Discovery of novel N-(5-chloro-2,4-dimethoxyphenyl)-N-heterocyclic ketone analogs as potent anti-inflammatory agents against ulcerative colitis

As the incidence of ulcerative colitis (UC) has increased globally, there is a great unmet clinical need for efficacious, tolerable, and economical, orally administered drugs for its treatment. To help meet this need, we investigated anti-inflammatory small-molecule drugs with a novel structure, high activity, and high selectivity for the treatment of UC. Here, we designed and synthesized a series of novel anti-inflammatory compounds based on the molecular hybridization strategy by merging fragments from anti-inflammatory drugs. Among them, compound 11a best-exhibited lipopolysaccharide (LPS)-induced inflammation in RAW264.7 cells in vitro. Anti-inflammatory mechanism studies showed that compound 11a inhibited the release of pro-inflammatory cytokines and alleviated the inflammatory process by blocking the activation of the ASK1/p38 MAPKs/NF-κB signaling pathway in LPS-stimulated RAW264.7 cells. Analysis of the in vivo biological activity showed that compound 11a significantly alleviated dextran sodium sulfate-induced ulcerative colitis in mice while demonstrating an excellent safety in acute toxicity tests. Our study provides a novel compound for the treatment of UC that is worthy of further investigation and structural optimization.

Intestinal ultrasound in Crohn’s disease: A systematic review of its role in diagnosis, monitoring, and treatment response

BACKGROUND

Intestinal ultrasound (IUS) has gained prominence as a safe, non-invasive imaging technique for managing Crohn’s disease (CD), offering real-time evaluation without radiation exposure.

AIM

To systematically review the role of IUS in diagnosing, monitoring disease progression, assessing treatment response, and managing complications in CD.

METHODS

A literature search of PubMed and Embase databases was conducted, identifying 207 original research articles published between 1953 and June 2024. The review focused on diagnostic accuracy, disease monitoring, therapeutic utility, and advancements in IUS applications.

RESULTS

IUS has shown high diagnostic accuracy for detecting inflammation, particularly in the ileum and colon, with limitations in jejunal and rectal regions. It is effective in assessing disease activity using parameters like bowel wall thickness (BWT) and vascularity and correlates well with endoscopy and magnetic resonance enterography. IUS can predict early response to biologics, with reductions in BWT serving as an important marker. In known CD, IUS influences clinical decisions during remission, flares, and therapy evaluations. It reliably detects strictures, fistulas, and therapy-related complications. Small intestinal contrast ultrasound (SICUS) can improve the detection of strictures particularly proximal ones. Techniques such as CE-IUS and elastography enhance stricture characterization but require further validation. IUS is also useful in special scenarios like perianal fistulas, pregnancy, post-operative CD, and guiding endoscopic therapy.

CONCLUSION

IUS is a patient-friendly, cost-effective imaging tool that significantly impacts CD management across various stages. Its integration into clinical practice supports early diagnosis, disease monitoring, and therapeutic adjustments. Further studies are warranted to refine advanced techniques and standardize its application for broader use.

Integration of Artificial Intelligence-Enhanced Capsule Endoscopy in Clinical Practice: A Review of Market-Available Tools for Clinical Practice

The integration of artificial intelligence (AI) into capsule endoscopy is transforming gastrointestinal diagnostics by enhancing lesion detection and optimizing reading efficiency. This review focuses on the clinical applications of commercially available AI-powered capsule endoscopy systems, particularly for small bowel evaluation. Recent clinical trials and observational studies are analyzed to assess the diagnostic performance, practical benefits, and limitations of these systems. Additionally, key challenges related to standardization, data quality, and clinical validation are discussed. Currently available AI systems significantly reduce reading times and demonstrate high detection capabilities, depending on the algorithm and device used. However, a substantial number of lesions remain undetected, preventing full reliance on these tools. Future advancements must focus on improving detection rates and validating the clinical relevance of missed lesions. Additionally, standardizing AI algorithms across different capsule systems is essential to ensure consistency, reliability, and broader clinical adoption. Establishing homologation frameworks will be key to achieving uniform performance and seamless integration into routine practice.

DNA methylation changes in thyroid cancer patients infected with SARS-CoV-2

The impact of SARS-CoV-2 infection on thyroid cancer at the genomic level remains poorly understood. The purpose of our study was to determine whether significant DNA methylation changes occur in thyroid cancer tissues from patients with recent SARS-CoV-2 infection. Surgically resected normal thyroid and Papillary (PTC) tissues from three COVID-19-infected PTC patients (Cases) and three prepandemic PTC patients (Controls) were analyzed using DNA methylation EPIC arrays. Differentially methylated probes (DMPs) and differentially methylated regions (DMRs) were identified in normal thyroid and PTC tissues. Functional enrichment analysis was subsequently performed to explore the affected pathways. COVID-19-infected PTC tissues presented distinct DNA methylation profiles, with 6,848 DMPs in PTC tissues compared with 140 in normal thyroid tissues. SARS-CoV-2 infection did not significantly affect normal thyroid tissue by methylation. SARS-CoV-2 infection in PTC tissues was associated with hypermethylation of tumor suppressor genes (RUNX3, PAOX), the Wnt signaling pathway, the HOX gene family, cell adhesion-related genes and hypomethylation in response to virus-related genes. The key DMRs identified in PTC included GPR75, CCDC80, and ENTPD3, suggesting altered cell adhesion, tumor proliferation, and immune evasion. SARS-CoV-2 infection is linked to significant DNA methylation alterations in PTC tissues, with potential implications for tumor progression and aggressiveness. These findings suggest that COVID-19 may influence thyroid cancer biology. Further research is needed to validate these epigenetic modifications, establish causal relationships and determine their clinical relevance.

ECCO Topical Review on Predictive Models on Inflammatory Bowel Disease Disease Course and Treatment Response

BACKGROUND AND AIMS

Inflammatory bowel disease (IBD) poses a clinical challenge due to its variable progression and treatment response. Despite the development of predictive models, their clinical application remains limited due to validation and methodological inconsistencies. The current topical review examines existing predictive models, assesses their relevance, and discusses the barriers to their clinical implementation.

METHODS

An expert panel formed by European Crohn's and Colitis Organisation, including gastroenterologists, surgeons, and clinical epidemiologists, reviewed predictive models on IBD disease course and treatment response. Delphi methodology was applied to develop practice position statements. A practice position was set when at least 80% of participants reached agreement on a recommendation.

RESULTS

Fourteen practice positions and 2 perspective points were developed, highlighting factors included in models predicting IBD disease course and treatment response identified in the literature and barriers to clinical implementation. The appropriate methodological approaches for model development and validation have been defined, while methodological barriers to tackle have been identified. Perspectives on the inclusion of relevant biomarkers, and flexible study design have been outlined.

CONCLUSIONS

This topical review offers practice recommendations and guidance for future predictive models on IBD disease course and treatment response including their implementation in clinical practice.

Clinical application and feasibility of capsule endoscopy in children at a medical center in central Taiwan

BACKGROUND PURPOSE

Capsule endoscopy (CE) is a noninvasive examination for excellent visualization of small bowel mucosal lesions. We aimed to evaluate the clinical efficacy and safety of CE in pediatric patients.

METHODS

From April 2014 to December 2022, CE procedures performed in children younger than 18 years of age at Taichung Veteran General Hospital were analyzed retrospectively.

RESULTS

Among 136 procedures, the completion rate was 95.6% (n = 130), with a median age of 14 years old. Suspicion or evaluation of inflammatory bowel diseases (IBD) (41%) was the most common indication for CE. Other common indications of CE were chronic unexplained abdominal pain (35%) and obscure gastrointestinal bleeding or iron deficiency anemia (21%). No procedure-related complications occurred. The diagnosis of those patients with incomplete study were CD with small bowel stricture, graft-versus-host disease and duodenal ulcers. A total of 86 CE procedures showed positive findings, and the overall diagnostic yield rate was 63.2%. Small bowel ulcers (65.12%) were the most common findings. Overall, 26.5% of CE examinations resulted in a new diagnosis and 44.9% of CE exams led to a change in therapy. For patients with IBD, CE findings resulted in an even higher therapeutic change rate of 48.1%.

