搜索结果：Clinics and research in hepatology and gastroenterology

To systematically characterize existing prognostic models and to evaluate and compare their discriminative performance in patients with intrahepatic cholangiocarcinoma (iCCA) after curative resection. We systematically searched Web of Science, Embase, Cochrane Library, PubMed, and MEDLINE (January 2010 to January 2026). Two reviewers independently screened studies, extracted data, and assessed risk of bias using PROBAST+AI. Tested and selected variables were summarized using frequencies. Discriminative performance estimates (C-index and area under the curve [AUC]) with 95% CI were pooled via random-effects meta-analysis after logit transformation. All analyses were performed using R, version 4.4.2. A total of 60 studies involving 82 prediction models were included. Frequencies revealed that traditional variables were consistently considered, including markers of tumor burden and invasiveness, inflammation-related and nutrition-related markers, and individual characteristics. Meta-analysis of 36 studies showed a pooled training set C-index of 0.723 (95% CI: 0.705-0.740) and AUC of 0.767 (95% CI: 0.700-0.823), while the validation set showed a pooled C-index of 0.696 (95% CI: 0.673-0.718) and AUC of 0.787 (95% CI: 0.690-0.860). These performance metrics were consistently higher than those of the AJCC staging system (7th edition), the AJCC staging system (8th edition), and the LCSGJ staging system. Subgroup analyses suggested that incorporating treatment-related variables, distinguishing resection status, and using recurrence as an endpoint tended to improve model discrimination. Considerable heterogeneity was observed. In this systematic review and meta-analysis, existing prognostic models for iCCA demonstrated good discriminative performance. These models outperformed conventional staging systems and provided predictive value for both survival and recurrence. Nevertheless, methodological shortcomings remain in most models and warrant further refinement.

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality globally, with current diagnostic methods like AFP and imaging lacking sensitivity and specificity. Despite advances in proteomics, validated biomarkers reflecting HCC's metabolic heterogeneity are limited. This study addresses this gap by identifying novel protein biomarkers and constructing a diagnostic model to improve early HCC detection. Quantitative proteomics using data-independent acquisition (DIA) was performed on 31 pairs of HCC and adjacent tissues (Cohort 1). Differentially expressed proteins (DEPs) were analyzed via bioinformatics (GO, KEGG) and validated through Western blot, RT-PCR, and immunohistochemistry in two independent cohorts (18 and 34 patients). Partial least squares discriminant analysis (PLS-DA) and logistic regression were employed to develop a diagnostic model. Quantitative proteomics identified 8908 proteins, with 800 differentially expressed proteins (DEPs; 306 upregulated, 494 downregulated) significantly enriched in metabolic pathways. ADH1C and BHMT, metabolically linked to alcohol and homocysteine regulation, emerged as core biomarkers, showing consistent downregulation in HCC and correlations with the Edmondson-Steiner classification (P < 0.05). A diagnostic nomogram integrating these biomarkers demonstrated superior accuracy (AUC=0.946, 95% confidence interval (CI), 0.897-0.994, sensitivity = 91.18%, specificity = 88.24%) compared to single-marker assessments. Independent validation confirmed concordant suppression of ADH1C and BHMT at both protein and transcriptional levels. This study identifies metabolic dysregulation as a hallmark of HCC and proposes a robust diagnostic model with tissue-validated ADH1C and BHMT. Based on tissue-based validation, our findings pave the way for future development of liquid biopsy exploration and new insights into HCC metabolic mechanisms.

