Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal disorders that significantly impact patients' quality of life (QoL). While clinical trials support the efficacy and safety of vedolizumab, real-world data linking its effectiveness to QoL-related patient-reported outcomes remain limited. This prospective observational study assessed the effects of 14-week vedolizumab induction therapy on QoL (i.e., fatigue, mood, and sleep disturbances), clinical response, safety, and predictors of response. A total of 257 patients with ulcerative colitis (UC; n = 205) and Crohn's disease (CD; n = 52) received 14-week vedolizumab induction therapy. Disease activity, QoL (assessed using the total Inflammatory Bowel Disease Questionnaire [IBDQ]), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue]), mood and sleep disturbances (PROMIS Depression and Sleep Disturbance scales), and selected biomarkers were evaluated. Clinical response was assessed using the Mayo score for UC and Crohn's Disease Activity Index (CDAI) score for CD. At Week 14, clinical response was observed in 82% of UC patients and 82.7% of CD patients. Median total IBDQ scores increased by 45.0 points in UC and 31.5 points in CD (p < 0.001). Median prorated FACIT-Fatigue scores increased by 5.0 points in both groups (p < 0.001), while median prorated PROMIS Sleep Disturbance and Depression T-scores decreased (p < 0.05). Improvement in QoL was moderately correlated with clinical response (r = 0.5). In logistic regression analysis, baseline patient characteristics indicative of advanced disease were associated with a reduced likelihood of clinical and QoL response to treatment. A total of 28 adverse events were reported, including 11 serious events and four treatment-related events. Vedolizumab reduced disease activity and led to a rapid improvement in QoL during the 14-week induction therapy in patients with IBD. Clinical response was positively correlated with QoL improvement. Predictors of reduced response were consistent with features of advanced disease.
This study aimed to describe HRQoL of both children and parents in a Chinese DSD cohort, evaluate caregiver burden, and employ the latent profile analysis (LPA) to identify distinct parental HRQoL profiles and their associated determinants. This study included 147 parents of children with DSD and 519 parents of healthy controls. Group differences in HRQoL were analyzed using t-tests or one-way analysis of variance (ANOVA). Multivariate regression identified predictors of parental HRQoL, and LPA classified parental HRQoL profiles with multinomial logistic regression used to assess their associated factors. Children with DSD had similar HRQoL scores to healthy controls (p > 0.05), but their caregivers showed significant impairments across all domains (p < 0.05). In multivariate analysis, caregiver burden and child HRQoL were significantly associated with parental HRQoL (p < 0.05), with caregiver burden mediating 60.8% of the effect of child HRQoL on parental HRQoL. Latent profile analysis identified three parental HRQoL profiles: "Poor" (24.5%), "Moderate" (35.4%), and "Good" (40.1%). Higher caregiver burden increased the odds of "Poor" and "Moderate" profiles (OR = 1.52 and 1.26, both p < 0.001), while better child HRQoL protected against "Poor" profile membership (OR = 0.91, p = 0.002).  This study reveals that HRQoL of children with DSD is comparable to the healthy controls, while their parents experience significant impairments in HRQoL, primarily determined by caregiver burden and the child's HRQoL. As caregiver burden mediates the impact of child HRQoL on parental HRQoL, clinical care must adopt a family-centered approach focusing on burden alleviation. • Children with DSD face complex medical and psychosocial challenges that may affect HRQoL in both patients and their families. • Their caregivers often experience significant psychological burden, which can negatively impact their own well-being. • In a Chinese DSD cohort, children's HRQoL was comparable to healthy controls, whereas their parents exhibited significant and heterogeneous HRQoL impairments across all domains, with three distinct parental HRQoL profiles identified via latent profile analysis. • Caregiver burden mediated 60.8% of the effect of child HRQoL on parental HRQoL, highlighting burden alleviation as a priority target in family-centered clinical care for DSD.