CONCLUSION

CE is a safe and feasible diagnostic method to study the small intestine in children, especially for IBD. Incomplete study could be an indicator of positive finding and can potentially be a guide to identify the site of possible strictures.

An artificial intelligence-based diagnostic imaging system with virtual enteroscopy and virtual unfolded views to evaluate small bowel lesions in Crohn's disease

Since even subtle mucosal changes may be depicted using virtual endoscopy created by the three-dimensional reconstruction of MDCT images, we developed a novel diagnostic imaging system that integrates and displays virtual enteroscopy, curved planar reconstruction, and a virtual unfolded view, the width of which changes with increases/decreases in the inner luminal diameter. The system is also equipped with artificial intelligence that superimposes and displays depressed areas, generates an automatic small bowel centerline that connects fragmented small bowel regions, and performs electronic cleansing. We retrospectively evaluated the diagnostic performance of this system for small bowel lesions in Crohn's disease, which were divided into two groups: endoscopically-observable and endoscopically-unobservable. Lesion detection rates for stenoses, longitudinal ulcers with a cobblestone appearance, and scars were excellent in both groups. This system, when used in combination with endoscopy, shows slight mucosal changes in areas in which an endoscope cannot reach due to strictures, thereby extending the range of observation of the small bowel. This system is a useful diagnostic modality that has the capacity to assess mucosal healing and provide extraluminal information.

The importance of vitamin D levels in patients with inflammatory bowel disease

The possible role of vitamin D (VD) in the pathogenesis of inflammatory bowel disease (IBD) and the associations between VD levels and IBD activity remain unclarified. We aimed to assess VD levels in IBD patients and their associations with IBD activity. We evaluated VD levels in Greek patients aged 18-75 years old with Crohn's disease (CD) or ulcerative colitis (UC). Patients were ineligible under the following conditions: history of enterectomy/right colectomy, receiving VD or agent(s) interfering with VD metabolism during the last three months and any comorbidities that influence VD levels. Epidemiologic characteristics, clinical course, laboratory investigations, endoscopic and histologic findings were recorded. In total, 122 patients with CD and 71 with UC were included. Most of them had low levels of VD (90% of CD and 91.5% of UC patients). Patients with clinically active CD or UC had lower levels of VD compared to those in remission (p = 0.009 and p = 0.033, respectively).CD patients with low levels of VD had higher CRP and stool calprotectin compared to those with normal levels of VD (P = 0.032 and P = 0.002, respectively). In UC, patients with pancolitis had lower VD levels compared to patients with proctitis (P = 0.036). In conclusion, the majority of Greek IBD patients have low levels of VD. Clinical activity is related to lower levels of VD. Low compared to normal levels of VD in CD patients are associated with higher CRP and calprotectin levels, so VD levels might serve as an activity marker.

Diagnosing Ulcerative Colitis: Should We Go Beyond the Surface?

Ulcerative colitis is a chronic inflammatory bowel disease characterized by continuous mucosal inflammation of the large bowel. However, by conducting a literature search, it emerges that, although being considered a primary mucosal disorder in a subset of patients, the inflammatory process may extend beyond the mucosal surface. For this reason, we reviewed the pertinent literature to evaluate the evidence related to the aforementioned topic. The literature analysis confirmed that, although ulcerative colitis has to be defined as a primary mucosal disease due to its consistent mucosal onset, it can involve deeper layers of the colonic wall. The inefficacy of anti-inflammatory therapies in a considerable proportion of patients, along with the lack of histologic healing and the persistence of inflammatory status and colonic wall thickening at imaging despite mucosal healing, has led to consider an extension of the disease process beyond the mucosal layer. The recent application of more accurate diagnostic tools, both histological and radiological (i.e., intestinal ultrasound and magnetic resonance), has the potential to underline the early signs of disease extension and progression in order to improve ulcerative colitis clinical management.

Population Pharmacokinetics and Exposure-Response Relationships of Etrolizumab in Patients with Moderately-to-Severely Active Crohn's Disease

This study aimed to characterize the pharmacokinetics (PK) of etrolizumab, an IgG1-humanized monoclonal anti-β7 integrin antibody, and assess its exposure-response (ER) relationship for key clinical outcomes in patients with moderately-to-severely active Crohn's disease. ER analyses were based on data from Phase 3 BERGAMOT trial, which evaluated etrolizumab at 105 or 210 mg during induction phase and 105 mg during maintenance phase. Population pharmacokinetic analysis was performed to characterize etrolizumab PK and identify influential covariates. ER analyses were conducted at end of induction and maintenance for clinical remission, endoscopic improvement, and endoscopic remission. ER modeling was performed using logistic regression, and full covariate model was used to examine the impact of baseline covariates on clinical outcomes. Pharmacokinetics of etrolizumab was best characterized using a two-compartment model with first-order absorption, demonstrating a time-dependent decrease in clearance. Typical maximum reduction of clearance was 22.0% (95% CI: 20.5%-23.5%) with onset half-life of 3.45 (95% CI: 2.84-4.04) weeks. Baseline body weight, albumin, and C-reactive protein were the most impactful covariates for etrolizumab exposure. Based on population PK results, trough concentration at Week 4 of induction was selected as exposure metric. Etrolizumab exposure-response slope was significant (P < .05) for clinical remission, endoscopic improvement, and endoscopic remission final models in maintenance phase, but none of final ER models of induction phase. For all induction ER endpoints, tumor necrosis factor (TNF)-naive patients had significantly higher probability of a favorable outcome at end of induction compared to TNF-experienced patients. In summary, exposure-response was more evident at end of maintenance than at end of induction.

Edible batteries for biomedical innovation: advances, challenges, and future perspectives

In biomedical applications, the demand for advanced electronic devices that enable precise monitoring, targeted therapies, and non-invasive diagnostic tools is steadily increasing to enhance patient outcomes. Edible batteries seamlessly combine biocompatibility, energy efficiency, and safe ingestion, offering a reliable power source for in vivo devices and opening up new possibilities for innovative healthcare solutions. Beyond supporting precise monitoring and advanced therapeutic interventions, edible batteries overcome the inherent limitations of traditional batteries, such as rigidity, toxicity, and environmental concerns. Their unique properties make them essential for advancing precision medicine and promoting sustainable biomedical technologies. This transformative approach marks a significant leap in the evolution of battery technology for biomedical engineering applications. This review systematically categorizes edible batteries into various types, including lithium-based, sodium-based, magnesium-based, zinc-based, and other emerging systems. It further highlights key distinctions in material selection, structural design, and fabrication techniques, examining their influence on electrochemical performance and suitability for biomedical applications. Additionally, the review identifies existing challenges and outlines prospective research directions, paving the way for further advancements in this innovative field.

Recurrence after piecemeal hot-snare endoscopic mucosal resection of 10-20-mm nonpedunculated colorectal polyps: a multicenter cohort study

Guidelines are equivocal on the need for early surveillance colonoscopy (ESC) after piecemeal endoscopic mucosal resection (pEMR) of 10-20-mm nonpedunculated colorectal polyps (NPCPs). This study assessed recurrence rates and associated factors at ESC following hot-snare pEMR of 10-20-mm NPCPs.A retrospective, multicenter cohort study was performed at five hospitals in the Netherlands. Patients undergoing pEMR of 10-20-mm NPCPs (2014-2021) and referred for ESC (range 3-9 months) were included. The primary outcome was recurrence rate at ESC. Secondary outcomes included scar identification rates, both overall and at tattooed sites. A mixed-effects model was used to identify factors associated with recurrence.389 patients undergoing pEMR of 426 NPCPs 10-20 mm (median 15 mm, interquartile range 12.8-20.0 mm) were included. Overall, 262 scars (61.5%; 95%CI 56.8-66.0) and 81.6% of tattooed sites were identified at ESC. The recurrence rate was 35/426 (8.2%; 95%CI 6.0-11.2) overall and 35/262 (13.4%; 95%CI 9.8-18.0) when the scar was identified. Median recurrence size was 5 mm, without high grade dysplasia. No NPCP characteristics were associated with recurrence.This real-world study found a substantial recurrence rate after hot-snare pEMR of NPCPs sized 10-20mm at ESC. ESC scar identification was moderate but improved with tattoo placement. Although early surveillance could be considered to avoid missing recurrence, the small recurrence size and absence of high grade dysplasia suggest that modestly extending the interval beyond that of our study may still allow timely detection of recurrences and metachronous lesions.