To assess the prevalence of anti-mitochondrial antibodies (AMA) in autoimmune hepatitis (AIH) patients and to compare the clinical, biochemical, immunological, and histopathological profiles among AMA-positive AIH, AMA-negative AIH, and AIH/primary biliary cholangitis (PBC) overlap syndrome cohorts. A retrospective cohort study was conducted to analyze clinical data from 228 AIH patients and 227 AIH/PBC overlap syndrome patients diagnosed at Wuxi Fifth People's Hospital between 2017 and 2025. The AMA prevalence among the diagnosed and probable AIH patients was 19.05% and 18.63%, respectively. AMA-positive AIH patients exhibited significantly lower AMA-M2 titers compared to AIH/PBC patients. Biochemically and immunologically, the prevalence of anti-gp210 antibodies in confirmed and probable AMA-positive AIH patients was higher than that in AMA-negative AIH patients. Confirmed AMA-positive AIH patients showed lower levels of &#x3b3;-GT, ALP, and IgM compared to AIH/PBC overlap patients. Probable AMA-positive AIH patients also demonstrated reduced &#x3b3;-GT and ALP levels relative to AIH/PBC overlap syndrome.Regarding clinical symptoms, definite AMA-positive AIH patients had a higher prevalence of pruritus than AMA-negative AIH patients and AIH/PBC overlap syndrome patients, and a lower prevalence of anorexia than AMA-negative AIH patients. In probable AIH patients, no statistically significant differences in clinical symptoms were observed among different AMA statuses or when compared to AIH/PBC overlap syndrome patients. Clinical symptoms across different patient groups showed varying degrees of positive or negative correlation with serological markers. Pathologically, the prevalence of bile duct injury positivity in confirmed and probable AIH patients were lower than in AIH/PBC overlap syndrome patients. The inflammatory activity levels in confirmed and probable AMA-positive AIH patients were lower than in AMA-negative patients.Serial liver biopsy results indicated that bile duct injury in AIH patients often regressed, whereas in AIH/PBC overlap syndrome patients, it predominantly persisted. AMA positivity is not uncommon among AIH patients, and positivity for anti-gp210 antibodies may be associated with AMA status. The AIH/PBC overlap syndrome exhibits features of both conditions, characterized by more pronounced bile duct injury and cholestasis than isolated AIH.The dynamic evolution characteristics of bile duct injury can provide important pathological evidence for differentiating between the two diseases. The correlation between clinical symptoms and serological markers may offer valuable reference for assessing disease activity in AIH patients.

Liver disease (LD) remains a growing public health concern in the United States (US) despite declining mortality from other major chronic conditions, including cardiovascular disease and many cancers. We conducted a nationwide ecological time-trend study of adults aged 25 years and older using the Centers for Disease Control Wide Ranging Online Data for Epidemiologic (CDC WONDER) Underlying Cause of Death database (1999-2023). We assessed mortality counts and age-adjusted mortality rates (AAMRs) overall and by subtype, sex, age, race/ethnicity, census region, state, and 2013 NCHS urbanization. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CIs). During 1999-2023, 1.86 million liver-related deaths occurred, with annual deaths nearly doubling. The overall AAMR rose from 28.49 to 36.71 per 100,000 (AAPC: +1.01 %). Liver cancer (LC) (28.6 %) and alcoholic liver disease (ALD) (24.9 %) accounted for over half; ALD increased most rapidly (AAPC: +2.31 %), while viral hepatitis mortality declined (AAPC: -4.53 %). Female mortality rose faster than male (AAPC: +1.49 % vs +0.68 %). Adults 55-74 had the most deaths, but 25-34 showed the largest relative increase (AAPC: +3.83 %). In 2023, Hispanics had the highest AAMR (44.22 per 100,000); the West and South were the leading regions. Nonmetropolitan areas exhibited higher and more rapidly rising AAMRs. A post-2019 acceleration coincided with COVID-19. U.S. death toll from LD has risen substantially, driven largely by ALD and LC, with clear demographic and geographic disparities. Urgent priorities include expanded screening, viral hepatitis elimination, and improved access to liver care, particularly in high-burden states and rural areas. Strategies to reduce harmful alcohol use and to maintain continuity of chronic liver disease management during system stress are also essential.

