BMJ Open Gastroenterology最新文献

{"title":"Clinical characteristics and treatment patterns of elderly versus non-elderly adults with inflammatory bowel disease in Brazil: a cross-sectional study.","authors":"Vanessa Teixeira Martins Campos, Genalva de Almeida Couto, Valdiana Cristina Surlo, Raisa Araújo Lisboa, Jaciane Araujo Mota, Andrea Maia Pimentel, Neogélia Pereira de Almeida Morais, Flora Maria Lorenzo Fortes, Adriana Ribas Andrade, Bruno Cesar da Silva, Gustavo Gabriel Silva Cardoso, João Vitor Xavier Santos, Maria Luisa Rocha Terencio, Erick Santos Nery, Lidiane Matos Almeida Moura, Adam Cheifetz, Genoile Oliveira Santana","doi":"10.1136/bmjgast-2026-002439","DOIUrl":"10.1136/bmjgast-2026-002439","url":null,"abstract":"<p><strong>Objective: </strong>Inflammatory bowel disease (IBD) is increasingly diagnosed in older adults, but data from Latin America remain limited. This study aimed to compare the clinical, phenotypic and therapeutic characteristics of elderly and non-elderly adults with IBD in Brazil.</p><p><strong>Methods: </strong>This cross-sectional study included adults with confirmed Crohn's disease (CD) or ulcerative colitis (UC) attending an IBD clinic in Brazil. Patients were stratified as elderly (≥60 years) or non-elderly (<60 years); elderly individuals were further categorised according to age at diagnosis (<60 years vs ≥60 years). Clinical, therapeutic and frailty-related data were collected from medical records and structured interviews. The primary outcome was biologic therapy use.</p><p><strong>Results: </strong>450 patients were included in the study (115 elderly, 335 non-elderly). UC was more common among the elderly patients (77.4% vs 56.7%, p<0.001). Elderly patients had higher comorbidity scores (2.6 vs 0.3 for CD; 2.6 vs 0.4 for UC; p<0.001) and greater polypharmacy (21.7% vs 3.3%, p<0.001) but similar disease activity (CD: Harvey-Bradshaw Index <5, 92.2% vs 79.3%; UC: Mayo Score <2, 88.6% vs 78.3%). They received fewer biologics (26.1% vs 43.6%, p=0.001) and immunosuppressants (22.6% vs 47.5%, p<0.001). Among elderly patients, immunosuppressant use was lower in those diagnosed at ≥60 years (2.9% vs 30.9%, p=0·001). Most elderly patients (82.3%) were robust according to the Clinical Frailty Scale.</p><p><strong>Conclusion: </strong>Elderly patients were less likely to receive biologic and immunosuppressive therapy despite similar disease activity and had substantially greater comorbidity burden and polypharmacy. These findings suggest that therapeutic decisions in older adults should incorporate frailty and comorbidity assessment to support individualised age-adapted management.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023952","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":"MRI in MASLD: technical foundations and guideline-based applications.","authors":"Jun Pu, Liang Zhu, Yanlei Wu, Fan Ping, Jia Xu, Kang Zhou, Xuan Wang, Jie Pan","doi":"10.1136/bmjgast-2026-002471","DOIUrl":"10.1136/bmjgast-2026-002471","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major global health burden and fibrosis stage remains the principal determinant of liver-related and overall outcomes. As management increasingly relies on non-invasive risk stratification and treatment monitoring, MRI has become an important quantitative platform for liver assessment. This narrative review summarises the technical foundations and guideline-based applications of MRI in MASLD. MRI proton density fat fraction quantifies hepatic steatosis, magnetic resonance elastography measures liver stiffness as a marker of fibrosis and corrected T1 provides information on fibroinflammatory activity. MRI-based composite models, including magnetic resonance elastography combined with the fibrosis-4 index and MRI-aspartate aminotransferase score, integrate imaging and biochemical biomarkers for risk assessment. Current international guidelines generally recommend a stepwise pathway beginning with high-risk case-finding and blood-based fibrosis assessment, followed by elastography or other imaging-based tests when indicated. MRI is not routinely recommended for universal first-line screening but may add value in indeterminate or discordant cases, suspected advanced fibrosis or at-risk metabolic dysfunction-associated steatohepatitis, treatment selection and longitudinal monitoring. By integrating technical evidence with recommendations from major international societies, this review provides a practical framework for the use of MRI across the MASLD care pathway.