Circulating tumor DNA (ctDNA) has emerged as a clinically actionable biomarker for the management of colorectal cancer (CRC). Improvements in analytical accuracy and sequencing depth have expanded the role of ctDNA from early cancer detection to include molecular profiling of advanced disease, postoperative risk stratification, and real-time evaluation of therapeutic response and resistance. In screening and early detection settings, ctDNA-based assays integrating mutation analysis, methylation profiling, and fragmentomic features have demonstrated high specificity for CRC and multi-cancer early detection (MCED). Prospective studies suggest that ctDNA can identify CRC before clinical diagnosis; however, its sensitivity for advanced premalignant lesions remains limited, supporting its use as a complementary approach for individuals who do not participate in established screening rather than as a replacement for stool-based tests or colonoscopy. Postoperatively, ctDNA-based detection of minimal residual disease (MRD) is a strong independent predictor of recurrence and survival, often preceding radiographic evidence of relapse. Randomized trials have demonstrated that ctDNA-guided adjuvant strategies have the potential to reduce overtreatment and identify candidates for treatment escalation, although the impact on long-term outcomes remains under prospective validation. In metastatic disease, serial ctDNA monitoring enables early treatment-response assessment, detection of resistance mechanisms, and optimization of targeted therapy, including rechallenge strategies. The emerging concept of NeoRAS further illustrates the dynamic nature of tumor genomics and its therapeutic implications. Collectively, these advances have positioned ctDNA as a central tool in precision medicine. This narrative review summarizes recent clinical evidence supporting ctDNA-guided strategies for CRC and discusses their implications for the broader field of precision oncology. What is this review about? Colorectal cancer is a common cancer, and many people still die from it despite advances in treatment. Doctors need better ways to detect cancer early, decide who needs treatment after surgery, and monitor how well treatments are working. This review explains how a blood test called circulating tumor DNA (ctDNA) may help improve these decisions. What is circulating tumor DNA (ctDNA)? ctDNA consists of very small pieces of DNA released into the bloodstream by cancer cells. It can be detected using a simple blood sample. Because blood tests are less invasive than tissue biopsies, ctDNA can be measured repeatedly over time. How can ctDNA be used in colorectal cancer care? This review summarizes evidence showing that ctDNA can be useful at several stages of care. Before diagnosis, ctDNA blood tests can detect colorectal cancer with high accuracy, but they are not very good at finding precancerous polyps. Therefore, they should not replace standard screening methods such as stool tests or colonoscopy, but may help people who do not participate in existing screening programs. After surgery, ctDNA can detect tiny amounts of remaining cancer cells earlier than scans or standard blood markers. This can help doctors decide who truly needs additional chemotherapy and who may safely avoid it. In advanced cancer, repeated ctDNA testing can show whether treatments are working, identify early drug resistance, and help guide personalized treatment choices. Why is this important? Using ctDNA may reduce unnecessary treatments, detect cancer recurrence earlier, and support more personalized care. However, challenges remain, including cost, access, and the need for clear guidelines on when and how to use these tests. What comes next? More clinical studies are needed before ctDNA testing becomes routine in everyday colorectal cancer care.
Motility MRI is a validated marker of small bowel Crohn's disease (CD) activity. Objective assessment of small bowel motility with GIQuant (Motilent, London, U.K.) may have a valuable role to play in personalised patient care. The aim of this study was to assess the impact of implementing GIQuant on clinical impressions around treatment response in small bowel CD. Patients with small bowel CD on or starting therapy underwent two MRE scans (∼1 year apart) including motility MRI (mMRI) imaging. Twelve gastroenterologists from six U.K. participating centres evaluated patient response based on standard of care tests, grading them on a 6-point scale (much/somewhat/slightly worse through to slightly/somewhat/much better). After initial assessment, GIQuant scores and percentage change were revealed to the gastroenterologist who then updated their response assessment with this information. GIQuant scores at baseline and follow up are reported along with magnitude of change in clinically categorised responders and non-responders. Over the study period of 3.6 years a total of 253 patients (61% male), with ileal (52%) or ileocolonic (48%) CD underwent 506 MRE scans, with a median 10.4-month gap (range 2 to 36) between scans.In 120/253 (47%) patients, gastroenterologists reported a change in their impression of patient status (one step change or greater) after reviewing the GIQuant results with 55/253 (22%) reversing their overall assessment (between deterioration or improvement) across the two time points.In clinical responders, the GIQuant score increased from 123 to 163 (32% increase), P < .001 with non-responders showing a 2 point decrease in score (P = .9). GIQuant as a measure of motility MRI demonstrated robust utility to track the response of small bowel Crohn's activity to therapeutic intervention across time points.