Bowel urgency is one of the most distressing symptoms experienced by patients with inflammatory bowel disease (IBD). The relationship between bowel urgency and multidimensional IBD-related disability has not been well characterised. We conducted a multicentre cross&#x2011;sectional study including adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Patients completed self-administered questionnaires evaluating bowel urgency and IBD-related disability using the IBD-Disk questionnaire. Severe bowel urgency was defined as a IBD-disk bowel urgency subscore &#x2265;6. A total of 2,514 patients (1,715 with CD) were included. Severe bowel urgency was observed in 17.1% of patients with UC and in 20.4% of patients with CD, compared to 3.6% and 7.6%, respectively, in those in clinical remission according to PRO-2 criteria. In multivariate analysis in patients with UC, factors associated with severe bowel urgency were general well-being subscore &#x2265;2 and abdominal pain subscore &#x2265;2 while treatment with advanced therapy, clinical remission according to PRO-2, fatigue subscore <5, work productivity subscore <3 and sexual life subscore <2 were negatively associated. In patients with CD, factors were rectal bleeding subscore &#x2265;2, abdominal pain subscore &#x2265;2 and history of intestinal resection while clinical remission, fatigue subscore <5, work productivity subscore <3 and sexual life subscore <2 were negatively associated. Severe bowel urgency is frequent in both patients with CD and UC beyond IBD activity and is strongly associated with various dimensions of IBD-related disability. These findings emphasise the importance of systematically assessing urgency in routine clinical practice.

Helicobacter pylori (H. pylori) infection is highly comorbid with dyslipidemia. This study investigated their association using longitudinal trajectory analysis and Mendelian randomization (MR). 2433 individuals undergoing annual health examinations (2018-2021) were enrolled. Group trajectory modeling categorized subjects based on C14 breath test results into normal group, slow infection group and persistent infection group. Dyslipidemia incidence was tracked from 2022-2023. Log-rank tests compared incidence, and logistic regression calculated odds ratios (OR) with 95% confidence intervals (CI). Two-sample MR used H. pylori antibody GWAS data and UK Biobank dyslipidemia GWAS. Inverse Variance Weighted (IVW) was the primary method, supplemented by sensitivity analyses. Three trajectories were identified. The incidence of dyslipidemia in slow infection group(23.2%) and persistent infection group (27.5%) was significantly higher than that in normal group (15.4%; P<0.05). After adjustment, compared with the normal group, the risk of dyslipidemia in the slow infection group and the persistent infection group increased by 0.759 times (95%CI: 0.541-1.066, P=0.012) and 1.752 times (95%CI: 1.169-2.625, P= 0.007) . MR analysis (IVW) showed H. pylori GroEL antibody levels significantly correlated with total cholesterol and HDL levels, and VacA antibody levels correlated with triglycerides (P < 0.05). Sensitivity analyses confirmed no heterogeneity or horizontal pleiotropy. Both longitudinal and MR analyses consistently demonstrate a significant association between persistent H. pylori infection and increased dyslipidemia risk. Further research into the underlying mechanisms is warranted to understand H. pylori's extragastric effects.

To investigate the clinical characteristics, mutation spectrum of the ABCC2 gene, and genotype-phenotype correlations in Chinese pediatric patients with Dubin-Johnson syndrome (DJS). Six children diagnosed with DJS at Kunming Children's Hospital from April 2018 to August 2021 were enrolled. Clinical, biochemical, and imaging data were collected. Peripheral blood samples were obtained from the probands and their families. Targeted high-throughput sequencing of ABCC2 was performed, with identified variants validated by Sanger sequencing and segregation analysis. Pathogenicity was assessed following established guidelines. All patients presented primarily with jaundice; the proportion of serum direct bilirubin to total bilirubin ((DBIl/TBIl)) exceeded 20%. We identified 12 ABCC2 pathogenic mutant alleles, including 4 missense, 2 nonsense, 2 frameshift, 1 synonymous, 1 in-frame deletion, and 2 splice-site mutations. Among these, three were novel and previously unreported: c.4210_4212del, c.4237_4238insCT, and c.4532dupA. Exons 20, 28, and 30 emerged as mutational hotspots. Genotype-phenotype relationships were complex: carriers of in-frame deletions exhibited milder manifestations, while truncating mutations did not consistently lead to the most severe phenotypes. Comorbidities and allelic interactions together constituted a "composite pathogenicity burden" that determined phenotypic severity. This study expands the ABCC2 mutation spectrum in Chinese DJS patients, reports three novel mutations, and introduces a "composite pathogenicity burden" model that highlights the multifactorial nature of clinical presentation. These findings provide a basis for improved genetic counseling and precision management of DJS.

