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        <title>Frontiers in Gastroenterology | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/gastroenterology</link>
        <description>RSS Feed for Frontiers in Gastroenterology | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-14T16:02:52.249+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1716349</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1716349</link>
        <title><![CDATA[Comparative analysis of anal sphincter-preserving surgical techniques in ultra-low rectal cancer]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Hongjun Yuan</author><author>Jun Bu</author><author>Peng Zhang</author>
        <description><![CDATA[Ultra-low rectal cancer refers to a tumor situated very close to the anal verge, typically within 3 cm from the proximal end of the anal dentate line. Its location creates significant challenges for achieving clear surgical margins necessary to achieve local tumor control while preserving sphincter function to minimize the risk of developing fecal incontinence and other complications.This review summarizes six sphincter-preserving techniques for ultra-low rectal cancer: local excision, low anterior resection(LAR, with or without prophylactic ileostomy or ileal stent), intersphincteric resection (ISR), modified Bacon and Parks procedures, transanal total mesorectal excision (TaTME), and Natural Orifice Specimen Extraction Surgery with Precision Functional Sphincter-Preserving Surgery(NOSES-PPS). While most approaches achieve satisfactory oncological outcomes, postoperative anal function remains a major concern. Preliminary evidence suggests NOSES-PPS may offer benefits in preserving anal function, though current studies are limited by small sample sizes and lack of large-scale trials. Optimal outcomes depend on patient selection, surgical expertise, and perioperative management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1614154</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1614154</link>
        <title><![CDATA[Case Report: Massive rectal bleeding from stercoral ulcers in a pediatric patient]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Paolo Quitadamo</author><author>Antonia Pascarella</author><author>Linda di Napoli</author><author>Maria Giovanna Puoti</author><author>Sara Isoldi</author><author>Ludovica Carangelo</author><author>Paolo Siani</author>
        <description><![CDATA[A 10-year-old patient was admitted to the pediatric sub-intensive care unit due to massive rectal bleeding and severe acute anemia. His medical background included Asperger syndrome and a history of chronic constipation not adequately addressed by medical therapy. Colonoscopy showed two deep ulcers in the rectum and sigmoid colon of approximately 4 cm in diameter, which were diagnosed as stercoral ulcers related to stercoral colitis, a rare inflammatory form of colitis that occurs in patients with refractory constipation. Stercoral colitis has been mainly described in elderly patients with dementia or in bedbound patients and only occasionally in adults with psychiatric disorders. To the best of our knowledge, this is the first case of massive rectal bleeding from stercoral ulcers in a pediatric patient.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1681142</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1681142</link>
        <title><![CDATA[U.S.A. trends in intrahepatic and bile duct cancers from 1999–2023]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Samuel W. Berg</author><author>Taylor Billion</author><author>Abubakar Tauseef</author>
        <description><![CDATA[Liver and intrahepatic bile duct malignancies are an increasing cause of mortality in the United States due unclear reasons over the past 20 years, perhaps proportionately due to overall increase in age of the US population and improvement of diagnostic/screening strategies. This study utilizing the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, investigated trends of demographic (gender, race, age group) and geographical differences in liver and intrahepatic bile duct cancer related mortality. Average annual percentage changes were assessed using the CDC WONDER data base with respect to age-adjusted mortality rates (AAMR) and annual percentage change (APC). This study used the Joinpoint Regression Program to determine statistical significance of mortality trends between 1999 and 2023. During this study period (1999-2023), overall higher mortality rates were noted in the American Indian and Alaskan native population and a decrease in mortality in the Asian and Pacific Islander population, with the South and West regions having the highest AAMR. Furthermore, mortality rates demonstrated significantly greater trend in liver and intrahepatic bile duct cancers in males than in females during the entire study period. These results serve to inform on demographics that resources should be focused towards to make policy and encourage screening and diagnosing for at risk groups and regions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1783772</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1783772</link>
        <title><![CDATA[Current status of 5-aminosalicylic acid in Crohn’s disease treatment: a nationwide survey and analysis of perspectives and practice patterns among inflammatory bowel disease physicians]]></title>
        <pubdate>2026-04-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yuanli Li</author><author>Changxin Chen</author><author>Chengdang Wang</author>