This study aimed to systematically evaluate the efficacy and safety of different doses of domperidone (DOM) combined with esomeprazole (ESM) in the treatment of reflux esophagitis, providing a basis for precise clinical medication. This prospective single-center study enrolled a total of 376 eligible patients with reflux esophagitis (intention-to-treat [ITT] population) between January 2022 and December 2024, among whom 361 completed the full treatment course (per-protocol [PP] population). A total of 361 patients were randomly divided into four groups: control group (oral ESM, n = 90), low-dose group (oral ESM + 5 mg DOM, n = 92), medium-dose group (oral ESM + 10 mg DOM, n = 91), and high-dose group (oral ESM + 15 mg DOM, n = 88), all for an 8-week duration. The primary outcome was the endoscopic remission rate at 8 weeks, defined as the achievement of Los Angeles classification grade 0 or A (ITT and PP population). Secondary outcomes (PP population) included changes in symptom scores (Gastroesophageal Reflux Disease Questionnaire, Reflux Symptom Index, Reflux Disease Questionnaire), quality of life (GERD-Health Related Quality of Life scale, EuroQol Five-Dimension Five-Level Scale), high-resolution esophageal manometry parameters, 24-hour impedance-pH monitoring indices, serum inflammatory cytokine levels, and the incidence of adverse events. The medium-dose DOM combination group demonstrated the most favorable efficacy across all key endpoints. Its endoscopic remission rate was significantly higher than that of the other three groups (P < 0.05). The results of the ITT analysis were highly consistent with the PP analysis. In the ITT population, the medium-dose group demonstrated a significantly superior endoscopic remission rate (94.68%) compared to the other three groups (P < 0.05). This finding was corroborated by the PP analysis, which also showed the optimal efficacy in the medium-dose group (97.80%). Concurrently, this group exhibited the most pronounced improvements in symptom scores and quality of life, the greatest recovery in esophageal motility parameters, the most significant reduction in all types of reflux episodes, and the greatest decrease in inflammatory cytokine levels (all P < 0.05). The high-dose group ranked second in efficacy, while the low-dose group showed superiority over the control group only in partial indicators. Although there was no significant difference in the incidence of adverse events as reported in the study, the overall event incidence and the increasing trend among different groups suggest the possible existence of a dose-response relationship, especially in the high-dose group. Based on standard esomeprazole therapy, the addition of medium-dose DOM (10 mg three times daily) synergistically improves reflux control, mucosal healing, motility recovery, and inflammatory status. This dose achieves an optimal balance between efficacy and safety, providing high-level evidence for implementing individualized and precise medication strategies in clinical practice. Although overall adverse event rates did not differ significantly among groups, a dose-dependent trend was observed. Higher doses offer no additional benefit and may increase safety concerns.
Clostridioides difficile infection (CDI) remains a significant public health challenge, with variable diagnostic and treatment practices. This study evaluated current clinical practices for CDI diagnosis and management in Korean physicians through a nationwide survey. An online survey was conducted among physicians treating CDI, including gastroenterologists and infectious disease specialists. The survey covered diagnostic approaches, treatment regimens, and management strategies, including differentiation based on disease severity and recurrence. A total of 300 physicians responded. The most commonly reported indication for CDI testing was the occurrence of three or more diarrheal episodes within a 24-hour period. The majority of physicians (69.7%) preferred multiple diagnostic tests, favoring simultaneous testing (90.4%) over a stepwise approach. Preferred tests included nucleic acid amplification test (NAAT) (69%), glutamate dehydrogenase+toxin A/B combined assay (56%) and toxin enzyme immunoassay (EIA) (48%). Single-test users preferred toxin EIA (37.4%) and NAAT (29.7%). Treatment was primarily tailored to severity by 84.1% of physicians. For non-severe CDI, oral vancomycin (50.7%) and metronidazole (29%) were the main treatments, with 88% not recommending hospitalization. Severe CDI was treated with oral vancomycin (45.3%) or intravenous metronidazole in combination (44.9%), often for ≥ 14 days. For the first recurrence, 69.3% used oral vancomycin, with 22.6% opting for a tapered/pulsed regimen. Fecal microbiota transplantation use increased from 0.3% initially to 17.6% for multiple recurrences. In CDI with ileus, 64% preferred combination therapy, and 48% used vancomycin enemas. In inflammatory bowel disease patients, 99% underwent CDI testing for worsening diarrhea. Immunomodulators and biologics were continued in 79% and 73% of non-severe cases, respectively, but often paused during severe CDI. Korean physicians generally follow the recently developed Korean guideline for CDI practice, but certain gaps and inconsistencies in choices were observed in clinical situations. Further efforts are needed to monitor guideline implementation and to analyze gaps between guideline recommendations and real-world clinical practice to optimize CDI management in Korea.