Hypoalbuminemia is common in severe acute pancreatitis (SAP) and is associated with poor outcomes. Early administration of human albumin has been proposed to improve outcomes by expanding the intravascular volume and correcting hypoalbuminemia. We performed a systematic review to evaluate whether early albumin infusion in patients with moderate SAP reduces the incidence of sepsis and improves clinical outcomes. We searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases from inception to January 15, 2026, for studies of albumin infusion in adult patients with moderate or SAP. Eligible studies included randomized controlled trials (RCTs) and cohort studies that compared early albumin infusion with no albumin or crystalloid-only therapy. The primary outcome was sepsis incidence. The secondary outcomes included in-hospital mortality, and A.P.-related complications. Six studies (one RCT and five retrospective cohorts studies) met the inclusion criteria. Albumin infusion protocols varied (5% albumin 30 g/day for 2-3 days in the RCT). Early albumin administration was associated with a significantly lower risk of sepsis in patients with SAP. However, their effects on mortality were inconsistent. One cohort study of patients with hypoalbuminemic SAP reported significantly lower in-hospital mortality with albumin therapy. However, the RCT showed no difference in the 60-day mortality between the albumin and control groups. None of the included studies reported a clear reduction in pancreatitis-specific complications attributable to albumin. Early albumin infusion in moderate to SAP was associated with a lower risk of sepsis across studies but yielded no clear improvement in overall mortality.

Inflammatory Bowel Disease (IBD) negatively impacts quality of life, increasing the risk of psychological disorders. Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that has shown promise for individuals living with chronic illnesses. This meta-analysis aims to explore the efficacy of ACT in managing psychological symptoms in patients with IBD, compared to usual care. A systematic search was conducted across PubMed, Web of Science, SCOPUS, CENTRAL, and Google Scholar from inception to August 2025. Eligible studies comprised randomized controlled trials and quasi-experimental studies that compared ACT with usual or other interventions in IBD patients. Standardized Mean Differences (SMDs) with 95% confidence intervals (CIs) were calculated for assessed continuous outcomes. CRD420251153446. Nine studies involving 459 patients were included. ACT significantly reduced anxiety scores compared to non-ACT (SMD = -0.34; 95% CI: [-0.56 to -0.12]; P < 0.01). Still, the improvements in depression (P = 0.08), stress (P = 0.08), Crohn's disease activity (P = 0.06), and ulcerative colitis activity (P = 0.59) were not statistically significant compared to non-ACT. Subgroup analysis indicated significant improvements in anxiety (SMD = -0.34; 95% CI: -0.64 to -0.03; P = 0.03, I&#xb2; = 0%), depression (SMD = -0.44; 95% CI: [-0.80 to -0.08]; P = 0.02) and stress (SMD = -0.55; 95% CI: [-0.92 to -0.19]; P < 0.01) scores when ACT was compared with treatment-as-usual. In contrast, no significant differences in depression, anxiety, or stress were found between ACT and other active psychoeducational interventions. Anxiety score was significantly improved post-intervention (SMD = -0.37; 95% CI: [-0.70 to -0.04]; P = 0.03) and at 1-2 months (SMD = -0.33; 95% CI: [-0.63 to -0.03]; P = 0.03), while stress score was significantly improved at 1-2 months (SMD = -0.41; 95% CI: [-0.74 to -0.07]; P = 0.02). ACT reduced anxiety, depression, and stress versus treatment-as-usual. Additionally, ACT reduced anxiety and stress scores at 1-2 months versus the control group. However, no improvement was observed in CD or UC activity. ACT was not superior to other active controls, such as CBT. Larger, longer follow-up periods and randomized trials are needed to confirm effects on psychological outcomes and disease activity.