        <description><![CDATA[ObjectiveTo investigate the perspectives and clinical practice patterns of inflammatory bowel disease (IBD) physicians regarding the use of 5-aminosalicylic acid (5-ASA) in Crohn’s disease (CD).MethodsA 21-item questionnaire was distributed to IBD physicians across various regions in mainland China via WeChat. The survey evaluated prescription frequencies, indications, dosages, and physician rationales. The questionnaire was pilot-tested among 30 clinicians of varying seniority levels to ensure clarity and content validity. Responses were anonymized, and duplicate submissions were prevented through WeChat account verification. Statistical analysis employed the chi-square test.ResultsAmong 615 respondents, 90.4% reported prescribing 5-ASA for CD patients. It was primarily used for mild disease (91.7%), colonic involvement (77.9%), and non-stricturing, non-penetrating phenotypes (91.4%). For induction therapy, 58.1% of physicians utilized 5-ASA, with 89.2% employing it in combination regimens (predominantly with corticosteroids, 90.3%). Furthermore, 83.1% prescribed 5-ASA for maintenance therapy. The primary rationales cited were its favorable safety profile (75.5%) and perceived efficacy in mild cases (68.2%).ConclusionsDespite unequivocal evidence and international guidelines recommending against the routine use of 5-ASA in CD, it remains pervasively prescribed by Chinese clinicians. This highlights a profound discrepancy between evidence-based guidance and real-world practice. Such therapeutic inertia risks delaying the initiation of highly effective therapies, underscoring an urgent need for targeted continuing medical education to optimize CD management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1735281</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1735281</link>
        <title><![CDATA[Quantitative classification of pancreatic atrophy: the İstanbul morphometric pancreatic atrophy classification based on CT and MRI measurements]]></title>
        <pubdate>2026-04-22T00:00:00Z</pubdate>
        <category>Methods</category>
        <author>Fatih Öner Kaya</author><author>Esra Ümmühan Mermi</author><author>Alev Öztürk Günaldı</author><author>Haydar Kaan Karataş</author><author>Uğur Can Demir</author><author>Pınar Mert</author><author>Hüseyin Öztürk</author><author>Şule Sena Mazlum</author><author>Çağdaş Enginoğlu</author>
        <description><![CDATA[BackgroundPancreatic atrophy (PA) is a progressive reduction in pancreatic parenchymal volume, accompanied by acinar cell loss, fibrosis, and fatty infiltration. It is an important radiological marker of glandular damage associated with physiological aging, chronic inflammatory diseases, and metabolic disturbances, such as diabetes mellitus and obesity. However, PA is still reported mainly using subjective terms, which leads to inter-observer variability and limits reliable clinical correlation and longitudinal follow-up.PurposeThis study aimed to introduce and validate the İstanbul Morphometric Pancreatic Atrophy Classification (IM-PAC), a four-tier morphometric grading system based on CT and MRI measurements, and to evaluate its association with graded CP severity features (CP).MethodsIn this retrospective single-center study, 280 abdominal CT and MRI examinations performed in 2023 were analyzed. Pancreatic head, body, and tail thicknesses were measured at standardized anatomical landmarks. Chronic pancreatitis (CP)–related imaging features were graded using predefined ordinal severity scales for ductal abnormalities and MRI-defined fibrosis. Analyses used true modality-specific denominators (CT n = 168; MRI n = 112). Inter-observer reproducibility was assessed using intra-class correlation coefficients (ICC) and quadratic weighted Cohen’s kappa.ResultsIM-PAC grades were distributed as Grade 0 (n = 54, 19.3%), Grade 1 (n = 119, 42.5%), Grade 2 (n = 93, 33.2%), and Grade 3 (n = 14, 5.0%). Increasing IM-PAC grade was significantly and monotonically associated with ductal abnormality severity (Spearman ρ = 0.52, p < 0.001) and MRI-defined fibrosis severity (ρ = 0.48, p < 0.001). Calcifications assessed in the CT subgroup (n = 168) showed progressive enrichment across grades (p < 0.001). Inter-observer agreement was excellent for thickness measurements (ICC = 0.89; 95% CI: 0.84–0.92) and substantial for ordinal ductal and fibrosis grading (weighted κ = 0.81 and 0.78, respectively).ConclusionBy integrating severity-based CP grading, IM-PAC provides a reproducible and clinically relevant morphometric framework for quantifying pancreatic atrophy.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1729501</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1729501</link>
        <title><![CDATA[The challenging diagnosis of sinistral portal hypertension in a patient with liver cirrhosis: a case report and literature review]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Natalia Altarsha</author><author>Adrian Raoul Kobe</author><author>Emanuel Burri</author><author>Magdalena Filipowicz Sinnreich</author>