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850076","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":"Regional fat distribution as a novel predictor of fracture risk in inflammatory bowel disease: a DXA-based cohort study.","authors":"Suvan Suntharalingam, Marwan Bukhari","doi":"10.1136/bmjgast-2026-002445","DOIUrl":"10.1136/bmjgast-2026-002445","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether dual-energy X-ray absorptiometry (DXA)-derived femoral and abdominal fat percentage was independently associated with fracture history in adults with inflammatory bowel disease (IBD), with a focus on the glucocorticoid-treated IBD population.</p><p><strong>Methods: </strong>A retrospective cohort study of adults with a confirmed diagnosis of IBD underwent clinically recommended DXA scanning to quantify abdominal and femoral fat mass, bone mineral density (BMD) and total body composition between June 2004 and February 2024 in northwest England. Fracture history was the main outcome. After controlling for hip lean mass, body mass index (BMI), BMD, comorbidities and glucocorticoid exposure, multivariable logistic regression models assessed relationships between regional fat percentages and fracture history. To determine if the association was independent of peripheral lean mass, a subgroup analysis of 300 glucocorticoid-exposed patients and a sensitivity model incorporating hip lean mass were performed.</p><p><strong>Results: </strong>A total of 1302 patients with IBD underwent DXA scanning. Abdominal fat percentage showed a positive correlation throughout the full cohort (OR 1.02, 95% CI 1.001 to 1.037). The correlation remained in patients receiving glucocorticoids (OR 1.06, 95% CI 1.01 to 1.11) and in the lean-mass sensitivity model (OR 1.05, 95% CI 1.01 to 1.09). In all models, there was no correlation between the femoral fat percentage and fracture history. In the full cohort, low BMI was linked to fracture history (OR 2.48, 95% CI 1.02 to 6.04), although BMI (continuous) was only negatively correlated with glucocorticoid exposure (OR 0.91, 95% CI 0.84 to 0.99). After controlling for hip lean mass, BMI and BMD, and glucocorticoid exposure, the link between abdominal fat remained strong.</p><p><strong>Conclusion: </strong>The only regional body composition parameter that was consistently linked to fracture history in patients with IBD, including those receiving glucocorticoids, was abdominal fat percentage. This association held regardless of BMI, BMD and peripheral lean mass. According to these findings, skeletal vulnerability in IBD is linked to this phenotype of abdominal adiposity. To assess potential clinical value and show temporal correlations, prospective studies are required.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788367","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":"Outcomes of risankizumab use in adults with Crohn's disease in a real-world setting (ARISE-CD): a multicentre, retrospective cohort study.","authors":"Thomas D Butler, Anthony Beard, Abosede Ososanya, Emma Parr, Jon Kwok, Hibest Fekadu, Faris Chater, Villa Kakosa, James Morgan, Catherine Bonnar, Karen Kemp, Emma Nixon, Andrew Kneebone, Anish Kuriakose Kuzhiyanjal, Clare Ormerod, Paul P Knight, Elinor Shuttleworth, Rhys Butcher, Kelly Chatten, Ben Crooks, Jimmy K Limdi, Katherine White","doi":"10.1136/bmjgast-2026-002320","DOIUrl":"10.1136/bmjgast-2026-002320","url":null,"abstract":"<p><strong>Objective: </strong>Risankizumab is an interleukin-23 p19 subunit inhibitor, which gained UK approval in May 2023 for the treatment of Crohn's disease. Our aim was to evaluate risankizumab use in a real-world Crohn's disease cohort across North West England.</p><p><strong>Methods: </strong>ARISE-CD is a retrospective, multicentre cohort study of adults with Crohn's disease across nine hospitals in North West England between May 2024 and April 2025. The primary outcome was treatment persistence at 6 months. Secondary outcomes included steroid-free persistence; steroid-free clinical remission (Crohn's Disease Activity Index (CDAI) <150 or Harvey Bradshaw Index (HBI) <5), biochemical remission (C-reactive protein (CRP) ≤5 mg/L and faecal calprotectin ≤250 µg/g) and reporting of adverse events. The cohort was also stratified by prior ustekinumab exposure.