Annals of Gastroenterology最新文献

{"title":"Impact of <i>Helicobacter pylori</i> eradication on the progression of Correa's cascade.","authors":"Jannis Kountouras, Stergios A Polyzos, Ioannis S Papanikolaou, Michael Doulberis, Christos Liatsos, Elisabeth Vardaka","doi":"10.20524/aog.2026.1049","DOIUrl":"https://doi.org/10.20524/aog.2026.1049","url":null,"abstract":"","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"278-279"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497467","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":"Prevalence and risk factors of subclinical hepatic encephalopathy in patients with cirrhosis.","authors":"Elissavet Chloupi, Melanie Deutsch, Ioannis Vlachogiannakos, George Papatheodoridis","doi":"10.20524/aog.2026.1045","DOIUrl":"https://doi.org/10.20524/aog.2026.1045","url":null,"abstract":"<p><strong>Background: </strong>Subclinical hepatic encephalopathy (SHE) is considered an early stage of clinical encephalopathy and has been associated with shortened lifespan and increased healthcare-associated burden. We aimed to assess the prevalence of SHE in patients with cirrhosis and to elucidate the potential factors related to its occurrence.</p><p><strong>Methods: </strong>Thirty consecutive patients with cirrhosis were evaluated between March and July 2017. The exclusion criteria included overt hepatic encephalopathy, recent gastrointestinal hemorrhage, neurological disease, and the use of lactulose or non-absorbable antibiotics. After exclusion, 23 patients were included in this study. Twenty healthy age- and sex-matched controls were also included. SHE was assessed using the number connection test (NCT) and the inhibitory control test (ICT).</p><p><strong>Results: </strong>The NCT completion time was significantly longer in cirrhotic patients than in controls (77±45 vs. 27±6 sec, P<0.001), with 78.3% of cirrhotic patients showing abnormal results. ICT correct target recognition was also significantly lower in cirrhotic patients (18.5±21.8% vs. 56.2±15.8%, P<0.001), with 60.9% showing abnormal results. By combining NCT and ICT, 39.1% of patients with cirrhosis were diagnosed with SHE. No significant associations were detected between the Child-Turcotte-Pugh class or baseline parameters and the presence of SHE. At the 3-month follow up, the SHE diagnosis remained consistent, with 66.7% of those diagnosed at baseline still exhibiting SHE.</p><p><strong>Conclusions: </strong>SHE is prevalent in patients with cirrhosis and significantly affects cognitive and psychomotor abilities. Although the study sample was small, these findings highlight the necessity of regular psychometric testing in cirrhotic patients to identify and manage SHE.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"202-207"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497563","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":"Authors' reply.","authors":"Dionysios Kogias, Nikolaos Kafalis, Vaia Karapepera, Vasileios Papadopoulos, Georgios Kouklakis","doi":"10.20524/aog.2026.1051","DOIUrl":"https://doi.org/10.20524/aog.2026.1051","url":null,"abstract":"","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"277-278"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621651","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":"Consensus statements of the Hellenic Autoimmune Liver Diseases Study Group on the diagnosis and current management of primary biliary cholangitis.","authors":"George N Dalekos, Nikolaos Gatselis, Theodoros Androutsakos, Dimitrios Samonakis, Christos Triantos, Dina Tiniakos, Eirini I Rigopoulou","doi":"10.20524/aog.2026.1048","DOIUrl":"https://doi.org/10.20524/aog.2026.1048","url":null,"abstract":"<p><p>Primary biliary cholangitis (PBC) is an autoimmune epithelitis of small intrahepatic bile ducts that affects predominately females, and is characterized by chronic cholestasis, circulating PBC-related autoantibodies, and progressive disease at the histological level. Key manifestations include pruritus, fatigue, hyperpigmentation, dry-gland syndrome, xanthelasmas and frequent concurrent extrahepatic autoimmune diseases, although approximately half the patients are nowadays completely asymptomatic at diagnosis. The current Consensus Statements of the Hellenic Autoimmune Liver Diseases Study Group aim to provide updated and practical statements to clinicians for PBC diagnosis and management. The presence of antimitochondrial antibodies is a key diagnostic marker for PBC. PBC-specific antinuclear antibodies (anti-gp210 and anti-sp100) also bear diagnostic and prognostic significance. Following diagnosis, this document provides guidance on the comprehensive assessment and risk stratification of patients, using demographic