Clinical Significance of Small-Bowel Mucosal Changes in Liver Cirrhosis Patients With Suspected Small-Bowel Bleeding: A Capsule Endoscopy Study

BACKGROUND AND AIM

Although the type and prevalence of small-bowel lesions in patients with liver cirrhosis have been reported, the clinical significance of their endoscopic features is unclear. We aimed to clarify their association with small-bowel bleeding in liver cirrhosis patients with suspected small-bowel bleeding.

METHODS

We retrospectively included 165 patients with liver cirrhosis (96 men; median age, 73 years) who underwent capsule endoscopy at our institution: 32 without portal hypertensive enteropathy (Grade 0), 101 with inflammatory-like abnormalities (Grade 1), and 32 with vascular lesions (Grade 2). The main outcome measures were the rates of small-bowel bleeding at the initial bleeding episode and rebleeding. Factors associated with Grade 2 portal hypertensive enteropathy were examined.

RESULTS

At the time of initial bleeding, 66% of patients with Grade 2 portal hypertensive enteropathy had small-bowel bleeding, compared with only 3% of those with Grades 0 or 1 portal hypertensive enteropathy. Furthermore, the cumulative rebleeding rate from small-bowel lesions 1 year after the initial bleeding was 33% in patients with Grade 2, compared to 0% in those with Grades 0 and 1. Colorectal angioectasia, Child-Pugh Grade C cirrhosis, and a history of blood transfusion were independent predictors of small-bowel vascular lesions.

CONCLUSION

Our results suggest that patients with colorectal angioectasia, Child-Pugh Grade C cirrhosis, or a history of blood transfusion have a high risk of small-bowel bleeding and should, therefore, be examined via capsule endoscopy.

State-of-the-Art Evidence for Clinical Outcomes and Therapeutic Implications of Janus Kinase Inhibitors in Moderate-to-Severe Ulcerative Colitis: A Narrative Review

Background/Objectives: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing inflammation and incomplete response to conventional therapies. Although biologics have advanced UC management, many patients with moderate-to-severe disease experience treatment failure, relapse, or adverse effects. This review evaluates the pharmacology, efficacy, and safety of oral Janus kinase (JAK) inhibitors-tofacitinib, upadacitinib, and filgotinib-to guide their clinical use in UC. Methods: A comprehensive literature review was conducted using the PubMed, Embase, Cochrane, and Web of Science databases to identify relevant studies on JAK inhibitors in UC. The review included Phase 3 randomized controlled trials (RCTs), real-world observational studies, and recent network meta-analyses. We assessed pharmacologic profiles, clinical efficacy, and safety data for tofacitinib, upadacitinib, and filgotinib. Additionally, we reviewed emerging pipeline agents and future directions in oral immunomodulatory therapy for UC. Results: All three agents demonstrated efficacy in the induction and maintenance of remission. Upadacitinib showed superior performance, including rapid symptom control, high clinical remission rates, and favorable long-term outcomes in both biologic-naïve and -experienced patients. Tofacitinib offered strong efficacy, particularly in early response, but was associated with higher risks of herpes zoster and thromboembolic events. Filgotinib provided moderate efficacy with a favorable safety profile, making it suitable for risk-averse populations. Meta-analyses consistently ranked upadacitinib highest in clinical efficacy and onset of action. Conclusions: JAK inhibitors offer effective and convenient oral treatment options for moderate-to-severe UC. Upadacitinib emerges as a high-efficacy agent; tofacitinib and filgotinib remain valuable based on patient-specific risk profiles. Future studies are needed to clarify optimal sequencing, long-term safety, and the role of emerging agents or combination therapies.

Utility of the neutrophil-to-lymphocyte ratio and the ratio of neutrophil-to-lymphocyte ratio after and before adverse events for differential diagnosis of immune-related adverse events and bacterial infections in cancer patients treated with PD-(L)1 inhibitors

Differential diagnosis of immune-related adverse events (irAEs) or bacterial infections is sometimes very difficult in cancer patients undergoing treatment with PD-(L)1 inhibitors. This study aimed to assess the effectiveness of the neutrophil-to-lymphocyte ratio (NLR) in distinguishing between irAEs and bacterial infections in cancer patients receiving PD-(L)1 inhibitors. We conducted a retrospective analysis of cancer patients who received at least 1 dose of PD-(L)1 inhibitors at Affiliated Cancer Hospital of Zhengzhou University from 2018 to 2023. We compared the changes in peripheral blood cell counts before and after the occurrence of adverse events, as well as the ratios of the NLR that were closest after the occurrence of adverse events (post-NLR) to the NLR that were closest before the occurrence of adverse events (pre-NLR). Among the 4173 patients who were administered PD-(L)1 inhibitors, 217 individuals experienced a total of 249 irAEs, while 256 patients were diagnosed with 257 bacterial infections. The post-NLR increased significantly compared with pre-NLR in patients with bacterial infection (P < 0.001), while the post-NLR had smaller increase compared with pre-NLR in patients sufffering irAEs (P < 0.001). Notably, the NLR was significantly higher in patients with bacterial infection compared with those with irAEs (P < 0.001). Furthermore, the post-NLR/pre-NLR ratio was higher in the bacterial infection group than in the irAEs group (P < 0.001). The NLR along with the post-NLR/pre-NLR ratio could serve as valuable diagnostic indicators for irAEs and bacterial infections in cancer patients undergoing treatment with PD-(L)1 inhibitors.

Incidence of dysphagia-related safety incidents in older adults across feeding methods: A systematic review and meta-analysis

OBJECTIVE

Dysphagia-related safety incidents encompass near-miss events, no-harm occurrences, or harmful incidents associated with oral or enteral feeding methods. This systematic review and meta-analysis aimed to assess the incidence rates of dysphagia-related safety incidents in older adults across various feeding methods.

METHODS

A comprehensive literature search was conducted using PubMed, Embase, Web of Science, Cochrane Library, and CINAHL databases to identify studies reporting dysphagia-related safety incidents in older adults. The feeding methods analyzed included oral feeding, nasogastric (NG) tube feeding, and percutaneous endoscopic gastrostomy (PEG) tube feeding. Randomized controlled trials (RCTs), non-randomized studies, and cohort studies were included. The analysis adhered to the PRISMA guidelines, and meta-analytic outcomes were presented with 95% confidence intervals (CIs).

RESULTS

A total of 30 studies satisfied the inclusion criteria. The overall incidence rates of safety incidents were 13.8% for oral feeding, 23.9% for NG tube feeding, and 26.5% for PEG tube feeding. Aspiration pneumonia emerged as the most prevalent safety incident across all feeding methods, with incidence rates of 12.0% for oral feeding, 20.6% for NG tube feeding, and 12.4% for PEG tube feeding. Tube feeding methods were associated with diarrhea and wound infection. Additionally, specialized safety incidents were observed for each feeding method: suffocation in oral feeding; gastroesophageal reflux in NG tube feeding; and tube blockage, tube dislodgment, tube leakage, vomiting, nausea, site pain, gastrointestinal hemorrhage, and peritonitis in PEG tube feeding.

CONCLUSIONS

Dysphagia-related safety incidents in older adults demonstrated considerable variability in type and frequency across different feeding methods. Understanding these differences could provide healthcare professionals with valuable insights for targeted risk prediction and proactive management strategies to mitigate such incidents.