</p><p><strong>Results: </strong>131 patients were included. All patients started risankizumab at least 6 months prior to data collection, with a median of 41 weeks (34-52) follow-up and a median of 2 (1-3) prior advanced therapies. 90% had exposure to prior anti-tumour necrosis factor therapy and 56% had been exposed to ustekinumab therapy. 6-month treatment persistence was 91% and 6-month steroid-free persistence was 84%. There was no difference in treatment persistence stratified by prior ustekinumab exposure. At 6 months, 14 out of 21 (67%) patients were in steroid-free clinical remission, and 15 out of 40 (38%) patients were in biochemical remission. In patients with paired results at baseline and 6 months, there was a significant reduction in median CRP (6 mg/L vs 4 mg/L, p=0.002) and median faecal calprotectin (201 µg/g vs 141 µg/g, p=0.001) at week 24. Prior ustekinumab exposure did not impact rates of steroid-free clinical remission or biochemical remission. No new safety signals were noted.</p><p><strong>Conclusion: </strong>Risankizumab was effective in a multicentre, real-world cohort of patients with Crohn's disease, both with and without prior ustekinumab exposure. No new safety signals were noted.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788422","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":"Subclinical carotid atherosclerosis in inflammatory bowel disease: a population-based cross-sectional study.","authors":"Alexander Akhgar, Bernhard Wernly, Alexandra Feldman, Johannes Bauer, Julian Eberhardt, Christian Jung, Bernhard Paulweber, Bernhard Iglseder, Eugen Trinka, Elmar Aigner, Stephan Zandanell","doi":"10.1136/bmjgast-2026-002278","DOIUrl":"10.1136/bmjgast-2026-002278","url":null,"abstract":"<p><strong>Objective: </strong>Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular and cerebrovascular events, but the underlying mechanisms remain unclear. We aimed to assess subclinical carotid atherosclerosis in IBD in a large population-based cohort.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of the Paracelsus 10 000 cohort in Salzburg, Austria. Adults aged 40-77 years underwent standardised clinical evaluation, laboratory testing and bilateral carotid ultrasonography. The primary endpoint was carotid plaque burden; secondary endpoints included plaque presence, intima-media thickness, carotid stenosis, coronary artery calcium and polygenic risk scores. Multivariable ordered logistic regression models were adjusted for age, sex and comprehensive cardiovascular risk measures including Systematic Coronary Risk Evaluation 2 and Life's Essential 8.</p><p><strong>Results: </strong>Among 9723 participants, 70 had IBD and 9653 served as controls. Patients with IBD had higher levels of high-sensitivity C reactive protein (median 0.15 vs 0.12 mg/dL; p=0.039) and lower ferritin levels (86 vs 117 ng/mL; p=0.018). Carotid plaque prevalence (40% vs 38%; p=0.79) and plaque burden distribution (p=0.82) were similar between groups. Intima-media thickness, carotid stenosis, coronary artery calcium score categories and polygenic risk scores were also comparable. In multivariable analysis, IBD was not associated with higher plaque burden (adjusted OR 1.49; 95% CI 0.88 to 2.55; p=0.139).</p><p><strong>Conclusions: </strong>In this population-based cohort, IBD was not associated with increased subclinical carotid atherosclerosis. These findings suggest that cardiovascular risk in IBD may not be fully explained by atherosclerotic burden alone and may involve inflammation-related and prothrombotic mechanisms beyond atherosclerosis.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757739","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":"Industry payments and auditability of financial conflicts of interest in US gastroenterology and hepatology clinical practice guidelines: a cross-sectional analysis.","authors":"Stephanie Hosanna Rodriguez, Leah Zhu, Emily Zhi, Thomas Leventhal, Jonathan D Alpern","doi":"10.1136/bmjgast-2026-002390","DOIUrl":"10.1136/bmjgast-2026-002390","url":null,"abstract":"<p><strong>Objective: </strong>To assess industry payments to guideline authors, disclosure concordance with actual payments, and the auditability of conflict-of-interest governance in contemporary US gastroenterology and hepatology guidelines.