factors, clinical and biochemical laboratory findings, liver autoimmune serology and fibrosis stage. After 6-12 months of therapy with first-line treatment (13-15 mg/kg/day ursodeoxycholic acid [UDCA]), a new risk-stratification procedure should be performed, based on the assessment of biochemical response using a continuous scoring system (either GLOBE or UK-PBC score). In non-responders, add-on treatment to UDCA with a second-line agent, a proliferator-activated receptor agonist (PPAR), either elafibranor (PPARα/δ agonist) or seladelpar (PPARδ agonist), is recommended. The treatment target-also known as deep response-should aim to achieve bilirubin within the normal range, specifically at values <0.6× upper limit of normal, along with normalization of alkaline phosphatase. The disease-associated major symptoms (pruritus, fatigue and cognitive dysfunction) should also be promptly recognized and managed in a holistic manner, as they negatively affect the patient's health-related quality of life.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"123-160"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497448","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":"Efficacy of current therapeutic strategies for immune checkpoint inhibitor-related esophagitis.","authors":"Carolina Colli Cruz, Maria Julia M N Santos, Sharada Wali, Rachel Mortan, Rohan Ahuja, Jarrett Rong, Tanvi Gupta, Irene Jeong-Ah Lee, Cristina Natha, Varun Vemulapalli, Sean Ngo, Kei Takigawa, Krishnavathana Varatharajalu, Lucy B Kennedy, Aliyah Pabani, Bryan P Schneider, Karen C Kim, Mehnaz A Shafi, Anusha S Thomas, Yinghong Wang","doi":"10.20524/aog.2026.1042","DOIUrl":"https://doi.org/10.20524/aog.2026.1042","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitor-related esophagitis (IME) is often managed with proton pump inhibitors (PPIs). Severe or refractory cases may require steroids and/or selective immunosuppressive therapies (SIT). However, large-scale studies assessing IME treatment strategies are lacking. This study evaluated their efficacy.</p><p><strong>Method: </strong>This retrospective study at a tertiary cancer center included patients with malignancy who received immune checkpoint inhibitor (ICIs) from 2010-2024 and developed IME, defined as new or worsening upper gastrointestinal (GI) symptoms post-ICI initiation with other causes excluded.</p><p><strong>Results: </strong>Among 148 patients, 75% received PD-1/PD-L1 inhibitors for 4.9 months; 50.7% received concurrent chemotherapy. Isolated IME was present in 27.7% of patients, while the remainder had concurrent immune-mediated GI conditions. Only 24.4% of isolated IME cases were treated with PPIs, and there was no significant difference between the PPI and non-PPI groups in steroid administration, outcomes or recurrence. Corticosteroids were used in 27.7% of cases, significantly shortening the time to symptom resolution (12 vs. 45 days; P=0.015). Nausea (87.8% vs. 57%, P<0.001) and emesis (58.5% vs. 34.6%, P=0.008) were more frequently observed in the steroid group, along with higher rates of hospitalization (73.2% vs. 36.4%, P<0.001), need for intravenous steroids (30% vs. 0%, P<0.001), and ICI discontinuation (74.4% vs. 44.6%, P=0.002). SIT were required for other concomitant GI adverse events in 41.5% of the steroid-treated patients. No significant differences in clinical improvement, ICI resumption or all-cause mortality were noted between the corticosteroid and non-corticosteroid groups.</p><p><strong>Conclusion: </strong>Our findings showed faster clinical improvement with steroids, while PPIs demonstrated no significant effectiveness.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"228-237"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497466","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":"Determinants of the healthy gut microbiome: core features, modifying factors and normal functions.","authors":"Ilektra Kyrochristou, Gerasimia Kyrochristou, Fotios Fousekis, Konstantinos Katsanos, Dimitrios Schizas, Konstantinos Vlachos, Georgios D Lianos","doi":"10.20524/aog.2026.1034","DOIUrl":"https://doi.org/10.20524/aog.2026.1034","url":null,"abstract":"<p><p>The human gut microbiome represents a complex and dynamic ecosystem that is central to maintaining health and preventing disease. Defining a \"normal\" gut microbiome remains challenging, given the significant variability arising from host physiology, lifestyle, genetics, geography and environmental exposures. This review synthesizes current evidence regarding the composition and functions of the gut microbiota in healthy individuals from diverse populations. At the taxonomic level, healthy gut microbial communities are typically dominated by the phyla <i>Firmicutes</i> and <i>Bacteroidetes</i>, with additional contributions from <i>Actinobacteria</i> and <i>Proteobacteria</i>. However, substantial inter-individual and regional differences are observed, such as a higher prevalence of <i>Prevotella</i> in populations consuming fiber-rich Eastern diets, and greater <i>Bacteroides</i> abundance in Western cohorts. Anatomical location and health status also influence alpha-diversity, underscoring the need to interpret diversity metrics within context. Furthermore, the gut microbiome performs essential functional roles across multiple organ systems, including fermentation of dietary fibers into short-chain fatty acids, regulation of immune responses, modulation of the gut-brain axis, maintenance of intestinal barrier integrity, and support of cardiovascular and hepatic functions. These findings support the conceptualization of the microbiome as a multifunctional organ system that integrates host and environmental signals. In summary, a healthy gut microbiome is best understood as a dynamic equilibrium, characterized by functional resilience and adaptability, rather than a fixed microbial profile. Interpreting this variability is crucial for developing targeted interventions to prevent disease.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"191-201"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497461","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":"Long-term outcome after endoscopic ultrasound-guided pancreatic duct drainage.","authors":"Anouk Voutaz, Elodie Romailler, Mariola Marx, Meddy Dalex, Marie Philippart, Domenico Galasso, Sébastien Godat","doi":"10.20524/aog.2026.1046","DOIUrl":"https://doi.org/10.20524/aog.2026.1046","url":null,"abstract":"<p><strong>Background: </strong>Obstruction of the main pancreatic duct (MPD) may result in severe pain, recurrent pancreatitis, and pancreatic insufficiency. Endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct cannulation and stent placement is the standard first-line approach, yet it sometimes fails or is not feasible. Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) has emerged as a surgical alternative. We assessed the long-term outcomes, safety, and technical aspects of EUS-PDD.</p><p><strong>Methods: </strong>We retrospectively reviewed all adult patients who underwent EUS-PDD at a tertiary referral center between April 2016 and November 2022. Only patients who underwent pancreatogastrostomy or pancreatojejunostomy and had at least 12 months of follow up were included. Clinical success was defined as a residual visual analog scale score ≤2 without obstructive pancreatitis recurrence. Adverse events, reinterventions, and long-term outcomes were analyzed.</p><p><strong>Results: </strong>Thirty-five patients (mean age 58±11 years; 74% male) were included, with a mean follow up of 23±19 months. Chronic pancreatitis accounted for 54% of indications. Technical success was achieved in all patients. Overall clinical success was 80% (95% confidence interval [CI] 64-91%). Adverse events occurred in 17% (95%CI 7-33%), including severe events in 6%. Reintervention was required in 29% of patients, mainly because of stent dysfunction. During follow up, 26% experienced pancreatitis, most commonly related to stent dysfunction. Two deaths occurred, unrelated to pancreatic disease or the procedure.</p><p><strong>Conclusion: </strong>EUS-guided pancreatic duct drainage is a safe and effective long-term treatment option in selected patients with MPD obstruction or disruption when ERCP is not feasible, providing durable symptom control with acceptable morbidity.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"214-220"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497505","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":"Glucagonoma of the pancreas: diagnostic approach and therapeutic algorithm for a rare nosological entity.","authors":"Aikaterini Mastoraki, Dimitrios Spyropoulos, Sofia Stamatiadi, Krystallenia Alexandraki, Adam Mylonakis, Markos Despotidis, Aristeidis Sourgiadakis, Dimitrios Bistarakis, Nikolaos Koutsogoulas, Anna Paspala, Vasileia Ntomi, Chrysovalantis Vergadis, Ioannis Karavokyros, Dimitrios Schizas","doi":"10.20524/aog.2026.1037","DOIUrl":"https://doi.org/10.20524/aog.2026.1037","url":null,"abstract":"<p><p>Glucagonoma remains a very rare neuroendocrine tumor of the pancreas, accounting for 2% of all islet-cell carcinomas. The aim of this review is to highlight important aspects of pancreatic glucagonoma, including epidemiology, clinical presentation and diagnostic evaluation, and to elucidate the current therapeutic management of this nosologic entity. A combined automated and manual systematic search of the literature