The eradication efficacy of proton pump inhibitor (PPI)-based standard triple therapy (STT) for Helicobacter pylori infection has declined in Korea, largely because of increasing clarithromycin resistance. High-dose dual therapy (HDDT) using potent acid suppression represents a promising clarithromycin-sparing strategy. This study evaluated the efficacy and safety of fexuprazan-based modified HDDT (m-HDDT) including bismuth, compared with conventional PPI-based STT as first-line eradication therapy. This prospective, multicenter, randomized, open-label, non-inferiority trial was conducted at eight tertiary hospitals in Korea. Treatment-naïve adults with confirmed H. pylori infection were randomized to receive either m-HDDT (fexuprazan 40 mg twice daily, amoxicillin 1000 mg three times daily, and bismuth subcitrate potassium 300 mg three times daily) or STT (lansoprazole 30 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, all twice daily) for 14 days. Eradication was assessed by urea breath test 4-8 weeks after therapy. The primary endpoint was the eradication rate in the full analysis set (FAS), with a prespecified non-inferiority margin of -10%. Safety and compliance were evaluated as secondary outcomes. In total, 196 patients were included in the FAS (m-HDDT, n = 96; STT, n = 100). Helicobacter pylori eradication was achieved in 81.3% of patients in the m-HDDT group and 79.0% in the STT group, demonstrating non-inferiority of m-HDDT (one-sided Wald test, p = 0.0158). Per-protocol analysis yielded consistent results (p = 0.0215). Drug compliance was high in both groups, with mean compliance rates of 97.0% in the m-HDDT group and 99.0% in the STT group; more than 95% of patients in each group achieved ≥ 80% compliance. The incidence of treatment-emergent adverse events was comparable between groups (16.7% vs. 14.0%); most events consisted of mild gastrointestinal symptoms. No serious adverse events or treatment discontinuations due to adverse events were observed in either group. Fexuprazan-based m-HDDT with bismuth was non-inferior to PPI-based STT for H. pylori eradication and demonstrated comparable safety and excellent compliance. This clarithromycin-sparing regimen can be considered an alternative treatment option in regions with high macrolide resistance.
Esophageal adenocarcinoma (EAC) represents one of the most increasing malignancies in Western countries. The disease is multifactorial, involving modifiable risk factors and genetic susceptibility variants. These variants can be aggregated to a polygenic risk score (PRS) that reflects individual genetic risk. Investigation of the effects of lifestyle factors, PRS, and co-medication on EAC age at onset (AAO) is critical for shaping prevention strategies. A detailed questionnaire was used to assess pre-diagnostic exposure to lifestyle factors and clinical information from a large German EAC cohort. Linear regression analysis was performed to identify factors associated with EAC AAO in 1742 EAC patients. PRS was available for 1190 patients. Subgroup analyses were conducted to estimate the effects of the analyzed factors on AAO according to age group (early vs. late onset), sex, and prior diagnosis of Barrett's esophagus (BE). Earlier AAO was significantly associated with gastroesophageal reflux (GER), smoking and a higher PRS, whereas later AAO was associated with physical activity and higher consumption of fish and fruits. Among co-medication, combined use of proton pump inhibitors (PPIs) and acetylsalicylic acid (ASA) showed the most significant effect on AAO, whereas the use of PPIs and ASA alone showed weaker effects. This study represents the largest questionnaire-based analysis to date investigating factors influencing EAC development. Our findings show that the combined use of PPIs and ASA, both cost-effective medications, is associated with delayed EAC onset. In addition, lifestyle and genetics contribute to EAC AAO.
Annual stool testing with fecal occult blood testing (FOBT) or fecal immunochemical test (FIT) is commonly used for colorectal cancer screening but the incremental benefit of adherence to multiple rounds of stools tests for long-term reduction in CRC incidence has not been studied. Our aims were to study the incremental effect of repeat annual FOBT on 20-year CRC incidence in an average-risk screen-eligible population. We used data from the Minnesota Colon Cancer Control Clinical trial, which enrolled 45,661 individuals to undergo annual biennial or no screening. We studied the difference in 20-year CRC incidence between those who do and do not complete each round of screening, from round 1 to round 4, in the annual arm. Overall, 13,130 participants from the annual arm completed the first round of screening, and 12,638 were eligible for round 2, 10,863 were eligible for round 3 and 9206 were eligible for round 4. The adjusted risk of CRC at 20 years for those who completed round 2 was 1.60 (95% CI: 0.34-2.87) percentage points lower than that of those who did not. The adjusted 20-year incidence of CRC in those who completed rounds 3 and 4 was 0.51 (95% CI: -0.73, 1.75) and 0.08 (95% CI: -1.19, 1.35) percentage point lower than those who did not complete rounds 3 and 4, respectively, and was not statistically significant. Our study underscores the importance of adherence to more than 1 round of screening and provides information for providers and patients about the benefits they may accrue from at least 2 rounds of adherence. We also found that the overall value of repeat screening after 2 negative rounds is important but provides marginal gain. The implications are that perfect adherence over multiple rounds may not be necessary to accrue the benefits of a reduction in CRC incidence and mortality.