        <description><![CDATA[BackgroundLeft-sided portal hypertension (LSPH) is commonly associated with pancreatic disease and typically manifests with gastrointestinal bleeding, but not with ascites or hypoalbuminemia. The coexistence of LSPH with liver cirrhosis complicates diagnosis and management, as standard imaging often fails to identify the underlying cause of portal hypertension-related complications.Case presentationWe report a case of a 59-year-old man with decompensated alcohol-related cirrhosis and prior pancreatic surgery, who presented with recurrent gastrointestinal bleeding, severe hypoalbuminemia, and treatment-refractory ascites, all of which persisted despite placement of a transjugular intrahepatic portosystemic shunt (TIPS). Diagnostic work-up included repeated imaging and hemodynamic measurements. Importantly, invasive splenoportography was the only approach that allowed the detection of a hemodynamically significant splenic vein stenosis, and subsequent percutaneous transluminal angioplasty (PTA) led to rapid clinical improvement.Key findingStandard imaging failed to detect a splenic vein stenosis, which was identified only by invasive phlebography performed via the already placed TIPS. Following PTA, ascites resolved, serum albumin normalized, and no further gastrointestinal bleeding occurred. To our knowledge, this is the first case report describing the full reversal of such a constellation of symptoms after treatment of splenic vein stenosis.ConclusionThis case demonstrates that splenic vein stenosis can cause both hemorrhagic and non-hemorrhagic complications in patients with cirrhosis. Recognition and interventional treatment of LSPH may reverse refractory ascites and hypoalbuminemia, highlighting the importance of high clinical suspicion and invasive evaluation in complex portal hypertension cases.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1720586</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1720586</link>
        <title><![CDATA[Case Report: Hepatitis and autoimmune hemolytic anemia induced by EBV-associated infectious mononucleosis]]></title>
        <pubdate>2026-04-17T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Akram Alnounou</author><author>Henry Zou</author><author>Madison C. Laird</author><author>Sophie Numbers</author><author>Christopher Visak</author><author>Sage Bilsland</author><author>Neil Hughes</author><author>Eric Martin Sieloff</author>
        <description><![CDATA[Epstein-Barr virus (EBV) typically causes infectious mononucleosis, but in rare cases, it may lead to complications such as autoimmune hemolytic anemia (AIHA) and hepatitis. We report the case of an 18-year-old previously healthy female who presented with jaundice, red urine, and arthralgia. Laboratory workup revealed direct hyperbilirubinemia, elevated transaminases, and a direct antiglobulin test positive for IgG (negative for C3d), consistent with warm autoimmune hemolytic anemia in the context of EBV infection. Imaging ruled out biliary obstruction. The patient was managed conservatively, with cautious steroid use, and demonstrated clinical improvement without progression to hepatic failure. This case underscores the importance of recognizing atypical hepatic presentations of EBV and carefully managing overlapping autoimmune complications.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1754027</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1754027</link>
        <title><![CDATA[Primary prevention in liver cirrhosis patients with esophageal varicesa: a systematic review and network meta-analysis]]></title>
        <pubdate>2026-04-16T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Feng Li</author><author>Xiaoyi- Zhang</author><author>Jia-li Chi</author><author>Xuemei Zhang</author><author>Yu-jing Zhou</author><author>Han-fang Xu</author><author>Kai Zhang</author><author>Yi-jing Ren</author><author>Xiu-yan Wei</author>
        <description><![CDATA[ObjectiveTo compare the efficacy and safety of different primary preventive measures for esophageal variceal bleeding using a network meta-analysis.MethodsRandomized controlled trials (RCTs) on primary prevention were retrieved from PubMed, Cochrane Library, Embase, and Web of Science. Primary outcomes were the incidence of variceal bleeding, all-cause mortality, All-Cause Bleeding and Bleeding-Related Mortality. Secondary outcomes included adverse events and other decompensation events. Study quality was assessed with the Cochrane Risk of Bias tool. Data were analyzed using Revman 5.4 and Stata 16.0.ResultsA total of 50 RCTs (6510 patients) evaluating 16 interventions were included. For reducing bleeding incidence, the combinations Midodrine + Propranolol (Mido+PPL), Carvedilol + Endoscopic Variceal Band Ligation (Carv+EVBL), and Fuzheng Huayu Capsule + Propranolol (FZHYJN+PPL) were superior. For lower all-cause mortality, Carv+EVBL, Mido+PPL, and Nadolol + Isosorbide Mononitrate (Nado+ISMN) were favorable. Carv+EVBL, EVBL, and Endoscopic Injection Sclerotherapy (EIS) were better for reducing bleeding-related mortality. Regarding safety, Mido+PPL, Nadolol (Nado), and Carvedilol (Carv) had fewer general adverse events, while Isosorbide Mononitrate (ISMN), Mido+PPL, and Carv had lower rates of other decompensation events.ConclusionBased on low-certainty evidence, Mido+PPL demonstrated a favorable balance of efficacy and safety and is recommended as a preferred option. Mido+PPL, Carv+EVBL, and FZHYJN+PPL are recommended for primary prophylaxis in cirrhosis. For Child-Pugh A/B patients, Mido+PPL, Carv+EVBL, and FZHYJN+PPL are suggested, with EVBL as an alternative for those intolerant to drugs. EVBL may be considered for Child-Pugh C patients. Mido+PPL is recommended for prophylaxis within one year, FZHYJN+PPL for up to two years, and Carvedilol (alone or with EVBL) for long-term management beyond two years. Carvedilol and Propranolol showed superior net clinical benefit over Nadolol and Timolol. Although Nadolol (alone or with ISMN) may reduce mortality, its higher adverse event rate precludes it as a first-line strategy. FZHYJN, while effective, may increase the risk of other decompensation events.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1742374</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1742374</link>