was performed using electronic search engines (Medline/PubMed, Scopus, Ovid and Cochrane Library), until April 2025. Glucagonoma originates from the a-cells of the pancreatic Langerhans islets. Its reported incidence is 1 in 20,000,000 per year. Typical clinical manifestations include necrolytic migratory erythema, diabetes mellitus (DM), weight loss and anemia, along with elevated serum glucagon levels. Other symptoms, such as venous thrombosis, neuropsychiatric findings known as 4D (dermatitis, DM, deep-vein thrombosis, depression), or diarrhea can also be present. Unfortunately, metastases are encountered in the majority of patients. Prompt diagnosis is usually accomplished by computed tomography and magnetic resonance imaging. The only treatment option is the surgical resection of the tumor. Conservative management, based on the administration of chemotherapy, somatostatin analogs, molecular targeted therapy and peptide receptor radionuclide therapy is also an alternative.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"184-190"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497526","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":"Expert recommendations regarding the use of fecal calprotectin in daily clinical practice: statements of a taskforce process from the Hellenic Group for the Study of Inflammatory Bowel Disease (EOMIFNE).","authors":"Giorgos Bamias, Smaragdi Fessatou, Christina Kapizioni, Konstantina Kitsou, Georgios Kokkotis, Afroditi Kourti, Panagiotis Markopoulos, Eleni Orfanoudaki, Spyros Siakavellas, Maria Tzouvala","doi":"10.20524/aog.2026.1040","DOIUrl":"https://doi.org/10.20524/aog.2026.1040","url":null,"abstract":"<p><p>Fecal calprotectin (FC) has become an indispensable tool in everyday clinical practice for the diagnosis and management of inflammatory bowel disease (IBD). Nonetheless, specific and clear recommendations for its use are scarce. On behalf of the Hellenic Group for the Study of IBD (EOMIFNE), a group of experts have formulated 18 statements with the aim to provide evidence for the best use of FC and offer practical guidance in common clinical scenarios. Statements address issues for the proper application of FC measurement in the diagnostic workup of patients with gastrointestinal symptoms, and as a screening tool for the management of established IBD, including pediatric patients. Thus, the present manuscript aims to propose a standardized approach for the optimal use of FC in patient care, also taking into account non-medical concerns.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 2","pages":"161-173"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497454","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":"Predictors of a need for cholangioscopy-guided electrohydraulic lithotripsy in the management of difficult common bile duct stones.","authors":"Dionysios Kogias, Nikolaos Kafalis, Vaia Karapepera, Vasileios Papadopoulos, Georgios Kouklakis","doi":"10.20524/aog.2026.1026","DOIUrl":"10.20524/aog.2026.1026","url":null,"abstract":"<p><strong>Background: </strong>While standard endoscopic methods effectively clear most common bile duct stones, complex cases require specialized management. This study compared the effectiveness of cholangioscopy-guided electrohydraulic lithotripsy (EHL) against conventional techniques for treating difficult common bile duct stones (DBS).</p><p><strong>Methods: </strong>This retrospective study included 436 patients who underwent endoscopic retrograde cholangiopancreatography between April 2020 and April 2024. Demographic, laboratory and procedural data were recorded. Categorical regression identified predictors for EHL, and classification tree analysis was used to develop a prioritization algorithm.</p><p><strong>Results: </strong>Among patients with DBS (305/436, 70%), conventional methods succeeded in 28.9% (88/305). Endoscopic papillary large balloon dilation followed failed first-line techniques in 115 cases, with a 21.7% success rate. EHL was used in 192 patients, achieving a 98.4% success rate. Multivariate analysis showed that DBS (P<0.001), absence of wedged stones in the ampulla of Vater (P<0.001), and small papillae (P=0.002) were strong independent predictors for EHL use, with DBS being the most significant.</p><p><strong>Conclusions: </strong>DBS, absence of wedged stones in Vater and small papillae are key predictors of the need for cholangioscopy-guided EHL. Given its high success rate and comparable safety profile, EHL should be considered an early-line treatment in selected cases.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"32-39"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083927","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}