With guidelines recommending earlier advanced therapy (AT) use after 5-ASA failure for patients with moderately-to-severely active ulcerative colitis (UC), it is important to explore treatment preferences at the point of escalation to first-line AT. A web-based discrete choice experiment (DCE) survey was administered to AT-naïve patients with moderately-to-severely active UC and gastroenterologists in 5 European countries. Treatment attributes included time until symptom improvement, probability of remission and corticosteroid-free remission, risks of cancer, serious infection, and major adverse cardiovascular events (MACE), and mode of administration. Preference weights, relative attribute importance (RAI), and maximum acceptable risk were estimated. A latent class analysis explored preference heterogeneity. Probability of remission at 1 year was the most important attribute for patients (N = 514; RAI = 45.3%) and gastroenterologists (N = 397; RAI = 48.5%). Five-year cancer risk was the second most important attribute for patients (RAI = 11.8%) and third for gastroenterologists (RAI = 10.9%). RAI of MACE was higher for patients than gastroenterologists (10.6% vs. 6.8%). Both were willing to accept risks for increased probability of remission. Latent class analysis identified 4 groups of patients and 2 groups of gastroenterologists with distinct preferences. The relative importance of efficacy was higher compared with safety in latent classes representing 80% of patients. Clinical remission was most important to patients and gastroenterologists, and both were willing to accept some risk in exchange for the benefits of AT. However, some heterogeneity in preferences was observed. To support patient-centered, guideline-concordant care, gastroenterologists should discuss escalation to AT with patients not well-controlled on conventional therapy, incorporating individual preferences through shared decision-making.
Hepatitis B virus (HBV) infection poses a significant public health challenge, leading to liver cirrhosis and hepatocellular carcinoma (HCC). The clinical course of HBV infection is influenced by viral, environmental, and host genetic variants. Recently, a Cirrhosis Risk Score (CRS) based on seven genetic variants has been developed to identify individuals at risk of developing cirrhosis. This study aimed to assess the predictive value of seven gene signatures in Egyptian patients with HBV infection as molecular biomarkers for cirrhosis. In this cross-sectional study, 170 HBV-infected patients exhibiting various degrees of liver fibrosis were recruited. Genotyping for the seven gene SNPs was performed using allelic discrimination assays. Subsequently, the non-invasive scores APRI and FIB-4 were computed and compared with CRS values. Furthermore, an in silico analysis was performed to examine the alterations in gene expression associated with the progression of fibrosis. The findings revealed a significantly higher prevalence of high CRS scores in late fibrosis (p = 0.006). The mean of CRS was higher in late than in early fibrosis (0.70 vs. 0.60; P = 0.003). However, APRI and FIB-4 scores did not differ significantly across the groups. The ROC analysis indicated that the CRS score can distinguish between patients with early and late fibrosis, with an AUC of 0.63 (p = 0.0034). The risk genotypes in DEGS1 (rs4290029), STXBP5L (rs17740066), and AQP2 (rs2878771) were associated with late fibrosis. According to the in silico analysis, there is a remarkable upregulation of DEGS1 and a downregulation of STXBP5L in late fibrosis as compared to early fibrosis. While the AQP2 showed no significant variation between early and late fibrosis. The CRS score showed a modest predictive ability in HBV-infected Egyptian patients; it can be used in conjunction with imaging and clinical tools to improve risk stratification. Moreover, DEGS1, STXBP5L, and AQP2 genetic variants demonstrated a significant association with cirrhosis risk. However, only the DEGS1 and STXBP5L genes showed dysregulated expression levels, suggesting their potential relevance as diagnostic biomarkers in liver fibrosis.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally. The co-occurrence of COPD exacerbation and cirrhosis may compound clinical complexity and elevate adverse outcome risks. This study aimed to evaluate the impact of cirrhosis on outcomes among patients admitted with acute exacerbations of COPD. Data were extracted from the Nationwide Inpatient Sample database for the period of 2019 to 2021. Patients hospitalized with acute exacerbations of COPD were identified using ICD-10 codes. The study population was stratified into patients with cirrhosis and those without. The primary outcome was in-hospital mortality. Secondary outcomes included sepsis, hepatic encephalopathy, respiratory failure, cardiac arrest, cardiac arrhythmias, pneumothorax, pulmonary embolism, acute kidney injury, and hospital length of stay. Among 914,498 patients hospitalized with COPD exacerbations, 4.2% had cirrhosis. Cirrhotic patients were younger and had higher in-hospital mortality, longer length of stay, and higher hospital charges compared to noncirrhotics. Cirrhosis was independently associated with increased mortality and a higher risk of sepsis, acute kidney injury, encephalopathy, shock, and prolonged hospitalization. Associations with arrhythmia and cardiac arrest were not statistically significant. Cirrhosis is associated with higher in-hospital mortality and increased risk of complications in patients admitted for COPD exacerbations, contributing to longer hospital stays and higher healthcare costs. Clinical monitoring and tailored management are warranted in this group.
