BMC Gastroenterology最新文献

{"title":"Platelet P2Y12 inhibitor use and risk of colorectal cancer incidence and colorectal cancer-related mortality: a Swedish registry-based cohort study.","authors":"Michael Fuchs, Jane Ha, Jane Yan, Matteo Bottai, Mingyang Song, Tracey G Simon, Weimin Ye, Andrew T Chan, Jonas F Ludvigsson","doi":"10.1186/s12876-026-05422-z","DOIUrl":"https://doi.org/10.1186/s12876-026-05422-z","url":null,"abstract":"<p><strong>Background: </strong>Low-dose aspirin use is associated with reduced CRC incidence and CRC-related mortality. A similar association with P2Y12 inhibitor use remains uncertain. We investigated whether the use of P2Y12 inhibitors was associated with CRC incidence and CRC-related mortality among individuals diagnosed with atherosclerotic cardiovascular disease (ASCVD).</p><p><strong>Methods: </strong>From the ESPRESSO cohort, we identified 334,882 patients diagnosed with ASCVD between 2006 and 2021. We identified patients who initiated P2Y12 inhibitors ≥ 84 consecutive Defined Daily Doses (cDDDs). We estimated the risk of incident CRC and CRC mortality according to P2Y12 inhibitor use using Cox proportional-hazards regression models adjusting for potential confounders including comorbidities and regular aspirin use.</p><p><strong>Results: </strong>We documented 4,015 incident CRC cases and 2,610 CRC-related deaths during a median follow-up of 5.1 years (IRQ, 2.1-9.0 years). We did not observe an association between P2Y12 inhibitor use and CRC incidence. In contrast, a longer duration of P2Y12 inhibitor use was associated with lower CRC-related mortality. Compared to non-users, multivariable-adjusted hazard ratio (HR) for CRC mortality were 0.73 (95% CI, 0.60-0.89) in patients with 336-671 cDDDs of P2Y12 inhibitor and 0.81 (95% CI, 0.68-0.97) in those with ≥672 cDDDs. Among patients with incident CRC diagnosis, subsequent initiation of P2Y12 inhibitor after CRC diagnosis was associated with significantly lower CRC mortality (HR 0.42; 95% CI, 0.29-0.60).</p><p><strong>Conclusions: </strong>P2Y12 inhibitor use was not associated with risk of incident CRC but was significantly inversely associated with CRC mortality, which appeared to be due to improved survival among individuals who initiate P2Y12 inhibitors after CRC diagnosis. These findings merit further study given the observational nature of the analysis and potential for residual confounding.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior diagnostic yield of mini-laparoscopy over transjugular liver biopsy in acute-on-chronic liver failure: a case-control study.","authors":"Louis Weisner, Malte Wehmeyer, Marcial Sebode, Julian Schulze Zur Wiesch, Felix Piecha, Lennart Well, Peter Bannas, Till Clauditz, Samuel Huber, Ansgar Lohse, Peter Huebener","doi":"10.1186/s12876-026-05401-4","DOIUrl":"10.1186/s12876-026-05401-4","url":null,"abstract":"<p><strong>Background & aims: </strong>Hepatic failure frequently requires liver biopsy for etiologic classification and delimitation from differential diagnoses to inform treatment decisions. Both mini-laparoscopic (MB) and transjugular liver biopsy (TB) are considered safe diagnostic modalities in liver cirrhosis (LC) patients but may associate with varying success and complication rates. We aimed to characterize the clinical values of MB and TB in patients with LC and particularly acute-on chronic liver failure (ACLF), where clinical acuity and patient risk are high.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed 73 consecutive adult ACLF patients undergoing liver biopsy (57x ACLF-MB, 16x ACLF-TB) and performed 1:2-matching with non-ACLF LC patients for either biopsy modality to assess technical success, complications, and diagnostic versatility.</p><p><strong>Results: </strong>Baseline disease severity was comparable between biopsy modalities (MELD score: ACLF-MB 27 [22-33] vs. ACLF-TB 27 [19.75-32], p = 0.640). MB and TB were successfully completed in the large majority (MB 169/171 vs. TB 48/48; p = n.s.) of procedures. While the presence of ACLF associated with a higher rate of minor complications following MB (ACLF-MB: 80.7% vs. LC-MB: 52.6%, p < 0.001), major biopsy-related complications were generally rare, and their occurrence did not differ between biopsy modalities. MB-specimens were technically evaluable in 100% of successfully performed procedures, contrasting 31.3% of technical failures in ACLF-TB and 37.5% in LC-TB (all p < 0.001), respectively. In suitable biopsies, failure to obtain a histological diagnosis was observed in 3.6% of ACLF-MB, 6.2% of ACLF-TB, 17.7% of LC-MB, and 6.2% of LC-TB cases, ultimately resulting in higher rates of established or corrected diagnoses via MB than TB.