BMC Gastroenterology最新文献

{"title":"Comparative effectiveness and safety of robotic versus laparoscopic liver resection for benign liver diseases: a systematic review and meta-analysis.","authors":"Guo-Wang Li, Jing Li, Qiang Kang, Chen Yang, Wei Wang, Xin Lu, Chun-Hang Qian, Qin Geng, Yang Ke, Yue-Hua Li","doi":"10.1186/s12876-026-05244-z","DOIUrl":"10.1186/s12876-026-05244-z","url":null,"abstract":"<p><strong>Background: </strong>Robotic liver resection (RLR) is increasingly used as an alternative to laparoscopic liver resection (LLR), but its comparative effectiveness and safety for benign liver diseases remain uncertain. We performed a systematic review and meta-analysis to compare perioperative outcomes between RLR and LLR.</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane Library, WanFang Data, VIP Database (CQVIP), and CNKI were searched from inception to November 2025. Studies comparing RLR with LLR for benign liver diseases were included. Weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated for continuous and dichotomous outcomes, respectively. Subgroup analyses were performed according to disease type.</p><p><strong>Results: </strong>Nine retrospective studies involving 790 patients (RLR, n = 268; LLR, n = 522) were included. Compared with LLR, RLR was associated with shorter setup-excluded operative time (WMD = -36.24 min, 95% CI = -52.88 to -19.60 min), lower intraoperative blood loss (WMD = -55.66 mL, 95% CI = -69.58 to -41.75 mL), a lower conversion rate to open surgery (RR = 0.27, 95% CI = 0.11 to 0.69), and shorter postoperative hospital stay (WMD = -0.68 days, 95% CI = -1.35 to -0.01 days). RLR was also associated with higher albumin levels on postoperative day (POD) 1 (WMD = 1.65 g/L, 95% CI = 0.41 to 2.88 g/L) and lower ALT levels on POD 1 (WMD = - 27.24 U/L, 95% CI = - 48.42 to - 6.05 U/L). Total operative time and postoperative complication rates were comparable between the two approaches. In subgroup analyses, RLR was associated with reduced intraoperative blood loss in both hepatolithiasis and hepatic hemangioma, with a numerically larger reduction in the latter subgroup; additionally, RLR was associated with lower conversion rates and shorter postoperative hospital stay in hepatolithiasis.</p><p><strong>Conclusions: </strong>RLR was associated with advantages in several specific perioperative outcomes compared with LLR for benign liver diseases, without an increase in postoperative complications. However, all available evidence was retrospective, and the clinical significance of modest postoperative biochemical differences remains uncertain. Large prospective multicenter studies are warranted to confirm these findings.</p><p><strong>Trial registration: </strong>PROSPERO CRD420251062434.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966378","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":"miR-215-5p aggravates severe acute pancreatitis by inhibiting SLC7A11 to induce ferroptosis.","authors":"Qian Gao, Chunyan Li, Jinyu Liu, Dongqin Shen, Chuan Liu","doi":"10.1186/s12876-026-05334-y","DOIUrl":"10.1186/s12876-026-05334-y","url":null,"abstract":"<p><strong>Background: </strong>Severe acute pancreatitis (AP) is accompanied by systemic inflammatory process and organ dysfunction. Emerging evidence suggests that miRNA contributes to pancreatic injury. This study investigated miR-215-5p in AP and its mechanistic insight.</p><p><strong>Methods: </strong>100 healthy controls and 130 patients with AP were enrolled. Based on disease severity, AP is classified into 72 mild acute pancreatitis (MAP) and 58 non-MAP (NMAP). Serum miR-215-5p abundance was quantified by qRT-PCR. The clinical significance was evaluated by logistic regression and ROC curve. A caerulein (CAE)-induced injury model was established in AR42J pancreatic acinar cells. Functional experiments, including cell viability, LDH release, and oxidative stress indicators, were performed. The RNA interaction was validated by dual-luciferase assay.