</p><p><strong>Methods: </strong>Cross-sectional analysis of adult gastroenterology and hepatology guidelines published between 1 January 2019 and 31 December 2024, by the American Gastroenterological Association, American College of Gastroenterology, and American Association for the Study of Liver Diseases. Author disclosures were compared with manufacturer payments recorded in the Centers for Medicare and Medicaid Services Open Payments database during the 36 months preceding guideline acceptance or publication. Payments were considered relevant when originating from manufacturers of therapies recommended in the guideline.</p><p><strong>Results: </strong>13 guidelines, including 125 author appearances and 102 unique authors, met the inclusion criteria. 61 authors (48.8%) received at least one relevant manufacturer payment, with payments totalling US$1 733 865.58. Median payment among paid authors was US$9644.96. Disclosure discordance ranged from 0% to 85.7% across guidelines. Leadership roles were designated in 2 guidelines, and 4 of 13 met Institute of Medicine transparency standards.</p><p><strong>Conclusion: </strong>Financial relationships between guideline authors and manufacturers of recommended therapies were common, and many guidelines lacked governance structures permitting external audit. Standardised leadership designation and transparent author-level disclosure may strengthen credibility of future guidelines.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677220","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":"Diagnostic accuracy of surveillance tests for hepatocellular carcinoma in cirrhosis: a systematic review and network meta-analysis.","authors":"Gabriel Rogers, Efthymia Derezea, Libby Sadler, Hanyu Wang, Matthew E Cramp, Stephen D Ryder, Kelsey Watt, Penny Whiting, Morwenna Rogers, John Bell, Felicity Oppe, Ken Stein, Nicky J Welton, Hayley E Jones","doi":"10.1136/bmjgast-2025-002155","DOIUrl":"10.1136/bmjgast-2025-002155","url":null,"abstract":"<p><strong>Objective: </strong>For surveillance for hepatocellular carcinoma (HCC) to be effective, tests-including imaging, serological biomarkers (conventional and genomic) and algorithms combining multiple tests-must identify early-stage tumours. We aimed to identify, appraise and synthesise studies reporting the accuracy of all such tests in people with cirrhosis.</p><p><strong>Design: </strong>Systematic review and network meta-analysis of diagnostic test accuracy (NMA-DTA) data.</p><p><strong>Data sources: </strong>MEDLINE and Embase (2005 to September 2025) and a published Cochrane review.</p><p><strong>Eligibility criteria: </strong>English-language, post-2005, one-gate or two-gate studies quantifying diagnostic accuracy of tests to detect HCC in populations wholly comprising people with cirrhosis, excluding those with pre-existing signs and symptoms of HCC.</p><p><strong>Data extraction and synthesis: </strong>Data extracted by one reviewer, checked by a second and made available in an open-access database. We assessed risk of bias using QUADAS-2. We synthesised data using Bayesian NMA-DTA, accounting for tumour stage and incorporating continuous tests across all possible thresholds.</p><p><strong>Results: </strong>We included 170 studies (62 643 participants). Of 115 index tests, 97 were amenable to NMA-DTA. Ultrasound appears no better than alpha-fetoprotein at detecting very-early-stage HCC (sensitivity 0.34 (95% CrI 0.21 to 0.55) vs 0.39 (95% CrI 0.28 to 0.47)), only becoming superior as stage advances. Least affected by stage are contrast-enhanced MRI (sensitivity 0.70 (95% CrI 0.50 to 0.84) very-early; 0.86 (95% CrI 0.73 to 0.94) early; 0.90 (95% CrI 0.67 to 0.98) advanced) and CT (0.68 (95% CrI 0.26 to 0.93) very-early; 0.77 (95% CrI 0.29 to 0.95) early; 0.92 (95% CrI 0.49 to 0.99) advanced). No genomic biomarkers show convincing improvements over combinations of conventional blood-markers. Most studies are at high risk of bias, but conclusions are robust when restricting to studies with favourable methodological characteristics.