</p><p><strong>Conclusions: </strong>MB provides higher diagnostic yield than TB at the cost of increased minor complication rates in ACLF. Where locally available and technically feasible, MB may be considered the preferred route of liver biopsy in end-stage chronic liver disease.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends and demographic disparities in mortality with co-mention of chronic liver disease and pneumonia in the United States, 1999-2024.","authors":"Abdul Moeez Awais, Vishan Das, Muhammad Wassam, Nawal Jahangir Mahsud, Fatima Sohail, Muhammad Touseef, Mustafa Saad, Abdul Raffay Awais, Muhammad Hanif Khan","doi":"10.1186/s12876-026-05402-3","DOIUrl":"10.1186/s12876-026-05402-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver disease is associated with immune dysfunction and increased susceptibility to pneumonia, yet national mortality trends involving both conditions remain poorly characterized. We examined temporal trends and demographic disparities in mortality with co-mention of chronic liver disease and pneumonia in the United States from 1999 to 2024.</p><p><strong>Methods: </strong>Using data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database, we identified deaths with co-mention of chronic liver disease and pneumonia as multiple causes of death. Age-adjusted mortality rates per 100,000 population were calculated and stratified by sex, age, race and ethnicity, region, and urbanization. Joinpoint regression was used to estimate annual and average annual percent change in mortality rates. Sensitivity analyses excluded deaths with a co-listed U07.1 (COVID-19) code, restricted to the pre-pandemic period, and applied broader diagnostic code definitions.</p><p><strong>Results: </strong>From 1999 to 2024, 81,759 deaths had co-mention of chronic liver disease and pneumonia. The overall mortality rate was stable from 1999 to 2018, rose sharply to a peak in 2021, and declined thereafter but remained above pre-pandemic levels through 2024; this pattern was retained across all sensitivity analyses. Males accounted for most deaths and consistently had higher mortality rates than females, though females showed a significant overall increase in mortality while males did not. Non-Hispanic American Indian/Alaska Native individuals had the highest mortality rate throughout most of the study period, with a sharp increase from 2018 to 2021 followed by a marked decline. The South accounted for the most deaths, while the West had the highest mortality rate by 2024. Non-metropolitan areas showed a greater increase in mortality than metropolitan areas. Most deaths occurred in inpatient medical facilities.</p><p><strong>Conclusions: </strong>Mortality with co-mention of chronic liver disease and pneumonia rose sharply during the COVID-19 pandemic and remained persistently elevated through 2024; this pattern was similar in sensitivity analyses excluding deaths with a co-listed U07.1 code and using alternative case definitions. Substantial and sustained disparities were observed, particularly among non-Hispanic American Indian/Alaska Native individuals and non-metropolitan residents. These findings reflect co-occurrence on death certificates rather than a confirmed causal relationship, and highlight priority populations for continued surveillance and targeted public health efforts.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large language models' performance in answering common patient questions about colonoscopy: an expert-based evaluation.","authors":"Neslihan Güneş Aydemi̇r, Dilek Yapar, Yasemin Demi̇r Avcı, Esra Tokur Sonuvar, Ahmet Mert Aydemir","doi":"10.1186/s12876-026-05345-9","DOIUrl":"10.1186/s12876-026-05345-9","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the performance of two large language models (LLMs) the ChatGPT-4 and the Google Bard in delivering medical information about colonoscopy. It also sought to evaluate the models' responses to common patient and caregiver questions in terms of accuracy, applicability, comprehensiveness, and communication quality, as assessed by experts using a rubric-based method.</p><p><strong>Methods: </strong>This comparative, expert-based observational study analyzed the responses of both models to 11 colonoscopy-related questions written in Turkish, simulating real patient inquiries. To ensure consistency and fairness, questions were asked in separate sessions using a standardized zero-shot approach without prior examples or context. The gastroenterology experts from various institutions in Türkiye were recruited using snowball sampling and evaluated the responses using a rubric-based scale across four domains. Data were collected online.