        <title><![CDATA[Case Report: A rare presentation of gastrointestinal amyloidosis: unmasking the hidden culprit of chronic epigastric pain and weight loss]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>FNU Veena</author><author>Muhammad Rizwan Akram</author><author>Mohamed Farag</author><author>Priscilla Lajara Hallal</author><author>Elona Shehi</author>
        <description><![CDATA[Amyloidosis is a rare, heterogeneous condition characterized by extracellular deposition of misfolded protein fibrils, resulting in organ dysfunction. Gastrointestinal amyloidosis (GIA), an uncommon manifestation, is often underdiagnosed due to its nonspecific symptoms, such as weight loss, abdominal pain, and diarrhea. Early recognition and accurate amyloid typing are crucial, as treatment strategies depend on the specific subtype involved. We report a case of a 42-year-old African male presenting with chronic epigastric pain, significant weight loss (BMI: 17.1), and a history of GERD. He had recently traveled to Equatorial Guinea. His symptoms, including nausea, decreased appetite, constipation, and persistent epigastric pain, were unresponsive to proton pump inhibitors. On examination, he was hypotensive and tachycardic. Laboratory workup revealed hyponatremia and elevated troponin T. Imaging showed fecal impaction and pyloric edema. Upper endoscopy and colonoscopy with biopsies confirmed amyloid deposition in the stomach, duodenum, ileum, and colon. Congo red staining demonstrated classic apple-green birefringence under polarized light. Cardiac evaluation revealed reduced global longitudinal strain. Serum studies showed elevated free lambda light chains and an IgG-lambda monoclonal band, while the urine protein/creatinine ratio was 361 mg/g, consistent with proteinuria. Chronic hepatitis B infection with detectable HBV DNA and elevated gamma/delta T cells on the lymphoma panel raised concerns for an underlying T-cell lymphoproliferative disorder. This case highlights the diagnostic complexity of gastrointestinal amyloidosis with multisystem involvement. The patient’s presentation, along with elevated free light chains and monoclonal gammopathy, raised suspicion for AL amyloidosis, though chronic hepatitis B and possible lymphoproliferative disease kept AA amyloidosis in the differential. Consistent with the literature, vague gastrointestinal (GI) symptoms often delay diagnosis, underscoring the role of Congo red staining and mass spectrometry for confirmation and subtype identification. Recent trials support daratumumab for AL and patisiran/inotersen for ATTR amyloidosis. Early, accurate diagnosis is key to initiating appropriate therapy and improving outcomes, with multidisciplinary involvement crucial for optimal care.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1802268</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1802268</link>
        <title><![CDATA[Tangled contacts: mitochondrial interactions with cellular organelles in acute pancreatitis]]></title>
        <pubdate>2026-04-10T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Serge Chooklin</author><author>Serhii Chuklin</author>
        <description><![CDATA[ObjectiveMitochondria in pancreatic acinar cells function as central hubs integrating calcium signaling, ATP production, redox balance, autophagy, secretion, and cell-death regulation through dynamic interactions with other organelles.AimTo summarize current evidence on mitochondria–organelle interactions in pancreatic acinar cells and their relevance to acute pancreatitis.MethodsWe performed a narrative review of experimental and translational studies addressing mitochondrial interactions with the endoplasmic reticulum, lysosomes, autophagosomes, peroxisomes, the cytoskeleton, plasma membrane, nucleus, lipid droplets, and secretory granules in pancreatic acinar cells and experimental acute pancreatitis.ResultsMitochondria–endoplasmic reticulum contacts emerged as major determinants of pathological Ca2+ transfer, mitochondrial depolarization, and ATP depletion. Impaired crosstalk with lysosomes and autophagosomes disrupted mitophagy and favored the persistence of dysfunctional mitochondria, defective vacuolar processing, and inflammatory amplification. Altered functional coupling with peroxisomes and lipid droplets intensified oxidative stress, fatty-acid disequilibrium, and lipotoxic injury, particularly in metabolically unfavorable settings. Disturbed interactions with the cytoskeleton and plasma membrane impaired mitochondrial positioning, local Ca2+ buffering, and the spatial organization of stimulus–secretion coupling. Mitochondria-to-nucleus signaling promoted stress-responsive and proinflammatory transcriptional programs, while mitochondrial failure in the apical secretory region indirectly facilitated defective exocytosis and premature zymogen activation. Collectively, these alterations shifted acinar cells from adaptive stress responses toward necrosis, local pancreatic damage, systemic inflammation, and organ failure.ConclusionsMitochondria-associated inter-organellar networks are integral to acinar-cell homeostasis and critically influence the initiation and progression of acute pancreatitis. Their selective stabilization may represent a mechanistically grounded therapeutic direction.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1681972</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1681972</link>