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related death, particularly in China, with limited diagnosic sensitivity and specificity. Circulating cell-free DNA (cfDNA) has emerged as a promising non-invasive biomarker. Eukaryotic Translation Initiation Factor 2C1 (EIF2C1), commonly used as a reference gene in digital PCR, reflects total cfDNA burden. This study aimed to evaluate the diagnostic value of plasma EIF2C1-normalized cfDNA levels for HCC detection and to explore its association with disease severity and metastatic features at diagnosis. Plasma samples from 101 HCC patients and 90 healthy controls were analyzed using Real-Time Quantitative PCR (RT-qPCR) to quantify EIF2C1 levels, employing two sets of primers and probes (EIF2C1-1 and EIF2C1-2). Clinical data and tumor markers were collected to evaluate the association of EIF2C1 levels with disease severity and metastatic risk. EIF2C1 levels were significantly elevated in HCC patients and correlated inversely with hepatic synthetic markers ,while positively associating with tumor progression indicators. Higher EIF2C1 expression was linked to advanced stage, cirrhosis, liver dysfunction, and metastasis. The combined models of EIF2C1 and alpha-fetoprotein (AFP) demonstrated enhanced discriminatory ability compared with individual markers (EIF2C1-1 + AFP: AUC=0.744, 95% CI: 0.642-0.845; EIF2C1-2 + AFP: AUC=0.764, 95% CI: 0.662-0.866). Furthermore, elevated EIF2C1 levels were significantly associated with the presence of metastasis (OR=20.87, 95% CI: 5.13-84.92). Plasma EIF2C1 levels show promise as a complementary diagnostic and risk-stratification biomarker in HCC. Its combination with AFP improves the identification of metastatic disease at diagnosis, potentially aiding initial clinical management.

Due to the lack of uniform diagnostic criteria and the exclusive use of computed tomography as an indicator, the prevalence of sarcopenia in patients with stomach cancer varies considerably. Currently, limited data are available from comprehensive studies utilizing bioelectrical impedance analysis (BIA) for muscle mass, combined with handgrip strength and gait speed, to assess sarcopenia in treatment-na&#xef;ve gastric cancer patients. Therefore, this study aims to investigate this condition among treatment-na&#xef;ve gastric cancer patients in China. This study aimed to assess the prevalence of Chinese sarcopenia in treatment&#x2011;na&#xef;ve gastric cancer patients by using BIA with handgrip strength and gait speed, in line with the standard Chinese Guidelines for the Diagnosis and Treatment of Sarcopenia. Employing a single-center cross-sectional design, this study assessed the prevalence of sarcopenia in treatment-na&#xef;ve gastric cancer patients using BIA and standard Chinese diagnostic criteria. Additionally, comparative analyses of body composition and laboratory parameters were conducted to discern significant differences between patients with and without sarcopenia. Using Chinese diagnostic criteria and BIA, we identified a sarcopenia prevalence of 17.49% in treatment-na&#xef;ve gastric cancer patients. This cohort demonstrated significant muscle and fat depletion alongside a 62.68% prevalence of GLIM-defined malnutrition. Additionally, sarcopenia was associated with a higher risk of anemia and significantly reduced serum albumin and total protein levels relative to patients without the condition. Sarcopenia imposes a significant clinical burden on Chinese patients recently diagnosed with gastric cancer, and is frequently associated with severe malnutrition and anaemia.