</p><p><strong>Results: </strong>A total of 40 gastroenterologists participated (mean age 39.1 ± 6.4 years). For ChatGPT-4, more than 70% of responses were rated ≥ 4 across all domains, with median overall index scores ranging from 4.1 to 4.7. In contrast, Google Bard demonstrated lower performance, with median scores ranging from 3.6 to 4.0 and lower proportions of high ratings (≥ 4), particularly in comprehensiveness (55.7%) and applicability (58.4%). Comparative analysis showed that ChatGPT-4 significantly outperformed Google Bard across all domains: accuracy (p = 0.003, effect size = 0.47), applicability (p < 0.001, effect size = 0.64), comprehensiveness (p = 0.004, effect size = 0.46), and communication (p = 0.001, effect size = 0.52). No significant differences were observed across evaluator subgroups based on academic title, prior ChatGPT use, or age (all p-values > 0.05).</p><p><strong>Conclusions: </strong>ChatGPT-4 outperformed Google Bard across all domains, providing more accurate, comprehensive, and patient-centered responses. Despite these findings, human oversight remains essential to ensure safety and reliability in clinical communication. It should also be noted that different versions of LLMs may yield different results.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of dysfunction in fully versus partially covered self-expanding metal stents for malignant esophageal strictures: a 10-year multicenter study.","authors":"Özlem Çelebi, Christian Jürgensen, Michael Sigal, Andreas Adler, Ian Levenfus, Konstantinos Kouladouros, Martin Maibier, Tobias Blasberg, Jürgen Hochberger, Frank Tacke, Tobias Kleemann, Quang Trung Tran, Marcel Razpotnik","doi":"10.1186/s12876-026-05414-z","DOIUrl":"https://doi.org/10.1186/s12876-026-05414-z","url":null,"abstract":"<p><strong>Background: </strong>Esophageal self-expanding metal stents (SEMS) effectively restore oral intake in malignant obstruction, yet stent dysfunction remains a frequent clinical challenge. We aimed to identify and compare predictors of stent dysfunction in fully versus partially covered self-expanding metal stents (fcSEMS vs. pcSEMS).</p><p><strong>Methods: </strong>This multicenter retrospective cohort included patients undergoing SEMS placement for malignant esophageal strictures between 2014 and 2023. Stent dysfunction comprised migration, tumor overgrowth, or food bolus impaction. Patients with benign or anastomotic strictures, prior ablative therapy, or uncovered SEMS were excluded. Cumulative incidence and Fine-Gray subdistribution hazard models were used, treating death as a competing event. Interaction terms assessed effect modification by stent type.</p><p><strong>Results: </strong>Of 249 screened patients, 188 were included (mean age 68.0 ± 10.7 years; 78.7% male; 92 pcSEMS and 96 fcSEMS); technical success was 97.3%. Dysfunction occurred in 29.8% and was more frequent with fcSEMS than pcSEMS (36.5% vs. 22.8%; p = 0.04), primarily due to migration (31.3% vs. 10.9%; p < 0.01). Within 12 months, 37 patients (19.7%) died before dysfunction and were treated as competing events. In adjusted Fine-Gray models, strictures caused by other malignancies (non-squamous/non-adenocarcinoma) were strongly associated with dysfunction in the fcSEMS group (sHR 6.53; 95% CI 2.51-16.98; p < 0.01), with significant effect modification by stent type (sHR interaction 14.1; 95% CI 2.08-95.8; p < 0.01). Larger stricture diameter independently predicted dysfunction with fcSEMS (sHR per mm 1.21; 95% CI 1.01-1.45; p = 0.04), while lower esophageal location showed a borderline association (sHR 2.33; 95% CI 0.89-6.07; p = 0.08). Adverse-event rates were comparable (35.9% vs. 43.8%; p = 0.27).</p><p><strong>Conclusion: </strong>Patterns of stent dysfunction differed between fcSEMS and pcSEMS. Tumor etiology and stricture anatomy may guide risk-stratified stent selection and help reduce reinterventions.