</p><p><strong>Results: </strong>miR-215-5p was elevated in AP and NMAP subjects. miR-215-5p positively correlated with BISAP score. miR-215-5p exhibits strong performance in distinguishing NMAP from MAP. Multivariate analysis identified miR-215-5p as an independent risk factor for NMAP. In vitro, CAE treatment upregulated miR-215-5p and induced ferroptosis, as substantiated by the accumulation of Fe²⁺, ROS, and MDA and decreased GSH and GPX4 expression. Inhibition of miR-215-5p alleviated cellular injury, including suppressed ferroptosis, and reduced inflammatory cytokine production. miR-215-5p directly binds to SLC7A11. SLC7A11 silencing reversed the protective role of miR-215-5p inhibition on AR42J cells.</p><p><strong>Conclusions: </strong>miR-215-5p is elevated and associated with disease severity. miR-215-5p may promotes pancreatic acinar cell injury by targeting SLC7A11 and inducing ferroptosis.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023818","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":"Log-transformed systemic inflammation response index improves prediction of 28-day ICU mortality in critically ill patients with cirrhosis and atrial fibrillation: development in MIMIC-IV and external validation in eICU-CRD.","authors":"Xiangle He, Jiajing Han","doi":"10.1186/s12876-026-05291-6","DOIUrl":"10.1186/s12876-026-05291-6","url":null,"abstract":"<p><strong>Background: </strong>Short-term mortality is high among critically ill patients with cirrhosis and atrial fibrillation (AF). Existing scores such as SOFA, MELD-Na, and CHA₂DS₂-VASc do not directly reflect systemic inflammation. We investigated whether blood count-derived inflammatory indices could improve prediction of 28-day ICU mortality in this high-risk population.</p><p><strong>Methods: </strong>Adult ICU patients with cirrhosis and AF were identified from MIMIC-IV v3.1 (single-center development cohort) and eICU-CRD v2.0 (multicenter external validation cohort). Five inflammatory indices, including SIRI, log-SIRI, SII, log-SII, and NLR, were compared by adding each marker to a base model of age, sex, SOFA, and MELD-Na. The final model was developed using multivariable logistic regression. Internal validation used 1000-resample bootstrap, and performance was assessed by discrimination, calibration, reclassification, and decision curve analysis.</p><p><strong>Results: </strong>A total of 454 patients from MIMIC-IV and 121 from eICU-CRD were included. The 28-day ICU mortality rates were 19.6% and 16.5%, respectively. Among the five candidate markers, SII achieved the highest AUC (0.758) and lowest AIC, but its per-unit odds ratio (1.0001) made point-based nomogram construction impractical. log-SIRI was selected for its interpretable per-unit odds ratio (1.48) and near-identical discrimination to SII (ΔAUC - 0.007), together with the biological argument that its three-lineage formulation avoids platelet count, which is unreliable in cirrhosis. Adding log-SIRI to the base model increased the AUC from 0.721 to 0.751 (ΔAUC + 0.030, DeLong P = 0.026) and improved model fit on likelihood ratio testing (χ² = 9.18, P = 0.002), with concordant improvement in continuous NRI (0.241, P = 0.037) and calibration (Hosmer-Lemeshow P 0.002 to 0.729). The optimism-corrected C-index was 0.734. External validation in eICU-CRD yielded an AUC of 0.818.</p><p><strong>Conclusion: </strong>Log-SIRI was associated with 28-day ICU mortality after adjustment for age, sex, SOFA, and MELD-Na. The improvement in AUC over the base clinical model was modest but statistically significant, corroborated by concordant improvements in likelihood ratio, continuous NRI, and calibration. Prospective external calibration is needed before individual clinical use.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191258","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":"Diagnostic accuracy of Neutrophil Gelatinase-Associated Lipocalin (NGAL) for inflammatory bowel disease: a systematic review and bivariate diagnostic meta-analysis.","authors":"Ting Yu, Fanyu Meng, Kai Ma, Chen Wang","doi":"10.1186/s12876-026-05220-7","DOIUrl":"https://doi.org/10.1186/s12876-026-05220-7","url":null,"abstract":"<p><strong>Objective: </strong>To systematically assess the diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) for inflammatory bowel disease (IBD) and to compare its performance with fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) using marker-specific diagnostic test accuracy meta-analysis.