Protective effect of Dulaglutide, a GLP1 agonist, on acetic acid-induced ulcerative colitis in rats: involvement of GLP-1, TFF-3, and TGF-β/PI3K/NF-κB signaling pathway

A chronic inflammatory condition of the colon called ulcerative colitis (UC) is characterized by mucosal surface irritation that extends from the rectum to the near proximal colon portions. The rationale of this work was to conclude if dulaglutide (Dula) could protect rats from developing colitis caused by exposure to acetic acid (AA). Rats were randomly divided into seven groups (each with eight rats): Normal control, Dula control, AA (received 2 milliliters of 3% v/v AA through the rectum), Sulfasalazine (SLZ); given SLZ (100 mg/kg) orally from day 11 to day 21 then AA intrarectally on day 22 and Dula groups ( pretreated with 50, 100 or 150 μg/kg subcutaneous injection of Dula - once weekly for three weeks and AA on day 22 to induce ulcerative colitis, colon tissues and blood samples were taken on day 23. By generating colonic histological deviations such as inflammatory processes, goblet cell death, glandular hyperplasia, and mucosa ulcers, Dula dropped AA-induced colitis. Additionally, these modifications diminished blood lactate dehydrogenase (LDH), C-reactive protein (CRP), colon weight, and the weight/length ratio of the colon. In addition, Dula decreased the oxidative stress biomarker malondialdehyde (MDA) and increased the antioxidant enzymes (total antioxidant capacity (TAC), reduced glutathione (GSH), and superoxide dismutase (SOD) concentrations). Dula also significantly reduced the expression of transforming growth factor-1 (TGF-β1), phosphatidylinositol-3-kinase (PI3K), protein kinase B (AKT) signaling pathway, and the inflammatory cytokines: nuclear factor kappa B (NF-κB), interleukin-6 (IL-6), and interferon-γ (IFN-γ) in colonic cellular structures. In addition, Dula enforced the levels of glucagon-like peptide-1 (GLP-1) and trefoil factor-3 (TFF-3) that were crucial to intestinal mucosa regeneration and healing of wounds. By modulating TGF-β1 in conjunction with other inflammatory pathways like PI3K/AKT and NF-κB, regulating the oxidant/antioxidant balance, and improving the integrity of the intestinal barrier, Dula prevented AA-induced colitis in rats.

Multicentre Study of 10,369 Symptomatic Patients Comparing the Diagnostic Accuracy of Colon Capsule Endoscopy, Colonoscopy and CT Colonography

BACKGROUND

During the COVID-19 pandemic, NHS England introduced colon capsule endoscopy (CCE) at scale to support the recovery of endoscopy. Symptomatic patients referred with suspected colorectal cancer (CRC) and a faecal immunochemical test (FIT) ≤ 100 μg Hb/g faeces were offered CCE.

AIMS

To evaluate the safety, diagnostic accuracy and utility of CCE in this setting.

METHODS

Consenting patients, referred on a suspected CRC pathway with FIT ≤ 100 μg Hb/g faeces, were offered CCE, colonoscopy or CT colonography. Each cohort was to be age-, sex-, symptom- and FIT-matched. We performed a paired comparison of findings in those who required colorectal endoscopy after CCE and recorded clinical outcomes.

RESULTS

We recruited 4878 patients for CCE, 5025 for colonoscopy and 466 for CT colonography patients. CCE was safely tolerated by 98.4% of patients. CCE identified a matched mass lesion in all patients with CRC when the examination was complete and adequately prepared. More polyps ≥ 10 mm and 6-9 mm were detected by CCE than by colonoscopy or CT colonography. Per-patient sensitivities for polyps ≥ 10 mm and 6-9 mm were 97% in those with a paired, complete and adequately prepared CCE than colonoscopy. Completion (74%) and bowel preparation adequacy rates (74%) were poorer than those of colonoscopy and CTC (both 88%). However, CCE usefully performed a filter function in 86% of patients.

CONCLUSIONS

CCE is safe and accurate for the diagnosis of colorectal disease. In the suspected CRC pathway, its 'filter function' complements existing colorectal diagnostic services by creating additional capacity.

Panenteric capsule endoscopy in gastrointestinal bleeding - time to change old habits?

PURPOSE OF REVIEW

Capsule endoscopy (CE) is an effective tool for small bowel evaluation. Recent technical advancements, including long-lasting batteries and enhanced optics, have enabled featured capsules (panenteric capsules, PCs) to potentially assess the entire gastrointestinal (GI) tract. The PC provides a potential easy-to-use, comprehensive, single-device approach for evaluating GI bleeding patients. This review critically examines the potential role of PC in patients with GI bleeding by highlighting benefits, limitations, open issues, and future challenges.

RECENT FINDINGS

Evidence on PC for GI bleeding patients remains limited. Two retrospective studies and one recent prospective trial consistently show that when used in the workup of GI bleeding patients, PC is safe, feasible, achieves high diagnostic yield (both in the small and large bowel), and potentially reduces the need for unnecessary colonoscopies. Nevertheless, current challenges include the need for extensive bowel preparation, incomplete colon evaluation, and limited access to trained readers.

SUMMARY

The PC holds promise for optimizing the diagnostic workup of GI bleeding patients. However, significant challenges remain. Robust clinical trials comparing standard diagnostic methods to PC-based workup are needed before the adoption of PC in managing bleeding patients in clinical practice.

Navigating the Complexities of Common Variable Immunodeficiency Enteropathy: From Established Therapies to Emerging Interventions

Common Variable Immunodeficiency (CVID) is a prevalent primary immunodeficiency in adults, marked by low immunoglobulin levels and recurrent infections. This review examines the gastrointestinal complications of CVID, including both infectious and non-infectious manifestations. It highlights therapeutic strategies, from antimicrobials to novel biologics, and the role of immune modulation. The review also explores the impact of gut microbiota dysbiosis on CVID pathogenesis and emphasizes the need for personalized treatment approaches and routine cancer screening due to the elevated risk of gastrointestinal malignancy in CVID patients.

Clinical Significance of histologic healing in IBD: Evidence from randomized controlled trials (RCT) and real world (RW) data

Histologic mucosal healing (HMH) has emerged as a crucial target in managing inflammatory bowel disease, complementing the established goal of endoscopic mucosal healing. This review evaluates the significance of HMH in both Crohn's disease (CD) and ulcerative colitis (UC). In UC, strong evidence shows that HMH correlates with improved long-term outcomes, including reduced hospitalization rates, and decreased need for corticosteroids and colectomy. Histologic healing is increasingly being incorporated as an endpoint in RCTs. Small-molecule therapies, such as S1P modulators and Jak inhibitors, have demonstrated particular efficacy in achieving HMH in UC. Real-world evidence (RWE) further supports HMH's utility as a predictive marker for favorable clinical outcomes in UC. In CD, however, HMH's role is less clear, given challenges in assessing and standardizing histologic healing. RCTs, such as SERENITY and VIVID, show that advanced therapies can achieve HMH in CD, though inconsistent histologic scoring and remission criteria complicate conclusions. Some studies suggest that histologic remission at induction may predict sustained remission, but real-world data offer mixed results regarding its prognostic value. This review provides an overview of current literature, emphasizing the need for standardized histologic assessment and extended studies, particularly for CD, while affirming HMH's growing importance in achieving deeper remission in UC.

Delayed Liver Function Recovery After Right Hepatectomy for Metastatic Liver Tumors: Incidence, Risk Factors, and Impact on Prognosis

BACKGROUND

Systemic therapy, including liver resection, is crucial for treating metastatic liver tumors. Even when radical resection is successful, early recurrence of advanced or metastatic liver tumors may restrict subsequent treatment options, particularly if delayed liver function recovery (DLFR) occurs after hepatectomy. This study focused on DLFR after right hepatectomy for metastatic liver tumors.

METHODS

This study involved a retrospective analysis of 78 patients who underwent right hepatectomy for metastatic liver tumors between 2007 and 2022. DLFR was defined as a modified albumin-bilirubin (mALBI) grade that was lower than that preoperatively or ≤ 2b at 3 months after surgery. Patient characteristics, surgical outcomes, and perioperative factors were compared between patients with and without DLFR. Overall survival (OS) was also assessed in patients with colorectal liver metastases.

RESULTS

The median age was 63, and 6 patients had ASA-PS ≥ 3. Of the primary tumors, 67 were colorectal cancer. The median preoperative indocyanine green retention rate at 15 min (ICG-R15) was 5.8%, and sarcopenia was present in 23 patients. Eight patients had complications of Clavien-Dindo grade ≥ 3a classification. DLFR occurred in 24 patients (30.7%). Univariate analysis identified ASA-PS ≥ 3, ICG-R15 ≥ 10%, sarcopenia, and grade ≥ 3a complications as significant factors. Multivariate analysis found ICG-R15 ≥ 10% (p = 0.021, HR = 4.352) and sarcopenia (p = 0.035, HR = 3.852) to be the predictors of DLFR. Three-year OS was worse in the DLFR group (p < 0.001).