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and a single-centre temporal validation of a machine learning-based model for early prediction of acute pancreatitis-associated liver injury.","authors":"Ping Wang, Keyang Wang, Cunbo Yu, Xueli Yao, Hailong Feng, Yingjian Zhang","doi":"10.1186/s12876-026-05204-7","DOIUrl":"https://doi.org/10.1186/s12876-026-05204-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute pancreatitis (AP) is a common acute abdominal inflammatory disorder characterized by premature activation of pancreatic enzymes, leading to pancreatic autodigestion, edema, hemorrhage, and even necrosis. The liver, as the first portal organ receiving pancreatic venous drainage, is one of the most frequently affected extra-pancreatic organs in AP. AP-associated liver injury (LI) is closely correlated with the intensity of systemic inflammation, the development of multiple organ dysfunction, and increased mortality. While machine learning (ML) models have been successfully applied to predict various AP-related complications such as acute respiratory distress syndrome, acute kidney injury, and infected pancreatic necrosis, effective tools for early prediction of LI before its clinical onset remain lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively collected data from 1,184 patients diagnosed with AP at the First Affiliated Hospital of Henan University of Science and Technology between January 2018 and December 2023. After applying strict inclusion and exclusion criteria, 1,124 patients were included. The development cohort comprised 929 patients admitted between January 2018 and December 2022, randomly split into a training set (n = 650) and an internal test set (n = 279) in a 7:3 ratio. An independent temporal validation set consisted of 195 patients admitted from January to December 2023. Forty-nine clinical and laboratory parameters were collected within 24 h of admission to predict LI occurring after the first 24 h of hospitalization. Patients with any ALT/AST elevation &gt; 3×ULN within the first 24 h were not counted as LI events; the outcome was strictly defined as incident LI emerging after 24 h. In the training set, LASSO regression was used to identify key predictive factors, followed by the construction of nine machine learning models: logistic regression (LR), decision trees (DT), random forests (RF), XGBoost, and LightGBM, among others. All feature selection and hyperparameter tuning were nested within 5-fold cross-validation on the training set only, with no use of test or validation set information. Model performance was primarily assessed using the area under the receiver operating characteristic curve (AUC), calibration metrics (Brier score, calibration intercept/slope), and decision-curve analysis (DCA). The SHAP method was employed for interpretability analysis of the optimal model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;LASSO regression identified ten key predictors: amylase (AMY), lipase (LIP), total cholesterol (CHO), albumin (ALB), neutrophil percentage (N/W), serum calcium (Ca), alanine aminotransferase (ALT), gender, total bilirubin (TBIL), and drinking history. Among the nine models, the random forest (RF) model demonstrated superior predictive performance and temporal generalizability, achieving an AUC of 0.972 (95% CI: 0.954-0.989) with an accuracy of 0.921 in the internal test set, an","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report: an unusual case of ulcerative intestinal IgG4-related disease with clinical features overlapping with probable intestinal Behcet's disease.","authors":"Shukai Zhan, Jing Yang, Wenlong Liang, Hongli Huang, Yongjian Zhou","doi":"10.1186/s12876-026-05344-w","DOIUrl":"10.1186/s12876-026-05344-w","url":null,"abstract":"<p><strong>Background: </strong>IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition characterized by IgG4-positive plasma cell infiltration, typically presenting with organ enlargement or tumor-like masses. Luminal gastrointestinal involvement is rare, and ulcerative lesions are even less common. Overlap syndromes of IgG4-RD with other immune disorders have been reported, but overlap of its clinical features with those of intestinal Behcet's disease has not been documented.</p><p><strong>Case presentation: </strong>A 62-year-old man with a history of recurrent oral ulcers presented with sudden hematochezia and hypovolemic shock. Imaging revealed sclerosing mesenteritis, and endoscopy identified multiple small intestinal ulcers. Histopathological examination of the resected intestinal segment demonstrated dense infiltration of IgG4-positive plasma cells (70/HPF, IgG4⁺/IgG⁺ ratio 42.3%), confirming intestinal IgG4-RD. The patient also met diagnostic criteria for probable intestinal Behcet's disease based on recurrent oral ulcers, crateriform intestinal ulcers, and histologic evidence of vasculitis. Following partial enterectomy and postoperative immunosuppressive therapy (prednisone and cyclophosphamide), the patient achieved sustained remission with no recurrence during the one-year follow-up.</p><p><strong>Conclusions: </strong>This is the first reported case of concurrent intestinal IgG4-RD and probable intestinal Behcet's disease. The overlapping presentation expands the clinical spectrum of IgG4-RD and suggests a potential pathogenic link between these two immune-mediated conditions.