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were searched for diagnostic studies using endoscopy and/or histopathology as the reference standard. The primary synthesis used directly reported complete four-cell table data and marker-specific bivariate random-effects models (Reitsma). Exploratory analyses using sensitivity/specificity records were performed only as supplementary checks because patient populations, thresholds, sample types, and reference standards were not sufficiently exchangeable for a formal diagnostic network meta-analysis. Subgroup feasibility, direct-data sensitivity checks, continuity correction use, and Deeks funnel plot asymmetry were assessed.</p><p><strong>Results: </strong>Seventy-eight studies with 148 diagnostic records were included. The primary bivariate analysis was based on 27 directly reported complete four-cell records, including 11 FC, 7 CRP, 5 ESR, and 4 NGAL records; 85 sensitivity/specificity records were used only for supplementary exploratory analyses. NGAL showed a pooled sensitivity of 90.9% (95% CI: 66.1%-98.1%) and specificity of 76.1% (95% CI: 42.4%-93.2%), but the estimate was imprecise and underpowered because only 13 NGAL records and 4 complete four-cell records were available. Exploratory network diagnostics did not support clinically interpretable ranking.</p><p><strong>Conclusion: </strong>NGAL may have high sensitivity for IBD diagnosis, but current evidence is preliminary, heterogeneous, and based on very limited complete four-cell data. NGAL should not be interpreted as a replacement for FC or as a stand-alone diagnostic test. Larger prospective studies with standardized thresholds, sample types, and reference standards are needed.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223178","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":"Cost-effectiveness analysis of durvalumab combined with tremelimumab versus sorafenib as first-line treatment for unresectable Hepatocellular carcinoma in China: a dual-model approach utilizing partitioned survival and markov models.","authors":"Ruixuan Liu, Yong Xiao, Zhen Wang, Qing Yang","doi":"10.1186/s12876-026-05305-3","DOIUrl":"10.1186/s12876-026-05305-3","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a major contributor to global cancer-related mortality, with the majority of patients diagnosed at unresectable stages. The STRIDE regimen (tremelimumab plus durvalumab) demonstrated superior survival benefits over sorafenib in the HIMALAYA trial. However, its cost-effectiveness within the Chinese healthcare system remains unverified.</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of first-line STRIDE versus sorafenib for unresectable HCC from the perspective of the Chinese healthcare payer.</p><p><strong>Methods: </strong>A comprehensive cost-effectiveness analysis was conducted using both partitioned survival (PartSA) and Markov state-transition models over a 10-year time horizon. Clinical efficacy parameters were derived from reconstructed HIMALAYA trial survival data. Direct medical costs were estimated based on post-negotiation drug pricing in China and published sources. Health utility weights were sourced from established literature. Scenario analyses (50% price reduction, 0% discount rate) and comprehensive deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate model uncertainty.</p><p><strong>Results: </strong>In the base-case analysis, the STRIDE regimen yielded incremental cost-effectiveness ratios (ICERs) of $204,713.55/QALY in the PartSA model and $208,385.86/QALY in the Markov model, both substantially exceeding China's willingness-to-pay threshold (3× GDP per capita, $36,975/QALY). Under a 50% price reduction scenario, the ICER dropped to $87,351.95/QALY but remained non-cost-effective. Probabilistic sensitivity analysis demonstrated a < 20% likelihood of STRIDE being cost-effective across tested scenarios. Key cost drivers included drug acquisition costs and progression-free utility values.</p><p><strong>Conclusion: </strong>Under current pricing, the STRIDE regimen is not cost-effective as a first-line treatment for unresectable HCC in China. While price concessions improve affordability, exploration of value-based pricing and future biomarker-guided patient stratification could be evaluated to optimize economic viability. The dual-model concordance reinforces the robustness of these findings.