CONCLUSIONS

Approximately 30% of patients developed DLFR following right hepatectomy. DLFR may adversely affect OS, and this risk should be carefully considered, particularly in patients with ICG-R15 > 10% or sarcopenia.

Efficacy and safety of Mirikizumab for ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials

Ulcerative colitis (UC) is a widespread incurable chronic inflammation of the colon mucosa. Currently, oral small-molecule medications targeting Janus kinase or sphingosine-1-phosphate and monoclonal antibodies to TNF-α,α4β7 integrins and Ustekinumab are the lines of treatment for UC. Up to 50% of patients either do not react to initial treatment or lose response over time, emphasizing the need for innovative treatment. Mirikizumab, a humanized IgG4-variant monoclonal antibody, binds to subunit p19 of interleukin-23. This systematic review aims to evaluate Mirikizumab compared to placebo in treating moderate-to-severe active UC. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and using the Population, Intervention, Comparison, Outcome, Study design (PICOS) model for inclusion and exclusion criteria, we systematically reviewed the literature. Our inclusion criteria encompassed randomized controlled trials assessing Mirikizumab efficacy in treating UC across demographics. We employed the Cochrane Risk of Bias tool (RoB1) to investigate bias within included studies across its seven domains. The statistical analysis was conducted using Review Manager Version 5 software. Four studies were included, comparing patients treated with mirikizumab to placebo groups. All doses of mirikizumab administered intravenously demonstrated clinical remission, specifically, the 200 mg and 300 mg doses showed significant efficacy, with risk ratios of 4.74 (95% CI [1.43, 15.69]) and 1.82 (95% CI [1.33, 2.50]), respectively. During the maintenance phase of extension trials, symptoms subsided with a subcutaneous 200 mg dose (RR = 1.46, 95% CI [0.47, 4.51], P = 0.51). To conclude, mirikizumab demonstrates significant efficacy in treating UC, substaintially improving clinical, endoscopic, and histological outcomes.

Use of Metabolic Scores and Lipid Ratios to Predict Metabolic Dysfunction-Associated Steatotic Liver Disease Onset in Patients with Inflammatory Bowel Diseases

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in inflammatory bowel disease (IBD) patients due to chronic inflammation and metabolic disturbances. However, reliable non-invasive biomarkers for MASLD prediction in this population are lacking. This study evaluated the predictive value of metabolic scores and lipid ratios for MASLD onset in IBD patients. Methods: An observational retrospective study was conducted on 358 IBD patients at the "Renato Dulbecco" Teaching Hospital in Catanzaro, Italy, in a period between 1 January 2021 and 31 December 2024. Clinical and laboratory data, including metabolic scores and lipid ratios, were analyzed using the chi-square and Kruskal-Wallis tests as appropriate. Post hoc comparisons were conducted using Dunn's test. Receiver operating characteristic analysis assessed their predictive accuracy for MASLD. p < 0.05 was considered significant. Results: IBD-MASLD patients had a significantly higher body mass index (BMI, 27 ± 4 vs. 22 ± 2 kg/m2; p < 0.001), waist circumference (100 ± 11 vs. 85 ± 4 cm; p < 0.001), other anthropometric parameters, metabolic scores, and lipid ratios than IBD-only patients. The metabolic score for insulin resistance [METS-IR, area under curve (AUC = 0.754)] and waist circumference (AUC = 0.754) exhibited the highest predictive accuracy, followed by the lipid accumulation product (LAP, AUC = 0.737), BMI (AUC = 0.709), and triglyceride/high-density lipoprotein (TG/HDL, AUC = 0.701). Insulin resistance scores, including the homeostasis model assessment of insulin resistance (AUC = 0.680) and triglyceride-glucose index (AUC = 0.674), were of moderate predictive use. The visceral adiposity index (AUC = 0.664) and low-density lipoprotein/high-density lipoprotein (AUC = 0.656) showed lower discriminative ability, while the fibrosis-4 index (AUC = 0.562) had the weakest diagnostic performance. Conclusions: Our findings suggest that MASLD in IBD is primarily driven by cardiometabolic dysfunction. The introduction of the METS-IR, LAP, and TG/HDL into clinical assessments of IBD patients could prove useful in preventing liver and cardiovascular complications in this setting.

Evidence for a Modulatory Effect of a 12-Week Pomegranate Juice Intervention on the Transcriptional Response in Inflammatory Bowel Disease Patients Reducing Fecal Calprotectin Levels: Findings From a Proof-of-Principle Study

This study aimed at investigating the effects of pomegranate juice (POMJ) consumption on inflammatory biomarkers and gene expression in patients with inflammatory bowel disease (IBD) in clinical remission. In this randomized, placebo-controlled trial, 16 subjects with IBD in remission consumed POMJ or placebo for 12 weeks. POMJ consumption significantly reduced fecal calprotectin (FC) and plasma endotoxin levels. Transcriptomic analysis of peripheral blood mononuclear cells revealed upregulation of genes involved in mucosal immunity, including aryl hydrocarbon receptor (AHR), neutrophil cytosolic factor 4 (NCF4), and nuclear factor, interleukin 3 regulated (NFIL3). Urolithin metabotypes were predominantly of the B type, associated with intestinal dysbiosis. No significant changes were observed in serum inflammatory markers or colonic mucosal cytokine expression. POMJ consumption reduced markers of intestinal inflammation and modulated gene expression related to mucosal immunity and barrier function in patients with IBD. These findings suggest the potential of POMJ as a beneficial dietary intervention for maintaining remission in IBD, highlighting the promise of targeted nutritional strategies in managing chronic inflammatory conditions. Further research is needed to elucidate the long-term clinical implications of these molecular changes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03000101.

A network meta-analysis of optimal strategies for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Numerous interventions have been proposed to reduce the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but it remains uncertain which approach is the most effective. The objective of this network meta-analysis was to evaluate and compare different preventive strategies for overall, mild, and moderate-to-severe PEP in both average- and high-risk patients. A systematic search was conducted for randomized controlled trials across the PubMed, Embase, and Cochrane Central databases. The inclusion criteria encompassed studies that featured at least two of the following interventions: pre-procedural administration of 100 mg of rectal diclofenac (D) or indomethacin (I), aggressive hydration utilizing normal saline (NS) or lactated Ringer's solution (LR), 5-french pancreatic duct stent (S), and either a placebo or an active control (C). The interventions were ranked according to their surface under cumulative ranking (SUCRA) values. The study protocol has been registered in PROSPERO (CRD42024538533). Of the total 42 (n = 11,493) identified studies, 23 studies (n = 5,410) were categorized into the average-risk group and 19 studies (n = 6,083) were categorized into high-risk group. Based on SUCRA, I + NS was ranked as the best preventive method for overall and mild PEP in average-risk group. However, I + LR was the most effective method of prevention of moderate-to-severe PEP in this group. In high-risk group, I + S was the best preventive method of overall and mild PEP. However, D was the most effective method of prevention of moderate-to-severe PEP in this group. The findings of this network meta-analysis indicate that endoscopists should consider all available prophylactic options when performing ERCP, rather than favoring one over the others.

Disease Clearance in Ulcerative Colitis: A Narrative Review

Ulcerative colitis (UC) is a chronic relapsing disease with significant associated risks such as colectomy, hospitalization, or colorectal cancer. A treat-to-target approach that mitigates disease activity and progression from an early stage is needed. The latest STRIDE II guidelines advocate for clinical and endoscopic remission as the main therapeutic targets in the management of UC; however, histological remission is increasingly being recognized as an important outcome. The concept of disease clearance, a composite outcome comprising clinical, endoscopic, and histological remission, has been proposed as a potential target for patients with UC and has been precisely defined by the International Organization for the Study of Inflammatory Bowel Disease, with the aim of standardizing its use in clinical practice and research. Despite challenges, including variable standardized definitions and uncertainties regarding the timing of reaching different definitions of remission, disease clearance corresponds to comprehensive disease control, and its use as an outcome could help clinicians to better evaluate the actual status of the disease. Furthermore, achieving disease clearance may be related to an improved disease course, positive long-term outcomes, and an improvement in health-related quality of life. Real-world evidence supports the feasibility of achieving disease clearance with various treatment modalities, including vedolizumab, the only gut-selective antilymphocyte trafficking drug. The aim of this narrative review is to explore the concept of disease clearance in patients with disease clearance, mainly focusing on trials evaluating vedolizumab but also other biologics.