</p><p><strong>Conclusions: </strong>Using advanced synthesis methods, we found that tests have low sensitivity for detecting early-stage HCC. Given rising prevalence of cirrhosis and HCC, we need better tests and a stronger evidence-base to inform optimal surveillance strategies.</p><p><strong>Prospero registration number: </strong>CRD42022357163.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469136","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":"Changes in the indications for and outcomes of gastrostomy tube placement: an analysis of serial, prospective multi-site audits in Northern England.","authors":"Alice Rose Weidner, Christopher G Mountford, David Oliver, Chris Wells, Jo Hulley, Emma Johns, Nick Thompson","doi":"10.1136/bmjgast-2025-002109","DOIUrl":"10.1136/bmjgast-2025-002109","url":null,"abstract":"<p><strong>Objective: </strong>Gastrostomy tubes placed either endoscopically (percutaneous endoscopic gastrostomy (PEG)) or radiologically (radiologically inserted gastrostomy (RIG)) are established as standard methods for medium to long-term enteral feeding. There is a paucity of large-scale audit data to identify the main indications, complication rates and outcomes of patients having a PEG or RIG in the UK. The aim of our study was to determine changes in the use of and outcomes from gastrostomy tube placement in a large cohort of patients across the North East of England and North Cumbria.</p><p><strong>Methods: </strong>The Northern Nutrition Network is a multidisciplinary network involving all hospitals in the North East of England and North Cumbria-an area with a population of 3.2 million in 2024. We conducted six 3-month cross-sectional prospective audits covering all hospitals where gastrostomies are placed between 2004 and 2022.</p><p><strong>Results: </strong>A total of 889 procedures were performed during the six audit periods. Mean age has decreased from 71 years in 2004 to 63 years in 2022. Estimated incidence of gastrostomy placement in 2022 was 19.2 per 100 000. The most common indication in the first three audits was stroke; however, subsequently, this was replaced by dysphagia due to an ear-nose-throat/upper gastrointestinal malignancy. The use of prophylactic antibiotics increased from 83% to 93% during the 18-year period. 7-day mortality reduced from 2% in 2004 to 1% in 2022. Reduction was demonstrated in 30-day mortality rate from 9% in 2004 to 2.5% in 2022.</p><p><strong>Conclusion: </strong>Changes in gastrostomy placement practice have occurred over time, with a change in the most common indication, a trend to use in younger patients, greater use of prophylactic antibiotics and a reduction in 7-day and 30-day mortality. Dementia no longer appears as an indication for the placement of a gastrostomy, in keeping with international guidelines.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469097","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":"Association between <i>Helicobacter pylori</i> infection and colonic diverticulosis: a retrospective observational study in an asymptomatic Austrian endoscopy-based screening cohort.","authors":"Andreas Völkerer, Sarah Wernly, Georg Semmler, Maria Flamm, Mathias Ausserwinkler, Jutta Horejs-Hoeck, Anabel Berger, Hannah Hofer, Elmar Aigner, Christian Datz, Bernhard Wernly","doi":"10.1136/bmjgast-2026-002450","DOIUrl":"10.1136/bmjgast-2026-002450","url":null,"abstract":"<p><strong>Objective: </strong>Colonic diverticulosis is highly prevalent in ageing populations, yet the role of microbial factors remains unclear. <i>Helicobacter pylori</i> (HP) exerts systemic and microbiome-modulating effects and has been linked to extragastric inflammatory states, rendering an association with diverticulosis biologically plausible. However, this hypothesis has not been examined in asymptomatic screening populations with simultaneous endoscopic diverticulosis classification and histological HP confirmation. This study aimed to investigate whether HP infection is associated with colonic diverticulosis in an asymptomatic Austrian screening cohort.