Emerging evidence suggests that the oral-gut-liver axis may play a role in the immunopathogenesis of autoimmune liver diseases (AILDs), particularly autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). Alterations in the oral microbiota may influence hepatic immune responses; however, this relationship remains poorly defined. This systematic review aimed to evaluate current evidence on the association between oral microbiota dysbiosis and AILDs, with a focus on microbial alterations, inflammatory profiles, and potential diagnostic implications. A systematic search of PubMed, Web of Science, and Scopus was conducted up to January 2026 in accordance with PRISMA guidelines. Eligible studies investigated oral microbiota composition in patients with AILDs compared with healthy controls. Data extraction was performed independently, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Six studies published between 2015 and 2021 met the inclusion criteria, comprising 252 patients with AILDs and 345 healthy controls. All included studies reported significant oral microbiota dysbiosis in AILD patients. The most consistent findings were an increased abundance of Veillonella in AILDs and Eubacterium in the PBC subgroup, along with a reduced presence of Streptococcus and Fusobacterium. These microbial alterations were associated with elevated salivary inflammatory markers, and showed correlations with disease activity. Some studies also suggested interactions between oral and gut microbiota, potentially mediated by increased intestinal permeability and bacterial translocation. Current evidence supports an association between oral microbiota dysbiosis and inflammatory mechanisms. Although causality cannot be established, the oral-gut-liver axis may represent a promising source of biomarkers and therapeutic targets.

End-of-life care in home or hospice settings has increased in the United States, yet contemporary data describing demographic and geographic differences remain limited. Cholangiocarcinoma (CCA) is a rare, aggressive malignancy with poor prognosis, and patterns of place of death for CCA patients are poorly characterized. This study examined long-term trends in home or hospice deaths among CCA decedents, with attention to demographic and regional disparities. CCA data from 1999 to 2024 were obtained from the CDC (Centers for Disease Control) WONDER database using ICD-10 codes C22.1, C24.0, C24.8, and C24.9. The proportion of deaths occurring at home or in hospice was analyzed overall and stratified by sex, ethnicity, census region, and urbanization (available through 2020). Joinpoint regression (version 5.40) assessed temporal trends. Among 181,776 CCA decedents, 104,208 (57.3%) died at home or in hospice. The proportion increased from 42.0% in 1999 to 69.0% in 2020, then declined to 62.0% in 2024 (Average Annual Percent Change AAPC 1.71%, 95% CI 1.40-1.92). Trends were almost similar by sex with minor variations. Non-Hispanic Black patients had the lowest proportion of home or hospice deaths (47.29%), despite comparable upward trends across ethnic groups. Regional differences were modest, with the South and West showing the highest proportions (59.7%). Urban and rural areas exhibited parallel increases. Home or hospice end-of-life care among CCA patients has risen over 25 years, though recent declines and persistent demographic disparities remain. Targeted strategies are required to ensure equitable access to high-quality end-of-life care for underserved populations.

Inflammatory bowel disease (IBD) is often associated with fatigue and reduced quality of life, which are not fully addressed by pharmacologic therapy. Evidence for lifestyle interventions remains limited. We evaluated the feasibility and patient-reported effects of a multimodal rehabilitation program to assess its impact on disability, quality of life, and functional outcomes. We conducted a prospective study in adults with IBD referred perioperatively or after a severe flare. The 6-week programme comprised two supervised weekly sessions combining physical activity, education workshops, and individual dietary counselling. Assessments were performed at baseline (W0), end-of-programme (W6), and month 12 (M12). Primary endpoint was the change in IBD-Disk score at W6 (0-100; higher = greater disability). Secondary outcomes included SF-36 quality of life (0-100; higher = better), ECIPE disease-knowledge score (0-39; higher = better), functional capacity tests, biomarkers, and safety. Thirty-seven patients were included. No serious adverse events occurred. Disability improved significantly at W6 (IBD-Disk -11.9 points; 95%CI -16.9 to -6.9; p = 5 &#xd7; 10&#x207b;&#x2075;), with 55.6% responders (&#x2265;0.5 SD). Quality of life increased (+13.0 points on SF-36; p = 1.1 &#xd7; 10&#x207b;&#x2074;), and disease knowledge markedly improved (+7.63 ECIPE; p = 1.9 &#xd7; 10&#x207b;&#x2079;). Physical activity (&#x2265;18/45 active patients) increased from 47.2% to 87.5% at W6 (p = 1.39 &#xd7; 10&#x207b;&#x2076;). Functional outcomes improved statistically significantly. Biomarkers remained stable. Exploratory analyses at 12 months suggested that improvements were partially sustained. A short multimodal rehabilitation program is feasible, safe, and associated with improvements in disability, quality of life, disease knowledge, and physical performance. These findings support the need for larger controlled trials to confirm the effectiveness and long-term sustainability of lifestyle-oriented rehabilitation strategies in IBD care.