Non-Invasive Tests as a Replacement for Liver Biopsy in the Assessment of MASLD

Metabolic dysfunction-associated steatotic fatty liver disease (MASLD) is a worsening global health issue, affecting over one-third of the adult population and representing the leading cause of liver-related morbidity and mortality. MASLD is not only a key precursor to chronic liver disease, but also a systemic condition that leads to numerous extrahepatic complications, increasing the risk of cardiovascular diseases, chronic kidney disease, type 2 diabetes, and certain cancers. The primary reference method for assessing liver fibrosis, allowing for precise determination of its location and severity, remains liver biopsy. However, it is an invasive procedure and involves certain risks. In recent years, the importance of MASLD diagnosis using noninvasive diagnostic methods has been increasing, including serological markers, methods based on multi-omics, and imaging techniques such as liver elastography. This review presents data on the diagnosis and evaluation of this disease that may find application in future clinical practice. The focus is on presenting both currently used and newly identified noninvasive diagnostic methods that open up the prospect of gradually replacing biopsy in the diagnosis of MASLD.

Non-celiac Enteropathies

PURPOSE OF REVIEW

Non-celiac enteropathies (NCE) can be due to a variety of causes. The workup for NCE includes history, physical, laboratory and histology review and can be difficult. Enteropathies can result in serious illness due to consequences of malabsorption including severe weight loss, nutritional deficiencies, and debilitating diarrhea. Recognition and support of these consequences while investigating underlying etiology is essential.

RECENT FINDINGS

Recent studies in NCEs have focused on improving diagnostic accuracy and predicting long-term outcomes in patients with NCEs. Further, literature has emphasized the importance of histological analysis, with a focus on differentiating between various enteropathies that cause villous atrophy, highlighting the complexity and need for personalized approaches in managing these conditions. Identification of etiologies of NCEs requires review of patients' detailed history, medications, and lab results. Common etiologies include immunodeficiencies, infectious, iatrogenic, and malignant causes. Using a systematic approach can lead to proper diagnosis and tailor treatment choices, benefiting patient outcomes. Supportive nutrition care should be initiated early when applicable to minimize morbidity.

Identification of the M2 Macrophage-associated Gene THBS2 as a Predictive Marker for Inflammatory Cancer Transformation

Ulcerative colitis (UC)-induced colitis-associated colorectal cancer (CAC) has a worse prognosis than sporadic colorectal cancer. And with the incidence of ulcerative colitis on the rise, it is critical to identify new therapeutic targets in time to stop the progression of inflammation to cancer. Through immunohistochemistry (IHC) and Gene Expression Omnibus (GEO) database analysis, we acquired the gene M2DEG, which is differentially expressed in M2 macrophages. The impact of M2DEG on the immune environment and clinical variables was confirmed through various data sets and actual tissue samples. Our findings indicate that patients with UC exhibiting reduced M2 macrophage infiltration tend to have more widespread disease, elevated endoscopic Mayo scores, and a higher probability of developing CAC. Through examining the string of M2DEG between UC and CAC, THBS2 emerged as a key marker. Elevated levels of THBS2 were notably linked to reduced overall survival (OS) and progression-free survival (RFS), and this heightened THBS2 expression played a crucial role in the spread of tumors, as verified by immunohistochemical studies. To sum up, patients with UC exhibiting reduced M2 macrophage infiltration have a higher propensity for CAC development, making THBS2 a crucial focus for converting UC into CAC. Furthermore, identifying antibody analogues targeting THBS2 could potentially lower the likelihood of CAC transformation in patients with UC.

Prevalence of metabolic syndrome in patients with inflammatory bowel disease: a meta-analysis on a global scale

BACKGROUND

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases (CVD). Patients with inflammatory bowel disease (IBD) may be at higher risk of developing MetS due to chronic inflammation, altered adipokine profiles, and the effects of corticosteroid treatment. However, the prevalence of MetS in IBD patients remains inconsistent across studies. This meta-analysis aims to estimate the prevalence of MetS in IBD patients and compare its occurrence between Crohn's disease (CD) and ulcerative colitis (UC).

METHODS

A systematic search was conducted across PubMed, Scopus, Embase, and Web of Science from their inception up to January 19, 2025. Eligible observational studies reporting MetS prevalence in IBD patients were included. Meta-analysis was performed using a random-effects model, with heterogeneity assessed via the I² statistic. Comprehensive Meta-Analysis (CMA) software, version 4.0 was used for analysis.

RESULTS

The pooled prevalence of MetS in IBD patients was 21.8% (95% CI: 14.3-31.6%). The prevalence was higher in UC patients (32.7%, 95% CI: 16.0-55.5%) compared to CD patients (14.1%, 95% CI: 8.6-22.3%). Patients with UC had significantly higher odds of MetS than those with CD (OR = 1.38, 95% CI: 1.03-1.85, P = 0.02). Additionally, IBD patients with MetS were significantly older than those without (MD: 9.89, 95% CI: 5.12-14.67, P < 0.01).

CONCLUSION

In summary, this meta-analysis reveals a notable prevalence of MetS among patients with IBD, particularly in those with UC, where the prevalence is higher than in CD. The analysis also shows that IBD patients with MetS tend to be older, suggesting age as a contributing factor. These findings underscore the need for routine metabolic screening in IBD care, especially in UC and elderly patients.

Epidemiology, pathogenesis, diagnosis, and treatment of inflammatory bowel disease: Insights from the past two years

ABSTRACT

Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is a chronic inflammation of the gastrointestinal tract with unknown etiology. The cause of IBD is widely considered multifactorial, with prevailing hypotheses suggesting that the microbiome and various environmental factors contribute to inappropriate activation of the mucosal immune system in genetically susceptible individuals. Although the incidence of IBD has stabilized in Western countries, it is rapidly increasing in newly industrialized countries, particularly China, making IBD a global disease. Significant changes in multiple biomarkers before IBD diagnosis during the preclinical phase provide opportunities for earlier diagnosis and intervention. Advances in technology have driven the development of telemonitoring tools, such as home-testing kits for fecal calprotectin, serum cytokines, and therapeutic drug concentrations, as well as wearable devices for testing sweat cytokines and heart rate variability. These tools enable real-time disease activity assessment and timely treatment strategy adjustments. A wide range of novel drugs for IBD, including interleukin-23 inhibitors (mirikizumab, risankizumab, and guselkumab) and small-molecule drugs (etrasimod and upadacitinib), have been introduced in the past few years. Despite these advancements, approximately one-third of patients remain primary non-responders to the initial treatment, and half eventually lose response over time. Precision medicine integrating multi-omics data, advanced combination therapy, and complementary approaches, including stem cell transplantation, psychological therapies, neuromodulation, and gut microbiome modulation therapy, may offer solutions to break through the therapeutic ceiling.

The Role of Histology Alongside Clinical and Endoscopic Evaluation in the Management of IBD-A Narrative Review

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions requiring continuous monitoring. Today, endoscopy is the gold standard for assessing disease activity, with histological evaluation providing additional insights. Studies suggest that persistent histological inflammation, despite endoscopic remission, may be associated with a higher risk of relapse in UC, suggesting its role in treatment decisions. In CD, histological assessment is limited by its patchy nature, transmural inflammation and lack of validated scoring systems. Few retrospective studies with conflicting results have examined the prognostic value of histological remission in CD, and its role in predicting long-term outcomes remains unclear. This narrative review aims to summarize and discuss the available evidence regarding the additional value of histological assessment in IBD management. In UC, the ongoing VERDICT study is expected to provide evidence on the impact of incorporating histological remission as a treatment target compared to a strategy based on clinical and endoscopic activity. Recently published interim results indicate that targeting histological remission does not lead to better clinical/biochemical disease activity. Thus, while patients achieving histological healing are associated with better outcomes, the question arises whether achieving histological remission is an intrinsic (biological) characteristic of the patient and indicator of an easier to treat patient group or a result of more effective therapy.