        <title><![CDATA[Case Report: Endoscopic anal papillectomy combined with ligation: a new approach for the treatment of grade IV hemorrhoids (with video)]]></title>
        <pubdate>2026-04-07T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xiaopan Lv</author><author>Mingli Zhu</author><author>Xianzhong Zeng</author><author>Zheng Li</author><author>Kaitong Jiang</author><author>Xuemin Yuan</author>
        <description><![CDATA[Background and aimsHemorrhoids represent the most prevalent anorectal disorder globally. They are categorized into three types based on location: internal, external, and mixed hemorrhoids. Furthermore, internal hemorrhoids are classified from I to IV, depending on their appearance and degree of prolapse. Surgical intervention is frequently required for Grade III-IV and mixed hemorrhoids, which exhibit complex and severe symptoms. The challenges of these surgical procedures include extensive incisions, substantial intraoperative bleeding, intense postoperative pain, and a heightened risk of complications. Consequently, the exploration of alternative therapies continues.MethodsThis report introduces an innovative endoscopic technique employed to treat a female patient suffering from Grade IV hemorrhoids for three years. Utilizing an endoscope, the prolapsed hemorrhoid and hypertrophic anal papillae were progressively excised with a snare, followed by the application of a ligator to ligate the lax mucosa above the dentate line at multiple sites, thereby preventing future prolapse.ResultsThe procedure resulted in minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up.ConclusionThis technique is particularly innovative as endoscope facilitates a clearer surgical view and more precise manipulation, thus minimizing damage to the rectal mucosa and anal skin. Furthermore, this technique can be utilized to concurrently remove hemorrhoids during gastrointestinal endoscopy, which will alleviate the patient’s multiple suffering and save money and time. This method offers a new direction for treating Grade IV hemorrhoids. Longer follow-up periods and larger sample size comparative studies are needed in the future to verify its safety and efficacy.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1699553</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1699553</link>
        <title><![CDATA[Positioning double-balloon enteroscopy in the diagnostic algorithm for suspected small bowel Crohn’s disease: a retrospective analysis of decision-making at a tertiary referral centre]]></title>
        <pubdate>2026-04-01T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Thomas Sheehan</author><author>Cormac Hegarty</author><author>Roisin Connaughton</author><author>Barry Hall</author><author>Orlaith B. Kelly</author>
        <description><![CDATA[BackgroundSmall bowel capsule endoscopy (SBCE) enables non-invasive mucosal assessment of the small bowel, while double-balloon enteroscopy (DBE) allows histological confirmation and therapeutic intervention. Appropriate patient selection is essential to maximise diagnostic yield and minimise unnecessary invasive procedures.MethodsWe performed a retrospective analysis of patients referred for investigation of suspected small bowel Crohn’s disease over a two-year period at a tertiary referral centre. Demographic data, prior investigations, SBCE findings, and subsequent DBE decisions were recorded. The primary outcome was the decision to proceed to DBE. Secondary outcomes included the diagnostic yields of SBCE and DBE. Multivariate logistic regression was used to identify factors associated with DBE referral.ResultsNinety-eight patients with complete data were included. SBCE was performed as the initial investigation in 90.8%, while 5.5% proceeded directly to DBE for therapeutic or histological indications. The SBCE-to-DBE conversion rate was 30.4%. SBCE alone established or excluded inflammatory bowel disease in 70% of patients. Among those undergoing DBE, Crohn’s disease was confirmed in 21% and excluded in 79%. Increasing age (OR 1.04 per year; 95% CI 1.01–1.07) and diagnostic uncertainty on SBCE (OR 2.0; 95% CI 1.8–3.5) independently predicted DBE referral.ConclusionSBCE is diagnostic in the majority of patients with suspected small bowel Crohn’s disease and functions effectively as a triage tool. DBE should be reserved for cases requiring histological confirmation, clarification of indeterminate findings, assessment of proximal disease, or therapeutic intervention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1740221</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1740221</link>
        <title><![CDATA[The importance of Helicobacter pylori eradication: a narrative review]]></title>
        <pubdate>2026-04-01T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Orlaith Casey</author><author>Marta Dobric</author><author>Orlaith Kelly</author><author>Colm Antoine O’Morain</author>