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148516","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":"Changing clinical presentation of pediatric celiac disease over time.","authors":"Ozlem Kalaycik Sengul, Petek Bal Gumustas, Kardelen Celikel, Asude Sule Arikan, Ozden Can, Sebahat Cam","doi":"10.1186/s12876-026-05313-3","DOIUrl":"https://doi.org/10.1186/s12876-026-05313-3","url":null,"abstract":"<p><strong>Background: </strong>Celiac disease (CD), often associated with malabsorption, presents with a wide spectrum of gastrointestinal and extra-intestinal manifestations. It was aimed to investigate changes in the clinical presentation of CD in children over a 16-year period and to assess whether clinical forms (classical, non-classical and asymptomatic) vary according to age, sex, and histopathological severity.</p><p><strong>Methods: </strong>This retrospective study included 216 pediatric patients (aged 1-18 years) diagnosed with biopsy-confirmed CD at a tertiary center between January 2008 and November 2023. Patients were divided into two groups based on the year of diagnosis (group 1 = 2008-2015, group 2 = 2016-2023). Demographics, presenting symptoms, histopathological findings, Oslo-based clinical classifications were analyzed.</p><p><strong>Results: </strong>The mean age at diagnosis was 92.0 ± 51.2 months, with female predominance (65%). Classical CD was observed in 53.2% of the patients. Over time, the overall distribution of clinical presentation did not differ significantly between the two periods (p = 0.658), although classical CD decreased numerically and non-classical CD increased numerically. Diarrhea and abdominal distention decreased significantly (p = 0.008 and p = 0.006), while constipation (p = 0.063) and isolated short stature (p = 0.304) showed numerical increases that did not reach statistical significance. Histopathological severity decreased over time, with a significant reduction in total villous atrophy (Marsh 3 C, p < 0.001). Asymptomatic patients were diagnosed at an older age than the other clinical presentation groups (three-group comparison, p = 0.007).</p><p><strong>Conclusions: </strong>The clinical profile of pediatric CD appears to be evolving, with a significant decline in classical symptoms - especially chronic diarrhea and abdominal distension, alongside numerical (non-significant) trends toward increased non-classical manifestations such as constipation and isolated short stature. Awareness of these evolving presentations, including non-classical and screen-detected diseases, is essential for early diagnosis and prevention of long-term complications.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104209","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":"Food choices and beliefs in adults with inflammatory bowel disease in Sweden.","authors":"Sara Andersson, Katarina M Korwel, Klas Sjöberg, Katarina Pihl Lesnovska, Kevin Whelan, Charlotte Rh Hedin, Alexandra Vulcan","doi":"10.1186/s12876-026-05300-8","DOIUrl":"10.1186/s12876-026-05300-8","url":null,"abstract":"<p><strong>Objectives: </strong>Diet is a recognised risk factor for inflammatory bowel disease (IBD) and a management strategy. Concerns persist regarding the adverse effects of restrictive diets, including nutritional deficiencies and selective eating. The impact of IBD on patients' beliefs and dietary choices remains poorly characterised, especially in different geographic contexts.</p><p><strong>Aim: </strong>To investigate dietary practices and beliefs in patients with IBD in Sweden, including variations by disease phenotype.</p><p><strong>Methods: </strong>A 42-item questionnaire on food choices and beliefs was distributed to all adult members of Sweden's largest IBD-patient organization.</p><p><strong>Results: </strong>Of the 2,193 individuals invited, 738 (34%) responded, (Crohn's disease (CD) 361 (49%); Ulcerative colitis (UC) 377 (51%)). IBD impacted thoughts about food in 71% (n = 521). A higher proportion of those with CD (254, 70%) than UC (231, 61%), reported changing their diet due to IBD (p = 0.009). A higher proportion of patients with CD (187, 52%), compared with UC (164, 43%), avoid certain foods in the belief that this can prevent flare-ups (p = 0.024). 