Diagnosis of small bowel inflammation using small bowel capsule endoscopy combined with abdominal CT scan

Background and study aims

Abdominal computed tomography (CT) scans are simple to perform and widely used in evaluating small bowel inflammation. However, detailed evaluation of small intestinal mucosa is difficult with CT. Conversely, small bowel capsule endoscopy (SBCE) is noninvasive and useful for evaluation of mucosal inflammation. We evaluated presence or absence of mucosal inflammation by SBCE in patients with CT findings of suspected small bowel inflammation and analyzed their backgrounds.

Patients and methods

The Lewis score was determined by SBCE, and scores ≥ 135 placed 65 patients in the enteritis group and scores of < 135 placed 87 patients in the pseudoenteritis group.

Results

Blood tests revealed higher C-reactive protein (CRP) levels in the enteritis group ( P < 0.01). Regarding comorbidities, chronic renal failure ( P < 0.01) and carcinoma ( P = 0.05) were more common in the enteritis group, as was use of proton pump inhibitors ( P = 0.02). Target sign, accordion sign, and fat stranding/centipede sign, which are known findings on CT of small intestinal inflammation, were more frequently observed in the enteritis group ( P < 0.01). Small intestinal wall thickness was greater in the enteritis group (5.3 mm vs 3.4 mm, P < 0.01) and the cut-off value was 4.15 mm.

Conclusions

Backgrounds of patients with inflammatory mucosa included high CRP, use of nonsteroidal anti-inflammatory medications, chronic renal failure, and cancer. If a patient with a thickened small intestinal wall (> 4.15 mm) on CT has these characteristics, it may be worth considering performing SBCE.

Novel outcomes in inflammatory bowel disease

Inflammatory bowel diseases (IBD), Crohn's disease (CD), and ulcerative colitis (UC) are lifelong chronic, relapsing, and remitting conditions that culminate in disease progression in many patients. Effective management of CD and UC requires consideration of both short- and long-term treatment outcomes. Historically, short-term outcomes such as clinical and endoscopic remission and symptom relief have been evaluated in clinical trials. With the expansion of treatments targeting underlying disease pathophysiology, there is the opportunity to develop management strategies that improve disease control and patients' lives in both the short and the long term. Researchers have been examining novel outcomes for assessing the efficacy of CD and UC treatments that are important to patients, and also those that go beyond symptomatic improvements or clinical remission. These include new patient-reported outcomes for symptoms, as well as transmural/histological healing and disease clearance that can be more reflective of deeper remission states and disease modification. This review analyses published clinical studies involving patients with UC and CD treated with biologics or small molecule therapies. It highlights novel IBD endpoints employed in published clinical trials and discusses their likely value for assessing disease activity and disease modification, and as predictors of reduced risk of complications and morbidities.

Ultrasound of Bile Ducts-An Update on Measurements, Reference Values, and Their Influencing Factors

Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data published between 1975 and end of 2024 were extracted, discussed, and complemented with the own experiences of the authors. The clinical implications are presented and discussed. Results: For the diameter of the common bile duct, reference values between 5 and 9 mm have been published. The main influencing factors are age and history of cholecystectomy, and other factors to be considered are discussed here. The cut-off for the common bile duct wall is set at 1.5 mm. The literature on measurements of intrahepatic bile ducts is scarce. A diameter of <2-3 mm can be considered normal. The method of ultrasound examination is presented here, as well as a comparison with other imaging methods and their clinical implications. Conclusions: Standardized measurement techniques and normal values in the context of influencing factors are crucial for the ultrasound examination of the bile system.

Recurrence rates and risk factors in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding (OGIB), defined in 2010, involves bleeding from the GI tract that remains unexplained after standard diagnostic procedures. OGIB, which accounts for about 5% of all GI bleeds, poses diagnostic and management challenges, particularly due to the anatomical features of the small intestine. Advances in capsule endoscopy (CE) and balloon-assisted endoscopy have improved the diagnostic and therapeutic landscape for small intestinal lesions.

Objective

To determine the recurrence rate and identify risk factors for recurrence following diagnostic and therapeutic interventions using CE and balloon-assisted endoscopy in patients with OGIB.

Methods

A retrospective cohort study at Gifu University Hospital analyzed CE procedures for patients with OGIB from 2008 to 2022. Patients underwent CE with subsequent treatments based on the findings. Statistical analyses, including Kaplan-Meier and Cox proportional hazards models, were used to estimate cumulative recurrence rates and identify recurrence risk factors.

Results

Out of 417 patients, 65.2% had positive CE findings, leading to therapeutic interventions in 16.3% of cases. The cumulative recurrence rates at 12, 24, and 36 months were 4.3%, 9.0%, and 13.9%, respectively. Liver cirrhosis (hazard rate: 4.15, 95% confidence interval 1.88-9.18, p < 0.01) was identified as a significant risk factor for recurrence.

Conclusions

A significant recurrence rate in OGIB patients, with liver cirrhosis being a major risk factor. Despite diagnostic and therapeutic advances, a comprehensive approach including careful follow-up and consideration of risk factors is essential for management.

Guidelines for endoscopic diagnosis and treatment of inflammatory bowel diseases

In recent years, we have seen a considerable increase in the number of patients with inflammatory bowel diseases of unknown etiology, including both Crohn's disease and ulcerative colitis. Inflammatory bowel diseases can cause intestinal lesions throughout the gastrointestinal tract, necessitating gastrointestinal endoscopy for examining all relevant aspects, especially lesion characteristics, for differential diagnosis and histological diagnosis, to select the appropriate treatment options, determine treatment effectiveness, etc. Specific guidelines are necessary to ensure that endoscopy can be performed in a safe and more tailored and efficient manner, especially since gastrointestinal endoscopy, including enteroscopy, is a common procedure worldwide, including in Japan. Within this context, the Japan Gastroenterological Endoscopy Society has formulated the "Guidelines for the Endoscopic Diagnosis and Treatment of Inflammatory Bowel Diseases" to provide detailed guidelines regarding esophagogastroduodenoscopy, enteroscopy, and colonoscopy procedures for definitive diagnosis, as well as determination of treatment effectiveness in clinical cases of inflammatory bowel diseases.

YouTube as a possible learning platform for patients and their family caregivers for gastrostomy tube feeding: A cross-sectional study

BACKGROUND

Many patients and family caregivers have informational needs, especially regarding gastrostomy care and home gastrostomy tube feeding. YouTube is a potential accessible option for educational resources concerning these topics.

METHODS

This study aimed to explore the educational quality and content of informational YouTube videos. We used "gastrostomy," "G-tube," "enteral feeding," and "enteral nutrition," as search keywords on YouTube on October 3, 2021. A total of 229 videos were evaluated using the global quality scale (GQS) and modified DISCERN scoring system. Variables extracted from the videos included general features, video parameters, and content themes.

RESULTS

The GQS and modified DISCERN scores were 3.31 ± 0.90 and 2.63 ± 1.23, respectively. There were educational quality and differences among videos uploaded by various agencies. Frequent video content themes included "cleaning and dressing a gastrostomy tube," "bolus method," and "replacing a balloon-type of gastrostomy tube."

CONCLUSION

Results showed that YouTube can be a supplemental educational resource for people requiring gastrostomy care and for their caregivers. However, given the open-access nature of YouTube, healthcare professionals' guidance is needed for video selection. Healthcare professionals should know and use specific, reliable resources to effectively guide and educate patients with gastrostomy and their caregivers, enhancing their self-management skills and knowledge.

