodules in the pancreatic head and body. EUS-guided fine needle biopsy (FNB) using a 22-G acquire needle was carried out for further evaluation. Histopathological examination showed chronic inflammation of the pancreatic tissue without evidence of malignancy.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1763923"},"PeriodicalIF":0.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297183","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":"GLP-1 and GLP-2 as intestinal reparative therapies in inflammatory bowel disease: mechanisms, translation, and clinical opportunity.","authors":"Joseph J Lee, Pratikiran Bajgain, Amy L Lightner","doi":"10.3389/fgstr.2026.1790420","DOIUrl":"10.3389/fgstr.2026.1790420","url":null,"abstract":"<p><p>Inflammatory bowel disease remains a chronic condition in which a substantial proportion of patients fail to achieve durable clinical remission despite advances in therapy. Although the treatment landscape has expanded to include biologics and small-molecule agents, contemporary management is increasingly focused on altering the course of the disease rather than relying on symptom control alone. Central to this shift is the recognition that intestinal reparative therapy, defined by objective endpoints such as endoscopic and histologic healing, is strongly associated with improved long-term outcomes. Emerging mechanistic data highlight epithelial repair pathways as actionable therapeutic targets. Among these, glucagon-like peptides secreted by intestinal enteroendocrine cells have gained attention for their roles in epithelial integrity and inflammation modulation. This review synthesizes basic science and translational evidence supporting glucagon-like peptide-1, glucagon-like peptide-2, and dipeptidyl peptidase-IV inhibition as emerging therapeutic concepts in inflammatory bowel disease. Furthermore, it provides a critical appraisal of recent human observational data, distinguishing metabolic benefits from intrinsic disease-modifying effects, and outlines the practical clinical friction points and prospective trials necessary to validate these pathways in future treatment paradigms.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1790420"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152391","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 analysis of anal sphincter-preserving surgical techniques in ultra-low rectal cancer.","authors":"Hongjun Yuan, Jun Bu, Peng Zhang","doi":"10.3389/fgstr.2026.1716349","DOIUrl":"10.3389/fgstr.2026.1716349","url":null,"abstract":"<p><p>Ultra-low rectal cancer refers to a tumor situated very close to the anal verge, typically within 3 cm from the proximal end of the anal dentate line. Its location creates significant challenges for achieving clear surgical margins necessary to achieve local tumor control while preserving sphincter function to minimize the risk of developing fecal incontinence and other complications.This review summarizes six sphincter-preserving techniques for ultra-low rectal cancer: local excision, low anterior resection(LAR, with or without prophylactic ileostomy or ileal stent), intersphincteric resection (ISR), modified Bacon and Parks procedures, transanal total mesorectal excision (TaTME), and Natural Orifice Specimen Extraction Surgery with Precision Functional Sphincter-Preserving Surgery(NOSES-PPS). While most approaches achieve satisfactory oncological outcomes, postoperative anal function remains a major concern. Preliminary evidence suggests NOSES-PPS may offer benefits in preserving anal function, though current studies are limited by small sample sizes and lack of large-scale trials. Optimal outcomes depend on patient selection, surgical expertise, and perioperative management.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1716349"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038379","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: Massive rectal bleeding from stercoral ulcers in a pediatric patient.","authors":"Paolo Quitadamo, Antonia Pascarella, Linda di Napoli, Maria Giovanna Puoti, Sara Isoldi, Ludovica Carangelo, Paolo Siani","doi":"10.3389/fgstr.2026.1614154","DOIUrl":"10.3389/fgstr.2026.1614154","url":null,"abstract":"<p><p>A 10-year-old patient was admitted to the pediatric sub-intensive care unit due to massive rectal bleeding and severe acute anemia. His medical background included Asperger syndrome and a history of chronic constipation not adequately addressed by medical therapy. Colonoscopy showed two deep ulcers in the rectum and sigmoid colon of approximately 4 cm in diameter, which were diagnosed as stercoral ulcers related to stercoral colitis, a rare inflammatory form of colitis that occurs in patients with refractory constipation. Stercoral colitis has been mainly described in elderly patients with dementia or in bedbound patients and only occasionally in adults with psychiatric disorders. To the best of our knowledge, this is the first case of massive rectal bleeding from stercoral ulcers in a pediatric patient.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1614154"},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965772","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":"U.S.A. trends in intrahepatic and bile duct cancers from 1999-2023.","authors":"Samuel W Berg, Taylor Billion, Abubakar Tauseef","doi":"10.3389/fgstr.2026.1681142","DOIUrl":"10.3389/fgstr.2026.1681142","url":null,"abstract":"<p><p>Liver and intrahepatic bile duct malignancies are an increasing cause of mortality in the United States due unclear reasons over the past 20 years, perhaps proportionately due to overall increase in age of the US population and improvement of diagnostic/screening strategies. This study utilizing the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, investigated trends of demographic (gender, race, age group) and geographical differences in liver and intrahepatic bile duct cancer related mortality. Average annual percentage changes were assessed using the CDC WONDER data base with respect to age-adjusted mortality rates (AAMR) and annual percentage change (APC). This study used the Joinpoint Regression Program to determine statistical significance of mortality trends between 1999 and 2023. During this study period (1999-2023), overall higher mortality rates were noted in the American Indian and Alaskan native population and a decrease in mortality in the Asian and Pacific Islander population, with the South and West regions having the highest AAMR. Furthermore, mortality rates demonstrated significantly greater trend in liver and intrahepatic bile duct cancers in males than in females during the entire study period. These results serve to inform on demographics that resources should be focused towards to make policy and encourage screening and diagnosing for at risk groups and regions.</p>","PeriodicalId":73085,"journal":{"name":"Frontiers in gastroenterology (Lausanne, Switzerland)","volume":"5 ","pages":"1681142"},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944105","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}