42% (n = 311) of patients had not received dietary advice from health care providers, which was more common in UC (209, 55%) than CD (102, 28%), (p < 0.001).</p><p><strong>Conclusions: </strong>Beliefs about food and diet appear to influence dietary choices in IBD, many of whom report modifying their diet. This appears to be more pronounced among people with CD than UC, although the latter are less likely to receive dietary advice, highlighting potential disparities in access to dietary guidance.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879085","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":"Evaluation of sleep quality and obstructive sleep apnea in non-alcoholic fatty liver disease: a cross-sectional study.","authors":"Sahar Ravanshad, Mohadese Nikookar Golestani, Mitra Ahadi, Mona Kabiri, Hassan Mehrad-Majd, Lahya Afshari Saleh, Anahita Azinfar, Mehrshad Rajabi","doi":"10.1186/s12876-026-05298-z","DOIUrl":"10.1186/s12876-026-05298-z","url":null,"abstract":"<p><strong>Background: </strong>Sleep is essential for metabolic homeostasis and overall health. NAFLD, recently reclassified as MASLD, is the most prevalent chronic liver disease globally (~ 25% prevalence) and is strongly linked to metabolic comorbidities. Growing evidence associates adverse sleep conditions including short sleep duration, OSA, and circadian misalignment with NAFLD onset and progression. However, data from Iranian and Middle Eastern populations remain scarce, and no study has simultaneously evaluated sleep quality and OSA risk in a large Iranian NAFLD cohort. This study aimed to address this gap using the PSQI and STOP-BANG questionnaire.</p><p><strong>Methods: </strong>This cross-sectional study utilized registry data from the PERSIAN Organizational Cohort Study (POCS) at Mashhad University of Medical Sciences. A total of 958 NAFLD patients diagnosed by abdominal ultrasonography were included.</p><p><strong>Results: </strong>Among 958 participants (69.6% male; mean age 46.7 ± 9.1 years), 35.4% had sleep disturbance (31.6% mild; 3.8% moderate). Over half (53.4%) were at intermediate OSA risk. Sleep disturbance was significantly associated with female sex (p = 0.022), single marital status (p = 0.019), higher BMI (p = 0.026), and hypertension (p = 0.007). BMI correlated weakly but significantly with PSQI scores (r = 0.072, p = 0.036). Hepatic steatosis grade was not associated with sleep disturbance (p = 0.193) but correlated positively with STOP-BANG scores (r = 0.232, p < 0.001).</p><p><strong>Conclusions: </strong>Sleep disturbance and elevated OSA risk are common among patients with NAFLD and were associated, in unadjusted analyses, with female sex, elevated BMI, hypertension and single marital status. These findings support consideration of sleep assessment in this population on case-finding grounds; whether identifying or treating these conditions improves hepatic or metabolic outcomes cannot be determined from a cross-sectional study.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023838","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":"Effectiveness of digital health interventions for the management of Low Anterior Resection Syndrome (LARS) after sphincter-preserving surgery for rectal cancer: a systematic review and meta-analysis.","authors":"Yuyan Zhao, Xiaoyi Cao, Li Niu, Zhuojing Yang, Juzi Wang","doi":"10.1186/s12876-026-05258-7","DOIUrl":"10.1186/s12876-026-05258-7","url":null,"abstract":"<p><strong>Background: </strong>Low anterior resection syndrome (LARS) frequently occurs following sphincter-preserving rectal cancer surgery. Although recent studies have reported the effects of digital health interventions for LARS management, no systematic review and meta-analysis has been conducted.</p><p><strong>Methods: </strong>We searched five English databases and three Chinese databases from inception to 18 December 2025, supplemented by gray literature sources and reference checking. Randomized and non-randomized controlled studies involving adults who had undergone sphincter-preserving rectal surgery were eligible. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. When at least two studies reported similar outcomes, meta-analysis was performed using mean difference or standardized mean difference with 95% confidence intervals, with the I² statistic used to measure heterogeneity. Narrative synthesis was used when pooling was not appropriate. Certainty of evidence was assessed using GRADE. The protocol was registered in PROSPERO.