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coordinated upregulation of Hippo, NF-κB and interferon pathway genes in pancreatic ductal adenocarcinoma: a retrospective tissue qRT-PCR profiling study with external tumour-versus-non-tumour validation, molecular subtype and survival analyses.","authors":"Eda Balkan, Murat Kızılkaya, Sevilay Özmen, Necip Altundaş, Mert Yüksel, Mahmut Aktürk, Abdulkadir Aktepe, Nurhak Aksungur","doi":"10.1186/s12876-026-05259-6","DOIUrl":"https://doi.org/10.1186/s12876-026-05259-6","url":null,"abstract":"<p><strong>Objectives: </strong>Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid tumours. Alterations in Hippo, NF-κB and interferon (IFN)-related signalling have each been implicated in its biology, but the extent to which these transcriptional programmes are coordinately dysregulated in tumour tissue remains incompletely defined. This study therefore set out to determine whether these programmes are coordinately upregulated in PDAC tissue, and whether individual transcripts discriminate tumour from non-tumour tissue reproducibly in an independent cohort.</p><p><strong>Methods: </strong>In this retrospective study we profiled 17 mRNA targets by real-time quantitative PCR in 50 formalin-fixed paraffin-embedded PDAC specimens and 35 non-tumoural pancreatic tissue samples, covering the Hippo pathway core and output, the inflammation/IL-6 module, the IFN-related axis and the NF-κB cascade, normalised to GAPDH using the 2 - ΔΔCt method. Discrimination was assessed by full-cohort receiver-operating-characteristic analysis without resampling and by nested cross-validation, and associations with clinicopathological variables were tested with Benjamini-Hochberg correction. Findings were evaluated externally in GSE62452 and TCGA-PAAD.</p><p><strong>Results: </strong>All 17 transcripts were significantly upregulated in PDAC (FDR < 0.05), with median fold-changes from 3.4 (WWTR1) to 18.4 (LATS1). MYD88, ANKRD1, ISG15 and YY1 discriminated best (AUC 0.853-0.911), and nested cross-validation gave a signature AUC of 0.890 (95% CI 0.821-0.959), only marginally better than MYD88 alone. No clinicopathological variable was associated with transcript abundance after correction. In GSE62452 (69 PDAC, 61 adjacent non-tumour tissues) eight transcripts replicated with concordant direction, led by YAP1 (AUC 0.791), TEAD1 (0.760) and MYD88 (0.755), and the fixed four-gene discovery signature retained discrimination (AUC 0.798, 95% CI 0.719-0.877). Replication was gene-specific rather than module-wide: IL6, the remaining NF-κB transcripts and four Hippo members did not replicate, and IFNB1 was discordant. Hippo output genes tracked the basal-like subtype in both external cohorts. In TCGA-PAAD, high YY1 (HR 2.01; p = 0.001) and high YAP1 (HR 1.72; p = 0.010) predicted shorter survival, but both associations lost significance when the analysis was restricted to ductal-type histology.</p><p><strong>Conclusions: </strong>PDAC tissue shows coordinated upregulation across these four modules, but only eight of the seventeen transcripts replicated externally, most strongly within the Hippo effector axis and for MYD88. YAP1, TEAD1, MYD88 and STK4 reached validation AUCs above 0.70 and are prioritised for prospective study. Because transcript abundance does not measure pathway activity and all data derive from bulk tissue, these associations are hypothesis-generating rather than mechanistic.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leucine-rich alpha-2 glycoprotein as a predictor of primary non-response to anti-TNF-α therapy in biologic-naïve Egyptian IBD patients.","authors":"Ibrahiem Amer, Hassan El Batae, Yasmine A Elshaer, Dalia Elsayed Sherief, Mahmoud A Elkerdawy, Mohamed H Emara, Shimaa El Sharawy","doi":"10.1186/s12876-026-05180-y","DOIUrl":"10.1186/s12876-026-05180-y","url":null,"abstract":"<p><strong>Background: </strong>Anti-tumor necrosis factor-α (anti-TNF-α) agents are a cornerstone in inflammatory bowel disease (IBD) therapy, yet primary non-response remains a significant practical challenge. Leucine-rich alpha-2 glycoprotein (LRG) has been recognized as a promising marker for disease activity. This study aimed to evaluate the predictive significance of pre-treatment serum LRG for response to anti-TNF-α therapy in biologic-naïve Egyptian IBD patients.