        <description><![CDATA[BackgroundHelicobacter pylori (H. pylori) is a gram-negative bacterium infecting over 40% of the global population, with highest prevalence in low- and middle-income regions. Chronic infection leads to persistent gastritis and can result in peptic ulcer disease, dyspepsia and gastric adenocarcinoma. Despite its high pathogenic potential, population-based screening and eradication programmes remain limited, particularly in Europe.MethodsThis narrative review summarisescurrent evidence on the epidemiology, clinical burden and eradication strategies for H. pylori. A literature search of PubMed, Embase and the Cochrane Database was performed to identify recent publications relating to H. pylori infection, consequences and screening approaches.ResultsH. pylori has been classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen and is the leading cause of infection-attributable cancer worldwide, accounting for approximately 850,000 gastric cancer cases annually. Robust evidence demonstrates that eradication of H. pylori reduces the risk of peptic ulcer recurrence, dyspepsia, and gastric cancer incidence, with recent meta-analyses reporting a pooled relative risk reduction of up to 44%. Population-based eradication initiatives, such as the Matsu Islands study, have shown dramatic declines in H. pylori prevalence, peptic ulceration, and gastric cancer incidence. Current international guidelines, including the Maastricht VI/Florence and 2025 Taipei Global Consensus reports, now recommend universal eradication of confirmed infections and support population-level or family-based screening in high-risk regions. Ongoing European pilot studies, including the TOGAS initiative, aim to inform the implementation of gastric cancer screening programs. Concerns regarding antibiotic resistance remain, though recent evidence suggests that the risks are manageable with appropriate antibiotic stewardship.ConclusionPopulation-based H. pylori screen-and-treat strategies represent a cost-effective and evidence-based approach to preventing gastric cancer. Further large-scale European studies are warranted to guide optimal implementation, timing, and cost-effectiveness of such programs.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1737942</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1737942</link>
        <title><![CDATA[Hepatoprotective effects of oyster-derived bioactive compounds in alcoholic liver disease: a systematic review]]></title>
        <pubdate>2026-03-17T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Rui Chen</author><author>Yanan Qin</author><author>Ping Yu</author>
        <description><![CDATA[BackgroundAlcoholic liver disease (ALD) is a major global cause of liver-related morbidity and mortality, driven by excessive alcohol consumption and characterized by oxidative stress, inflammation, disordered lipid metabolism, and gut–liver axis dysfunction. Oyster-derived bioactive compounds have shown hepatoprotective potential in experimental settings; however, their efficacy and role in ALD management remain unclear.ObjectiveTo systematically evaluate and synthesize preclinical and clinical evidence on oyster-derived bioactive compounds for the prevention and treatment of ALD.MethodsPubMed, Web of Science, and Scopus were searched for studies examining oyster-derived bioactives, including polysaccharides, peptides, protein hydrolysates, and related extracts, in alcohol-induced liver injury models. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the SYRCLE tool for animal studies and RoB 2.0 for human trials. Certainty of evidence was evaluated using the GRADE framework.ResultsEleven studies met the inclusion criteria, comprising ten animal studies and one randomized controlled trial. In animal models, oyster-derived interventions reduced alanine and aspartate aminotransferase levels by approximately 34-56%, increased antioxidant defenses (glutathione and superoxide dismutase increased by up to 45% and 40%, respectively), and decreased inflammatory mediators including TNF-α, IL-1β, and IL-6. Improvements in lipid metabolism and gut–liver axis markers were also reported in several studies. The single human trial demonstrated a modest reduction in γ-glutamyl transferase, with no significant changes in ALT or AST. Overall, the certainty of evidence ranged from very low to low, reflecting methodological heterogeneity, risk of bias, and limited human data.ConclusionsOyster-derived bioactives consistently demonstrate hepatoprotective effects in preclinical models of ALD through antioxidant, anti-inflammatory, metabolic, and gut-mediated mechanisms. However, the current evidence base is preliminary, and well-designed, adequately powered clinical trials are required to determine their clinical efficacy, optimal formulation, and long-term safety.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251104584, identifier CRD420251104584.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1784785</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1784785</link>
        <title><![CDATA[Analysis of 386 alternative medicinal products implicated in liver injury reveal clinically relevant associations with potentially hepatotoxic botanicals, pharmaceutical adulteration, heavy metal contamination, and undisclosed animal content]]></title>
        <pubdate>2026-03-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Cyriac Abby Philips</author><author>Tharun Tom Oommen</author><author>Arif Hussain Theruvath</author><author>Aryalakshmi Sreemohan</author><author>Ambily Baby</author><author>Rizwan Ahamed</author><author>Ajit Tharakan</author><author>Philip Augustine</author>