Gastrointestinal symptom-specific anxiety (GSA) is increasingly recognized as an important construct in the disease experience of inflammatory bowel diseases (IBD). However, it remains unclear to what extent GSA overlaps with general anxiety in the IBD population, and whether it is associated with disability beyond general anxiety and other clinical and demographic variables. First, we examined how many patients with elevated GSA do or do not experience general anxiety, and vice versa. Second, we assessed the unique contribution of GSA to variance in IBD-related disability, keeping general anxiety, disease activity, and other variables constant. In a cross-sectional survey study, over 1000 IBD patients completed questionnaires on general anxiety (the anxiety subscale of the Hospital Anxiety and Depression Scale [HADS]), GSA (the Visceral Sensitivity Index [VSI]), IBD-related disability (the IBD Disk), and self-reported clinical disease activity (Patient-Reported Outcomes [PRO] and Manitoba IBD Index [MIBDI]) alongside a set of general demographic and clinical questions. GSA and general anxiety frequently co-occurred, but 38.0% of patients reported GSA without general anxiety. Additionally, GSA was significantly associated with IBD-related disability (P < .001) even when general anxiety, disease activity, and other variables were controlled for. Although general anxiety showed the strongest association with disability (β = .27), the association for GSA (β = 0.22) was stronger than for clinical disease activity (β = .18) and other demographic and clinical variables. Overall, this highlights the clinical significance of GSA beyond general anxiety and disease activity in IBD.
Acute Gastrointestinal Injury is a common and serious complication in critically ill adults associated with poor outcomes. Its progression involves intestinal barrier dysfunction, nutritional impairment, and gut microbiota alterations, which remain inadequately characterized across severity grades. This study aimed to evaluate the association between gut microbiota composition, nutritional status, clinical severity, and outcomes. A retrospective cross-sectional study of 550 adults with AGI (grades I-IV) and controls was conducted across multiple tertiary hospitals from June to September 2025, including 343 males. Clinical, nutritional, biochemical, and microbiota data were analyzed by AGI severity using diversity measures and multivariate regression models. Increasing AGI severity was associated with age, higher comorbidity burden, greater illness severity, increased organ support requirements, and worse clinical outcomes, including prolonged ICU stay and higher mortality (p < 0.001). Severe AGI (III-IV) patients showed pronounced gastrointestinal dysfunction, delayed and interrupted enteral nutrition, reduced caloric adequacy, and significantly impaired nutritional biomarkers. Marked gut dysbiosis was observed with increasing AGI severity, characterized by significantly reduced microbial diversity, depletion of beneficial taxa (Firmicutes, Bacteroidetes, Lactobacillus, Bifidobacterium, Faecalibacterium), and overgrowth of potentially pathogenic bacteria, particularly Proteobacteria and Escherichia-Shigella (all p < 0.001). Multivariate analysis identified higher age, APACHE II and SOFA scores, antibiotic and proton pump inhibitor use, and interruption of enteral nutrition as independent risk factors associated with severe AGI and dysbiosis, whereas higher BMI, serum albumin levels, and greater microbial diversity were associated with a lower likelihood of severe AGI. AGI severity is closely associated with worsening intestinal dysbiosis, deteriorating nutritional status, and poorer clinical outcomes. These findings highlight the importance of early nutritional support and microbiota-targeted interventions in managing critically ill AGI patients.
To characterise the clinical, microbiological and economic burden of hospital-admitted, injection-related infections among incarcerated people who inject drugs. Retrospective observational cohort study. Secure unit of the Princess Alexandra Hospital, Brisbane, Australia. Adults incarcerated in Queensland prisons who were admitted to hospital with an injection-related infection between 1 July 2019 and 30 June 2023. Types of injection-related infection, microbiological findings, requirement for surgical or radiological source control, hospital length of stay and inpatient healthcare costs. There were 321 hospital admissions for injection-related infection among 265 patients, accounting for 282 unique infections. Most patients were male (241; 90.9%), with a mean age of 33 years (standard deviation [SD], 7.4 years), and 76 (28.7%) identified as First Nations. The most frequent infections were soft tissue infections (77/282; 27.3%), acute hepatitis C (64/282; 22.7%) and cellulitis (43/282; 15.2%). Surgical or radiological source control was required in 95 infections (34.0%), and infectious diseases consultation occurred in 130 infections (46.1%). Among 39 true-positive blood cultures, Staphylococcus aureus was identified in 17 (43.6%), Burkholderia species in 10 (25.6%) and non-tuberculous Mycobacterium species in 3 (7.7%). Among the 218 non-acute hepatitis C infections, 50 (22.9%) were hepatitis C virus (HCV) RNA positive. Overall, HCV RNA was present in 114 of 282 infections (40.4%). The total inflation-adjusted inpatient cost was $8.39 million, with a median cost per infection of $11,602 (interquartile range, $7426-$34,544). Injection-related infections among incarcerated people who inject drugs were associated with substantial morbidity and healthcare costs in this large hospital cohort. A wide clinical spectrum was observed, including atypical pathogens, and clinically overt acute hepatitis C requiring hospital admission. These findings describe a significant burden of preventable disease in custodial settings and support the introduction of established primary prevention and harm-reduction interventions in prisons. The known: Injection‐related infections drive preventable hospitalisations among people who inject drugs, with prisons amplifying risk through unsafe injecting conditions. The new: To our knowledge, this is the first Australian study to characterise the clinical spectrum, microbiology and hospital costs of injection‐related infections among incarcerated people who inject drugs, identifying high rates of acute hepatitis C, atypical pathogens and $8.39 million in hospital costs. The implications: Prisons are a critical setting for reform. Implementing evidence‐based harm reduction—including expanded opioid agonist therapy and prison‐based needle‐syringe programs—offers a potential cost‐saving opportunity to prevent injection‐related infections, reduce hepatitis C transmission and close a long‐standing public health gap.