Ultrasound innovations in abdominal radiology: techniques and clinical applications in pediatric imaging

Contrast-enhanced ultrasound, microvascular imaging, elastography, and fat quantification have varying degrees of utility, with some applications in the pediatric setting mirroring that in adults and having unique uses when applied to children in others. This review will present novel ultrasound technologies and the clinical context in which they are applied to the pediatric abdomen. New ultrasound technologies have a broad range of applications in clinical practice and represent a powerful diagnostic tool with the potential to replace other imaging modalities, such as magnetic resonance imaging and computed tomography, in specific cases.

Predictive accuracy of fecal calprotectin for histologic remission in ulcerative colitis

BACKGROUND/AIMS

Accurate assessment of disease activity is crucial for effective management and treatment of ulcerative colitis (UC). This study evaluated the correlation between clinical, endoscopic, and histologic measures of disease activity in UC.

METHODS

Clinical, biochemical, endoscopic, and histologic disease activity was studied in 347 patients with UC. Agreements among various histologic classification systems, namely the Geboes Score (GS), Continuous GS, Nancy Index (NI), and Robarts Histopathology Index (RHI), were analyzed. The predictive accuracy of fecal calprotectin (FC) for endoscopic and histologic remission was assessed.

RESULTS

We demonstrate a fair to moderate correlation between clinical, endoscopic, and histologic measures of disease activity in UC. There was a robust concordance among GS, Continuous GS, NI, and RHI in distinguishing between patients in histologic remission or activity. The NI detected 75% of patients who met the remission criteria according to the RHI, whereas the RHI identified all patients in remission as defined by the NI. FC levels below 150 μg/g had >70% accuracy in predicting endoscopic remission. FC levels below 150 μg/g showed ≥80% accuracy, and FC levels below 100 μg/g demonstrated ≥ 85% accuracy in predicting histologic remission, regardless of the scoring index applied. Elevated FC levels were associated with both acute and chronic inflammatory infiltrates in biopsy samples.

CONCLUSIONS

FC is a reliable predictor of histologic remission, with higher accuracy at lower thresholds. The GS, Continuous GS, NI, and RHI demonstrate comparable performance. FC could help stratify patients' need for colonoscopy for the assessment of endoscopic and histologic remission.

The predictive value of triglyceride-glucose-high density lipoprotein-body mass index (TGH-BMI) for different degrees of hepatic steatosis and liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD)

BACKGROUND & AIMS

The triglyceride-glucose index (TyG) and triglyceride-glucose body mass index (TyG-BMI) have been identified as potential predictive factors for metabolic dysfunction-associated steatotic liver disease (MASLD). However, they do not include high density lipoprotein (HDL-C), which is closely related to lipid metabolism. Furthermore, there is a lack of comprehensive and longitudinal data to determine the cut-off points for different degrees of hepatic steatosis and liver fibrosis in MASLD. This study aimed to investigate the predictive capability of triglyceride-glucose-high density lipoprotein-body mass index (TGH-BMI) in determining hepatic steatosis and liver fibrosis in MASLD, as well as to establish the predictive cut-off points.

METHODS

We analyzed the relationships of TGH-BMI (TGH-BMI = ln [TG (mg/dL) ∗FBG (mg/dL)/HDL-C (mg/dL)] ∗ BMI (kg/m2)) with different degrees of hepatic steatosis and fibrosis in 35,114 participants who underwent health check-ups. A total of 2262 subjects without MASLD were selected for the analysis of cumulative hazard of hepatic steatosis and liver fibrosis in TGH-BMI dichotomous groups over a follow-up period of 1001 days.

RESULTS

Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) demonstrated a consistent upward trend as TGH-BMI increased across quartile groups, as determined by One-way analysis of variance (P < 0.001). TGH-BMI and CAP, LSM exhibit distinct curve-like relationships between males and females when utilizing smoothing functions and conducting threshold effect analysis (P < 0.05). In males, prior to the inflection point at TGH-BMI = 177.733, there was a significant increase of 0.807 in CAP for every 1 unit increase in TGH-BMI (P < 0.05), after the inflection point, there was still an increase of 0.417 in CAP for every 1 unit increase in TGH-BMI (P < 0.05); There was no significant correlation between LSM and TGH-BMI before the first inflection point at TGH-BMI = 131.689 (P > 0.05) and after the second inflection point at TGH-BMI = 253.268 (P > 0.05). Between the first and the second inflection, LSM showed an increase of 0.015 for every 1 unit increase in TGH-BMI (P < 0.05). In females, before the inflection point at TGH-BMI = 94.686, there was a significant increase of 0.272 in CAP for every 1 unit increase in TGH-BMI (P < 0.05), after the inflection point, there was a notable change as CAP increased by 0.806 for every 1 unit increase in TGH-BMI (P < 0.05). There was no significant correlation between LSM and TGH-BMI before the inflection point at TGH-BMI = 118.098 (P > 0.05), after the inflection point, LSM showed an increase of 0.017 for every 1 unit increase in TGH-BMI (P < 0.05). Notably, TGH-BMI has been shown to be a strong predictor for the severity of hepatic steatosis and liver fibrosis in MASLD. The Area Under Curves (AUCs) for hepatic steatosis, moderate or above hepatic steatosis, severe hepatic steatosis and liver fibrosis in males were 0.845, 0.846, 0.882 and 0.668 respectively, the AUCs for hepatic steatosis, moderate or above hepatic steatosis, severe hepatic steatosis and liver fibrosis in females were 0.855, 0.895, 0.939 and 0.705 respectively (P < 0.05). In individuals without MASLD, the cumulative hazard of hepatic steatosis was found to be strongly associated with the dichotomy of increased TGH-BMI (TGH-BMID2: Hazard Ratio (HR) = 2.412, 95 % Confidence interval (CI): 2.0164-2.9071, P < 0.0001), while the same is true in liver fibrosis (TGH-BMID2: HR = 1.454, 95 % CI: 1.0633-1.9883, P = 0.0191).

CONCLUSIONS

The TGH-BMI demonstrates a strong predictive value for hepatic steatosis and liver fibrosis, with significantly different cut-off points for men and women. Therefore, it is important to consider the potential need for gender-specific cut-off points for triglyceride, glucose, high density lipoprotein and body mass index in clinical practice. In individuals without MASLD, a higher TGH-BMI is associated with an increased risk of developing MASLD in the future.

Comparison of Vonoprazan Triple Therapy, Bismuth Quadruple Therapy, and Amoxicillin Therapy for Helicobacter pylori Infection: A Systematic Review

Helicobacter pylori (H. pylori) infection is a significant global health concern, leading to life-threatening gastric disorders. Despite innovation in standardised treatment protocols, it faces challenges due to rising antibiotic resistance, creating the need for alternative treatments. There is a need to synthesize evidence from recent trials to enhance knowledge in critical care practice. This review synthesizes current trial data to strengthen the understanding of the literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. The literature was searched using text terms and controlled vocabulary, employing Boolean operators "AND," "OR," and various combinations across PubMed, Embase, and the Cochrane Library. Open-access, full-text English papers from 2014 to 2024 involving human-based studies were searched. The quality was assessed using Revised Cochrane Risk of Bias Tool for Randomized Trials, Version 2.0 (ROB 2.0), and the evidence was appraised using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 68 articles were retrieved through the initial search. After screening and verifying eligibility according to the pre-specified inclusion criteria, the methodological quality of 25 randomized controlled trials (RCTs) was assessed using the Cochrane Risk of Bias 2.0 tool. The GRADE tool categorised three high-ROB RCTs as "low quality." However, four RCTs had low ROB and were classified as "high quality." Eighteen RCTs had uncertain ROB, lowering the evidence by one point to "moderate quality." The study found that bismuth-quadruple therapy is an excellent first-line treatment for H. pylori infection, although its adverse effects restrict its use. Vonoprazan Triple Therapy offers a superior eradication rate with improved tolerability, making it an effective treatment option. However, high doses of amoxicillin emerge as the safest and most effective treatment, especially where clarithromycin resistance is prevalent. The management of H. pylori infection is a dynamic process. As resistance patterns evolve and new treatments are developed, it is important for healthcare providers to stay informed about emerging options. Personalized treatment, taking into account patient preferences, tolerability, and concerns about resistance, will likely continue to offer the best chance for successful eradication. Ultimately, the goal is to select the most suitable therapy for each patient, ensuring both the effectiveness and comfort of the treatment.