        <description><![CDATA[BackgroundComplementary and alternative medicine (CAM)-related hepatotoxicity is a growing global concern. We utilized multi-modal analysis to characterize CAM product safety and identify predictors of severe liver injury.MethodsThis retrospective study analyzed 386 CAM products from 91 consecutive patients (mean 4.2 products/patient) presenting with CAM-related adverse events at a tertiary center in South India (2021–2023). Product-level analyses characterize the CAM supply chain while patient-level analyses inform clinical outcome associations. Investigations included ingredient documentation, heavy metal quantification, and GC-MS compound profiling.ResultsThe mean patient age was 48.2 years (75.8% male). ACLF occurred in 39.6% of all patients (36/91) and 41.9% of those with hepatic adverse events (36/86), with associated mortality of 38.9% (14/36) compared to 10.9% (6/55) in non-ACLF presentations (OR 5.20, P = 0.004). Heavy metals exceeded WHO limits in many products: mercury (34%), cadmium (25%), arsenic (21%), and lead (14%). Cadmium exposure exceeding WHO limits showed a strong association with ACLF (75.9% vs 22.6%, P<0.001, FDR q<0.001). The association with mortality did not reach statistical significance after correction for multiple comparisons (34.5% vs 16.1%, uncorrected P = 0.061, FDR q=0.24). Undeclared pharmaceutical adulteration (at least one adulterant found in 27.7% of products; exposure to at least one adulterated product in 46.2% of patients) and animal-derived content (31.3%) were prevalent. Notably, unlabeled product consumption significantly predicted mortality (P = 0.025).ConclusionCAM-associated liver injury frequently manifests as ACLF with high mortality, driven by pervasive heavy metal contamination and adulteration. Unlabeled product exposure is a strong mortality predictor, highlighting the urgent need for mandatory product surveillance.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2025.1629698</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2025.1629698</link>
        <title><![CDATA[Predictive models for post-ERCP pancreatitis: a systematic review and meta-analysis]]></title>
        <pubdate>2026-03-05T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Zhihang Zhong</author><author>Li Liu</author><author>Jia Liu</author><author>Qin Xie</author><author>Jing Wu</author>
        <description><![CDATA[Background and aimsPost-ERCP pancreatitis (PEP) is the most common complication following ERCP, leading to significant clinical and economic consequences. Predictive models for PEP can help identify high-risk patients and guide preventive strategies. However, the performance of these models varies, and a comprehensive evaluation is lacking. This study aims to assess the accuracy, reliability, and risk of bias in existing predictive models for PEP.MethodsA comprehensive search was conducted across five databases (PubMed, Embase, Web of Science, Cochrane Library, and CNKI) for studies published until January 2025. Studies that developed or validated predictive models for PEP were included. Models with external validation sets were included in a meta-analysis. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration. A random-effects meta-analysis was performed, with heterogeneity assessed using I² statistics. Data extraction and risk of bias were conducted using a standardized template combining the CHARMS and PROBAST tools.ResultsTwenty-three studies (21 model development studies and 2 external validation studies) were included, presenting 21 predictive models for PEP. Nine models incorporated external validation, with one study recalibrating an existing model and another externally validating two prior models. The mean events per variable (EPV) across studies was 10.2 (2.2 to 22.4). The pooled AUC for externally validated models was 0.79 (95% CI: 0.75–0.83). Machine learning models demonstrated higher AUC (0.84) than traditional logistic regression models (0.76). Common predictive factors included difficult cannulation, female sex, pancreatic duct dilation, and a history of pancreatitis.ConclusionsPredictive models for PEP show potential for improving patient risk stratification. However, variability in model performance, lack of external validation, and significant bias in many studies limit their clinical applicability. Further external validation, model refinement, and improved bias control are essential for broader clinical implementation.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024626168, identifier CRD42024626168.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1808344</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1808344</link>
        <title><![CDATA[Specialty grand challenge in gastrointestinal infections]]></title>
        <pubdate>2026-03-02T00:00:00Z</pubdate>
        <category>Specialty Grand Challenge</category>
        <author>Sahil Khanna</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1669563</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1669563</link>
        <title><![CDATA[Role of thalidomide in angiodysplasia-related gastrointestinal bleeding: a systematic review]]></title>
        <pubdate>2026-02-26T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Junaid Khan</author><author>Amna Yousaf Shah</author><author>Aamir Asif Khan</author><author>Ruqaiya Shahid Raja</author><author>Zubair Ahmed</author><author>Mahad Shahid Raja</author><author>Simona Eng</author><author>Qamar Iqbal</author>