The identification of a colonic stricture in patients with Crohn's disease (CD) often leads to surgery due to concerns about colorectal cancer (CRC) risk. However, data on the risk associated with colonic strictures remain limited, particularly in paediatric-onset CD. To evaluate the incidence of colonic stricture in CD and describe its natural course, focusing specifically on the risk of CRC. All patients diagnosed with CD <17y between 1988 and 2011, included in a population-based registry, were retrospectively followed until 2013. Colonic stricture was defined as digestive lumen narrowing observed on endoscopic or radiological examination. Risk factors for colonic stricture were explored using uni- and multivariable Cox proportional hazards models with time-dependent variables. A total of 1,007 patients diagnosed with CD between 1988 and 2011 were included. Median follow-up period was 8.8 years. Colonic stricture was diagnosed in 52 patients (5.1%), including 11 at CD diagnosis. Strictures were non-passable by the scope in 31% (n=16) and 14% (n=7) were symptomatic. The cumulative incidence of colonic stricture in CD was 2.9% [95% confidence interval (CI): 1.8%-4.0%] at 5 years. In multivariable analysis, risk of colonic stricture was associated with periods of active disease (HR=2.6 [1.4-4.9], p<0.01), absence of colonic involvement at diagnosis (HR=0.2 [0.0-0.8], p<0.05) and treatment with aminosalicylates (HR=0.4 [0.2-0.8], p<0.05). Stricture related colonic resection and endoscopic balloon dilation were needed in 23% (n=12) and 6% (n=3) of patients, respectively. After a median follow-up of 13.4 years, CRC was detected in one patient (2%) within 6 months after the diagnosis of colonic stricture. In this population-based study of paediatric-onset CD, colonic stricture was rarely associated with CRC.

Educational interventions have been proposed to improve adherence to bowel preparation instructions. We evaluated whether adding a short instructional video to standard written and oral information improves bowel preparation quality in an ambulatory setting. In this prospective, bicentric, randomized, single-blind trial, 282 outpatients scheduled for colonoscopy with polyethylene glycol preparation were randomized 1:1 to standard information alone or standard information plus a 2-minute educational video. The primary outcome was bowel preparation quality assessed using the Boston Bowel Preparation Scale (BBPS). Adequate preparation was defined as BBPS &#x2265; 7 with all segments &#x2265; 2. Secondary outcomes included patient comprehension and satisfaction measured using Likert-type scales. Of 282 randomized patients, 245 were analyzed (129 video, 116 control). Mean BBPS scores were similar between groups (8.32 &#xb1; 1.61 vs 8.51 &#xb1; 0.89; P = 0.25). Adequate preparation was achieved in 90.8% and 96.6%, respectively (P = 0.11). Comprehension (P = 0.003) and perceived usefulness of information (P = 0.024) were higher in the video group. No independent predictors of inadequate preparation were identified. In an ambulatory population with high baseline preparation quality, adding a short educational video improved patient-reported understanding but did not significantly change objective bowel preparation quality.