The mortality rate from liver disease among people with type 2 diabetes mellitus (T2DM) increased by 20% between 2001 and 2018. There are marked racial and ethnic differences among people with T2DM at risk of metabolic dysfunction-associated steatotic liver disease (MASLD) and related complications. We aimed to investigate the distribution of individual-level social determinants of health (SDOH) in people living with both T2DM and MASLD. In this small cross-sectional study, patients (N=50) were recruited from a tertiary care general hepatology clinic to complete a survey that assessed potential determinants of health. We sought to oversample Black and Hispanic patients to better understand the prevalence of SDOH. Electronic health records were reviewed to determine stage of liver disease, and these data were linked to survey results to identify the distribution of individual-level determinants of health in patients with cirrhosis. Black and Hispanic respondents were more likely to report more experiences of racial discrimination, worries about being discriminated against, and group-based medical mistrust, especially regarding unsupportive health care providers. Cirrhosis groups tended to have lower incomes and less coverage from private health insurance. However, no substantial trends were observed in the distribution of health literacy, discrimination, and diabetes stigma among patients with and without cirrhosis. These findings will inform a future study aimed at assessing and developing interventions to address the combined impact of individual- and neighborhood-level SDOH on health-related outcomes in patients with T2DM and MASLD.
Clinical guidelines recommend regular colonoscopy surveillance for individuals at elevated risk for colorectal cancer (CRC). While colonoscopy surveillance is proven to reduce the incidence of CRC, colonoscopy is an invasive procedure that can impact patient-reported outcomes (PROs). Assessment of PROs is recommended as a key indicator of the quality of health service delivery. However, there is no standard set of PROs and PRO measures (PROMs) to be applied in individuals undergoing regular surveillance colonoscopy. The aim of this scoping review was to identify PROs and PROMs applied for this population. The review followed the Joanna Briggs Institute guidelines. Five databases were searched: Medline (OVID), Scopus, Web of Science, CINAHL, and PsycINFO (OVID). Data extracted included the PROs assessed, PROMs used, indications for surveillance colonoscopy, and assessment timepoints. 8684 studies were screened, and 91 were included. Eighteen PROs and 12 PROMs were identified. Abdominal discomfort (60%), abdominal pain (60%) and nausea (56%) were the most frequently collected PROs. PROs were predominantly assessed after bowel preparation/before colonoscopy (55%) and 1-2 days after colonoscopy (48%). Hospital Anxiety and Depression Scale (33.3%), Short Form-36 (33%), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30-item (27%), and EQ-5D-5L (20%) were the most frequently used PROMs. There is variability in PROs and PROMs applied. This highlights the need for consensus on a standardised set of PROs to be assessed and PROMs to facilitate consistent and reliable data collection to better inform implementation and improve healthcare quality. The assessment of patient-reported outcomes is recommended as a key indicator of the quality of healthcare service delivery. Individuals at elevated risk for colorectal cancer need frequent colonoscopies and regular encounters with the health care system. Symptoms such as abdominal pain and vomiting are commonly reported in association with bowel preparation for colonoscopy, as well as complications following the procedure. It is therefore important to assess the patient-reported outcomes associated with colonoscopy in this population. However, there is a paucity of evidence on the standardised set of patient-reported outcomes to be assessed and patient-reported outcome measures to be applied. Our study identified the most frequently assessed patient-reported outcomes and the most frequently used measures. Notably, there was considerable variability in the patient-reported outcomes assessed and measures used, the timing of their assessment in relation to the colonoscopy procedure, as well as across different indications for surveillance colonoscopy. This shows the need to standardise patient-reported outcomes and measures to be applied in this population and at what timepoints. This will facilitate consistent and reliable data collection to better inform implementation and improve healthcare quality.