        <description><![CDATA[ObjectiveAngiodysplasia of the gastrointestinal (GI) tract is a leading cause of occult GI bleeding, and its management remains challenging. Various pharmacologic and endoscopic therapies are used with limited success. This systematic review evaluates the clinical efficacy of thalidomide in angiodysplasia-related GI bleeding.MethodsA comprehensive literature search was conducted across PubMed, Embase, Scopus, and CINAHL using MeSH terms “Vascular malformations” OR “Angiodysplasia” AND “Thalidomide,” covering the period from 1994 to February 16, 2024. We included clinical trials and case series with at least five adult patients treated with thalidomide for angiodysplasia-related GI bleeding. Six studies met the inclusion criteria: two randomized controlled trials (RCTs), one retrospective observational study, and three case series.ResultsA total of 265 patients were included, with a median age of 63.5 years; 37% were male. Angiodysplasia was diagnosed using endoscopy, colonoscopy, or push enteroscopy. Clinical outcomes varied across studies. Garrido et al. reported an 84% response rate based on hemoglobin improvement. In an RCT, Chen et al. demonstrated reduced bleeding episodes in 68.6% of patients receiving thalidomide 100 mg compared with 51% in the 50 mg group. Ge et al. reported a response rate of 71.4% (20/28) in the thalidomide group versus 3.7% (1/27) in the iron group (risk difference 67.7%, 95% CI 51.1–84.2). Common adverse effects included constipation, dizziness, fatigue, limb numbness, and peripheral neuropathy.ConclusionThalidomide appears effective in reducing bleeding episodes in angiodysplasia-related GI bleeding. However, heterogeneity in dosing, outcome definitions, and safety reporting highlights the need for larger, standardized trials to clarify optimal treatment strategies and long-term safety.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2025.1653955</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2025.1653955</link>
        <title><![CDATA[Management of late biliary complications in pediatric liver transplant recipients]]></title>
        <pubdate>2026-02-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Davide Cussa</author><author>Michele Pinon</author><author>Andrea Doriguzzi Breatta</author><author>Marco Fronda</author><author>Pier Luigi Calvo</author><author>Renato Romagnoli</author>
        <description><![CDATA[The number of pediatric liver transplant recipients with long-term follow-up exceeding 20 years is steadily increasing. These patients are characterized not only by their extensive medical histories but also by their long future life expectancy. In this context, careful management of post-transplant complications, including biliary issues, is essential. We identified 40 patients from our 193 pediatric transplants performed since the program’s inception in 1995, with more than 20 years of follow-up at our center. Thirteen of these patients developed either early or late biliary complications. Five developed complications within the first post-transplant year, while eight developed late complications, which are the main focus of this study. We detail the management of biliary complications in these patients, providing an in-depth analysis of four case models and an overview of the remaining patients. In addition to the standard interventional options, such as percutaneous bilioplasties and surgical revisions of anastomoses, we identified a subgroup that may benefit from a more conservative approach, provided they are closely monitored through a rigorous follow-up protocol.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fgstr.2026.1747118</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fgstr.2026.1747118</link>
        <title><![CDATA[Advancing therapeutic frontiers: a pipeline of novel drugs for UC management]]></title>
        <pubdate>2026-01-30T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Luisa Bertin</author><author>Alessandro Massano</author><author>Carlo Redavid</author><author>Marco Scarpa</author><author>Cesare Ruffolo</author><author>Imerio Angriman</author><author>Andrea Buda</author><author>Fabiana Zingone</author><author>Brigida Barberio</author><author>Edoardo Vincenzo Savarino</author>
        <description><![CDATA[Ulcerative colitis is a chronic inflammatory bowel disease with rising global prevalence. Despite therapeutic advances including biologic agents targeting tumor necrosis factor-alpha, integrins, and interleukin pathways, alongside Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators, substantial unmet needs persist in moderate to severe disease. Current advanced therapies achieve clinical response rates of only 30-60% in trials, with approximately 20% of patients requiring hospitalization and 7% undergoing colectomy within five years of diagnosis. The therapeutic pipeline for moderate to severe ulcerative colitis currently encompasses over 100 investigational agents in Phase II and III clinical development. Emerging mechanisms include next-generation Janus kinase and tyrosine kinase 2 inhibitors with enhanced selectivity, novel cell trafficking modulators, advanced tumor necrosis factor-alpha inhibition strategies, and selective interleukin-23 pathway antagonists. Tumor necrosis factor-like ligand 1A pathway inhibitors demonstrate particularly robust efficacy in early trials, with clinical remission rates exceeding 25% compared to less than 2% for placebo. Additional promising approaches target immune checkpoint pathways, receptor-interacting protein kinase 1, and intracellular signaling cascades. innovative combination therapy approaches demonstrated to achieve superior response rates compared to monotherapy. The convergence of novel therapeutic targets, gut-selective compounds minimizing systemic immunosuppression, and biomarker-guided therapy selection represents a paradigm shift toward precision medicine. These advances hold genuine promise for transforming moderate to severe ulcerative colitis management.]]></description>
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