</p><p><strong>Methods: </strong>We performed a retrospective observational study of 5646 asymptomatic adults undergoing screening colonoscopy with concurrent oesophagogastroduodenoscopy (2007-2020). Diverticulosis was classified endoscopically by distribution; HP status was determined histologically from gastric biopsies. Multivariable logistic regression adjusted for metabolic, sociodemographic and lifestyle factors. A subset with follow-up colonoscopy (n=510) was analysed descriptively.</p><p><strong>Results: </strong>Diverticulosis was present in 37% of participants and HP infection in 19%. No association was found between HP infection and diverticulosis in univariable (OR 1.01, 95% CI 0.88 to 1.15; p=0.935) or fully adjusted analysis (OR 0.86, 95% CI 0.72 to 1.02; p=0.078), with an effect size too small to be clinically meaningful. Subgroup analyses by diverticular distribution and interaction analyses across age, sex, metabolic syndrome and lifestyle factors showed consistent null results. In the longitudinal subset, diverticulosis prevalence at follow-up did not differ by baseline HP status (63.9% vs 62.1%; p=0.749).</p><p><strong>Conclusions: </strong>In this large screening cohort with simultaneous endoscopic and histological confirmation, HP infection was not associated with colonic diverticulosis across subtypes or risk strata. These findings do not support HP status as a clinically useful marker of asymptomatic diverticulosis. In future microbiome-focused studies of diverticulosis, HP infection may be best regarded as a potential confounder or marker of broader host, socioeconomic or healthcare-related factors.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454691","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":"Association between GLP-1-based therapy and small-bowel transit time during capsule endoscopy: a prospective, multicentre, observational study.","authors":"Fadi Abu Baker, Melhem Melhem, Osnat Kalnizki, Majd Khader, Michal Dardik, Mifleh Tatour, Rawi Hazzan","doi":"10.1136/bmjgast-2026-002360","DOIUrl":"10.1136/bmjgast-2026-002360","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between glucagon-like peptide-1 (GLP-1) based therapy and small-bowel transit time during capsule endoscopy.</p><p><strong>Methods: </strong>We conducted a prospective, multicentre, observational study of consecutive adults undergoing small-bowel capsule endoscopy for standard clinical indications. Patients receiving GLP-1-based therapy, defined as treatment with a GLP-1 receptor agonist or dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist, were compared with non-exposed controls. The primary outcome was small-bowel transit time. Secondary outcomes included gastric transit time, capsule completion, bowel preparation quality, repeat-examination recommendation and endoscopic findings.</p><p><strong>Results: </strong>Among 129 participants, 34 were receiving GLP-1-based therapy and 95 were non-exposed controls. Exposed patients had longer unadjusted small-bowel transit time than controls (median 311.0 (IQR 252.8-433.0) vs 236.0 (188.0-282.5) min; p<0.001). Gastric transit time was not significantly different between groups (33.5 (15.2-51.8) vs 22.5 (11.0-42.5) min; p=0.263). Capsule completion was numerically lower among exposed patients, but the difference was not statistically significant (91.2% vs 98.9%; p=0.056). Repeat capsule recommendation (11.8% vs 3.2%; p=0.078) and clinically significant endoscopic findings (23.5% vs 34.7%; p=0.322) were also not significantly different. In multivariable linear regression restricted to examinations with calculable small-bowel transit time and complete covariate data, GLP-1-based therapy was independently associated with longer small-bowel transit time after adjustment for age, body mass index, diabetes mellitus and indication for capsule endoscopy (adjusted β+83 min, 95% CI 3.1 to 162.8; p=0.042).</p><p><strong>Conclusion: </strong>GLP-1-based therapy was associated with longer small-bowel transit time during capsule endoscopy. These findings do not support routine discontinuation of GLP-1-based therapy before capsule endoscopy, but they support individualised assessment and larger studies powered to evaluate capsule completion and repeat examination.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454618","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}