</p><p><strong>Methods: </strong>In this prospective cohort study, 100 biologic-naïve IBD adult patients (50 Crohn's disease [CD], 50 ulcerative colitis [UC]) and 100 healthy controls were enrolled. Patients received induction therapy with adalimumab or infliximab. Clinical, biochemical, and endoscopic evaluations were conducted at baseline and at week 24. Response was defined by clinical indices and endoscopic improvement, while biochemical normalization was evaluated as a secondary, supportive parameter.</p><p><strong>Results: </strong>IBD patients had significantly elevated baseline LRG levels compared to the healthy controls (p < 0.001). Responders' baseline LRG was substantially lower than that of non-responders in both UC (26.53 vs. 34.88 µg/mL; p = 0.008) and CD (26.03 vs. 35.07 µg/mL; p = 0.006). Receiver operating characteristic analysis revealed a cut-off of > 29 µg/mL for predicting non-response, yielding sensitivities of 74.2% and 80.0% with specificities of 69.57% and 65.71% for UC and CD, respectively and negative predictive values of 85.7% for UC and 88.5% for CD. Multivariate regression confirmed baseline LRG as an independent predictor of non-response.</p><p><strong>Conclusions: </strong>Baseline serum LRG levels > 29 µg/mL demonstrated moderate discriminatory ability for predicting primary non-response to anti-TNF-α therapy in Egyptian IBD patients. LRG may serve as a useful adjunctive biomarker for pre-treatment risk estimation and recognizing patients who may require alternative therapeutic strategies.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of metabolic dysfunction-associated steatotic liver disease and its association with significant liver fibrosis in hospitalized patients with chronic hepatitis B: a single-center retrospective cross-sectional study.","authors":"Chun-Xia Wang, Jun Kang, Jia-Wei Zhang, Xiao-Yan Yuan, Dong Wang, Mao-Quan Li, Da-Feng Liu","doi":"10.1186/s12876-026-05290-7","DOIUrl":"10.1186/s12876-026-05290-7","url":null,"abstract":"<p><strong>Background: </strong>Coexistence of chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming more common in clinical settings, but the relationship between MASLD and significant liver fibrosis in CHB remains uncertain.</p><p><strong>Aim: </strong>To delineate the clinical profile of hospitalized CHB patients with concomitant MASLD and investigate the relationship of MASLD with significant liver fibrosis.</p><p><strong>Methods: </strong>A total of 776 hospitalized patients with CHB were retrospectively evaluated in this single-center cross-sectional analysis at the Public Health Clinical Center of Chengdu between December 2020 and December 2024. Using the current diagnostic criteria for MASLD, participants were assigned to either the CHB-only group or the CHB+MASLD group. Demographic data, laboratory findings, virological profiles, and FibroScan-derived liver stiffness measurements were collected. Between-group differences in clinical profiles were examined, followed by an evaluation of whether MASLD was associated with significant liver fibrosis.</p><p><strong>Results: </strong>The analysis comprised 776 patients with CHB, including 203 (26.2%) with concomitant MASLD. Patients in the CHB+MASLD group tended to be younger and had a shorter duration of hospitalization than those in the CHB-only group. They also had higher albumin and platelet levels but lower total bilirubin, AST, and prothrombin time values. Patients with CHB+MASLD were less likely to receive antiviral treatment. Multivariable modeling provided no evidence that MASLD was independently related to significant liver fibrosis (OR = 1.473, 95% CI: 0.970-2.236; P = 0.069). Restricting the analysis to patients whose ALT and AST values did not exceed 5 × the upper limit of normal produced an effect estimate in the same direction, but statistical significance was still not achieved (OR = 1.374, 95% CI: 0.860-2.195; P = 0.183). Older age, male sex, and elevated AST levels were consistently related to significant liver fibrosis in both the primary and sensitivity analyses. HBV DNA showed a significant association only in the primary model. The interaction between MASLD and antiviral treatment status was not statistically significant (P for interaction = 0.232).</p><p><strong>Conclusion: </strong>Concomitant MASLD was common among hospitalized patients with CHB. In the adjusted model, MASLD did not show a clear independent relationship with significant liver fibrosis. In contrast, older age, male sex, and higher AST levels were linked to greater odds of significant liver fibrosis. Because all participants were inpatients, these findings should not be directly extrapolated to the broader CHB population. Further multicenter studies enrolling patients across inpatient, outpatient, and community settings are needed to validate these findings.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}