Accurate histologic classification of ampullary lesions is essential for guiding therapeutic decisions; however, conventional biopsy is limited by sampling error and false-negative results. We evaluated the clinical utility of a generative artificial intelligence (AI)-based computer-aided diagnosis (CAD) system that integrates real and synthetic endoscopic images to improve diagnostic performance. In this retrospective multicenter study conducted across seven hospitals, duodenoscopic images were classified as Normal, Adenoma, or Cancer. A generative AI-based CAD system using latent diffusion synthesized 500 images per class for data augmentation and was trained to predict histologic classes from endoscopic images. External validation assessed accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve. A reader study involving five expert and five trainee endoscopists compared diagnostic performance with and without CAD assistance. The generative AI-based CAD system demonstrated high overall diagnostic accuracy (91.57%) and strong performance in identifying adenomas (accuracy, 88.76%). In the reader study, CAD assistance significantly increased adenoma sensitivity (63.47%-70.56%; p < 0.01), with corresponding improvements in predictive values. Both expert and trainee endoscopists benefited from CAD support, with reduced interobserver variability and consistent improvements across Normal, Adenoma, and Cancer classifications. A generative AI-based CAD system improved diagnostic accuracy and consistency in the evaluation of ampullary lesions. These findings support its potential as a clinically useful adjunct to routine duodenoscopy, particularly for improving adenoma recognition and supporting therapeutic decision-making.
Gastroparesis (GP) is a chronic gastrointestinal motility disorder that imposes a substantial clinical and economic burden. For patients with refractory GP, gastric peroral endoscopic myotomy (G-POEM) and botulinum toxin injection (BTI) are emerging therapies with differing efficacy profiles and procedural costs. Given these differences, we evaluated the cost-effectiveness of G-POEM versus BTI for refractory GP. We conducted a cost-effectiveness analysis using a decision tree model informed by randomized trial data from a US health care system perspective over 3- and 12-month time horizons. Procedural costs, adverse events, and repeat BTI sessions were incorporated. Quality-adjusted life-years (QALYs) were estimated from the Gastrointestinal Quality of Life Index (GIQLI) and from Short Form-12 (SF-12) scores. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) at a willingness-to-pay (WTP) threshold of $100,000/QALY. The base-case analysis was modeled on a 48.1-year-old patient with refractory GP-defined as persistent symptoms despite 6 months of medical therapy and a GP Cardinal Symptom Index score >2. At 3 months, G-POEM was associated with higher costs and marginally greater effectiveness than BTI (ICER $288,341/QALY), making BTI the cost-effective strategy in the short term. At 12 months, incorporating repeat BTI, G-POEM became the cost-effective option, with BTI yielding an ICER of $334,046/QALY relative to G-POEM. Sensitivity analyses identified clinical success rates and procedural costs as primary cost-effectiveness drivers. At 12 months, the cost-effectiveness acceptability curve showed G-POEM was cost-effective in most simulations at lower WTP thresholds, with BTI favored only at thresholds near $335,000/QALY. While BTI is more cost-effective in the short term, the cumulative costs of repeat sessions make G-POEM the more economically favorable strategy over 12 months. Improving clinical success rate by optimizing patient selection and refining procedural techniques could further improve cost-effectiveness profiles.
Following therapeutic advancements, recompensation has gained increasing recognition in patients on waitlist for liver transplantation (LT). Identifying key predictors of waitlist removal because of improvement can enhance prognostication and resource allocation. We hence examined predictors of improvement-related waitlist removal using a machine learning-based approach with data from the United Network for Organ Sharing database. In this retrospective cohort study, adult LT waitlist candidates from 2000 to 2025 in the United Network for Organ Sharing registry were included. A random survival forest model was applied to examine key predictors associated with improvement-related waitlist removal, while accounting for death and LT as competing risks. Variable importance (VIMP) measure and minimal depth were used to guide variable selection. Model performance was evaluated using the concordance index, Brier scores, and time-dependent area under the curve. The cohort included 127 978 individuals listed for LT. Eight thousand four hundred ninety-three (6.6%) were delisted because of clinical improvement. The random survival forest model demonstrated strong performance and discriminatory ability overall at 1, 5, and 15 y (concordance index was 0.777, 0.771, and 0.781; time-dependent area under the curve was 0.78, 0.78, and 0.80). Brier scores were reduced relative to the reference. Strong predictors of recovery highlighted in both VIMP and minimal depth-based assessments of VIMP included diagnosis, age, and serum albumin. Identified variables could inform the development of robust predictive models to guide individualized decision-making for LT. With further validation and integration into clinical workflows, such models could enhance prognostication of patient trajectory on the LT waitlist and facilitate appropriate resource allocation.