In individuals with normal body weight, altered fat distribution contributes to metabolic dysfunction and hepatic steatosis. We hypothesized that the weight-adjusted waist index (WWI), an indicator of abdominal fat accumulation, is associated with lean MASLD. We analyzed lean adults from 2017-March 2020 pre-pandemic (N = 824). MASLD was defined using controlled attenuation parameter (CAP) from vibration-controlled transient elastography together with metabolic criteria. Four machine learning models (XGB, GBM, LASSO, SVM) were trained to prioritize candidate predictors from anthropometric and metabolic indices. The top consensus predictor was then evaluated in an independent cohort (NHANES August 2021-August 2023, N = 782) using survey-weighted logistic regression, subgroup analyses, and smooth curve fitting to assess potential non-linearity. Across models, WWI ranked as the most important feature for discriminating lean MASLD and exceeded established indices such as the lipid accumulation product (LAP) and cardiometabolic index (CMI) in global importance metrics. The XGB model achieved the highest discrimination (AUC = 0.756). In the validation cohort, MASLD prevalence increased across WWI quartiles (7.5% to 44.0%). As a continuous variable, WWI was associated with MASLD after full adjustment (OR = 3.08, 95% CI: 1.53-6.21). However, quartile-based associations were attenuated and not statistically significant in the fully adjusted model. A modest trend across quartiles remained. Subgroup analyses demonstrated generally consistent associations across demographic and clinical strata. The dose-response analysis suggested a non-linear relationship, with MASLD risk increasing more steeply beyond a WWI of approximately 11 cm/&#x221a;kg. Among lean adults, WWI is independently associated with MASLD and may capture central-adiposity-related risk not reflected by BMI alone. WWI could serve as a simple complementary anthropometric marker for risk stratification in normal-weight populations, pending prospective validation.

Portal vein thrombosis (PVT) is a common complication in patients with liver cirrhosis. While anticoagulation improves outcomes, the optimal treatment strategy, including the role of direct oral anticoagulants (DOACs), remains unclear. In this retrospective cohort study, patients with liver cirrhosis and PVT were analyzed according to anticoagulation strategy (low-molecular-weight heparin [LMWH], DOACs, sequential LMWH/DOAC therapy, or no anticoagulation). Outcomes included bleeding events, portal vein recanalization, mortality, and event-free survival (EFS). Time-to-event analyses and multivariable regression models were applied. Anticoagulated patients showed significantly improved survival compared with non-anticoagulated patients. No significant differences in bleeding events, recanalization rates, or mortality were observed between anticoagulation strategies. Sequential LMWH/DOAC therapy was consistently associated with more favorable clinical outcomes, including lower mortality and improved EFS, (mortality HR &#x2248; 0.4-0.5; EFS log-rank p = 0.01), compared with LMWH monotherapy, although statistical significance was not reached. DOAC therapy was not associated with increased bleeding risk. Portal vein recanalization was associated with increased bleeding risk, and PVT recurrence was linked to higher mortality. Anticoagulation is associated with improved survival in patients with cirrhosis and PVT. DOACs appear safe in carefully selected patients, and sequential LMWH/DOAC therapy may offer clinical benefit, warranting confirmation in prospective studies.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally and affects a growing proportion of patients with colorectal cancer (CRC). Beyond shared risk factors such as obesity and metabolic syndrome, MASLD appears to actively shape a pro-metastatic hepatic microenvironment, with important implications for colorectal liver metastases (CRLM), particularly in the surgical setting. This narrative review synthesizes epidemiologic, mechanistic, imaging, and clinical data on the interplay between MASLD and CRC/CRLM, with a focus on hepatobiliary surgical relevance. MASLD is associated with increased risks of colorectal adenomas and CRC. Key mechanisms contributing to a pro-metastatic hepatic niche include insulin resistance, adipokine dysregulation, gut-liver endotoxemia with TLR4/NF-&#x3ba;B activation, chronic inflammation, fibrosis and extracellular matrix remodeling, and oxidative stress. Clinically, steatohepatitis and fibrosis are linked to higher perioperative morbidity, postoperative liver failure, and worse short-term outcomes after hepatectomy, whereas simple steatosis shows heterogeneous associations with survival. Chemotherapy-associated liver injury frequently overlaps with MASLD. In addition, MASLD reduces CT sensitivity for small hepatic lesions, while abbreviated non-contrast MRI improves surveillance. MASLD is a clinically relevant modifier of CRLM biology and surgical risk. Early identification, metabolic optimization, MASLD-informed perioperative planning, and MRI-based surveillance should be prioritized. Prospective phenotype-resolved studies are needed to refine risk stratification.