</p><p><strong>Results: </strong>Eight studies published between 2021 and 2025 were included, and seven contributed to the meta-analysis. Digital health interventions were associated with reductions in LARS scores compared with usual care (MD = - 3.00, 95% CI - 4.17 to - 1.83; P < 0.00001; I² = 28%) and with improvements in health-related quality of life, although heterogeneity for this outcome was substantial (SMD = 0.75, 95% CI 0.17 to 1.34; P = 0.01; I² = 89%). No statistically significant between-group effect was observed for self-efficacy, with substantial heterogeneity (SMD = 0.43, 95% CI - 0.15 to 1.01; P = 0.15; I² = 79%). Anxiety and depression outcomes, assessed in a small number of trials, did not show meaningful between-group differences. Evidence for self-management, activation, satisfaction, feasibility, and other implementation outcomes was suggestive but inconsistently reported and often study-specific.</p><p><strong>Conclusions: </strong>Digital health interventions show promising potential to reduce LARS symptom burden and may improve quality of life after sphincter-preserving rectal surgery. Nonetheless, confidence in these findings is limited by the small number of available trials, clinical and methodological heterogeneity, and inconsistent outcome measurement and reporting, particularly for psychological and intermediate pathway outcomes. Further well-designed, adequately powered studies are needed to confirm effectiveness and inform implementation in routine care.</p><p><strong>Trial registration: </strong>PROSPERO Registration: CRD420251250663.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079717","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":"Isolated extreme gamma-glutamyl transferase elevation as an early indicator of ampullary adenocarcinoma in a young adult: a case report with molecular insights.","authors":"Qiuhong Sun, Fang Wu, Jing Lou, Shihui Li","doi":"10.1186/s12876-026-05215-4","DOIUrl":"https://doi.org/10.1186/s12876-026-05215-4","url":null,"abstract":"<p><strong>Background: </strong>Ampullary adenocarcinoma is a rare gastrointestinal malignancy that typically occurs in older populations and characteristically presents with obstructive jaundice. Atypical biochemical presentations in young adults without hyperbilirubinemia are extremely rare and can lead to significant diagnostic delays.</p><p><strong>Case presentation: </strong>A 37-year-old asymptomatic male presented with a rapid, isolated, and extreme elevation of serum gamma-glutamyl transferase (GGT), surging from 78 U/L to 1793 U/L over 6 months, and an elevated CA19-9 level. Total bilirubin, transaminases, and baseline liver parenchyma remained entirely normal. Abdominal ultrasound followed by high-resolution magnetic resonance cholangiopancreatography (MRCP) revealed extrahepatic biliary dilation and focal thickening at the major duodenal papilla. Based on high radiological suspicion, a multidisciplinary team recommended direct surgical intervention without prior endoscopic ultrasonography (EUS) or biopsy. The patient underwent a curative pancreaticoduodenectomy (Whipple procedure). Histopathology confirmed a 2.8 cm, moderately-to-poorly differentiated ampullary adenocarcinoma of pancreatobiliary origin (pT3aN0M0, R0 resection) with perineural invasion. Molecular profiling demonstrated a KRAS wild-type, BRAF wild-type, microsatellite stable (MSS), and HER2 (2+) equivocal status. Postoperatively, the serum GGT normalized completely to 57 U/L by day 18.</p><p><strong>Conclusions: </strong>An isolated, rapidly rising GGT can serve as an independent early alert for occult terminal bile duct lesions before full mechanical occlusion and hyperbilirubinemia manifest. Early advanced imaging with MRCP is critical in such atypical presentations. Comprehensive molecular profiling provides additional targetable and prognostic insights for personalized postoperative surveillance.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9129,"journal":{"name":"BMC Gastroenterology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104163","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}