Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, represents a significant yet underrecognized extraintestinal manifestation of inflammatory bowel disease (IBD). Imaging techniques such as dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound, combined with functional performance tests, offer promising strategies for early diagnosis. However, elucidating the molecular drivers of muscle wasting remains crucial. In IBD, chronic systemic inflammation, gut microbiota dysbiosis, and malnutrition synergistically disrupt muscle homeostasis by activating catabolic pathways and suppressing anabolic signals. Key molecular mechanisms involve NF-κB and JAK/STAT3 activation, inhibition of the IGF-1/mTOR axis, and alterations in microbiota-derived metabolites. Emerging evidence supports the existence of a gut-muscle axis, mediating the systemic effects of intestinal dysbiosis on skeletal muscle integrity. This review provides a comprehensive analysis of the molecular drivers of IBD-associated sarcopenia and explores potential therapeutic interventions targeting the gut-muscle interplay to improve clinical outcomes.

Non-alcoholic fatty liver disease (NAFLD) affects nearly one-third of the adult population worldwide, and currently, there are no approved pharmacological therapies. Akkermansia muciniphila, a bacterium found in the gut, has been identified as a promising therapeutic candidate due to its influence on the gut-liver axis.

This evidence-based practical review is focused on the clinical features, investigations, and treatment of hemorrhoids, chronic anal fissures, dyssynergic defecation (DD), and fecal incontinence (FI), which are arguably the most common benign anorectal diseases encountered by gastroenterologists. These diseases are associated with bowel disturbances, which should be evaluated preferably with questionnaires, and with anal weakness and/or DD, often evident on a thorough digital rectal examination. Fissures and DD are closely linked to constipation, whereas FI is typically associated with diarrhea. For most patients with mild symptoms, lifestyle changes, dietary adjustments, and/or pharmacotherapy suffice. Some patients require tests to rule out serious diseases; assess anorectal functions, which are discussed in detail; and to identify structural abnormalities, such as rectoceles, which are occasionally clinically significant. Treatments are applied stepwise, starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids), with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease; for anal fissures, topical therapy using a calcium channel antagonist or nitroglycerine, followed by botulinum toxin and, less frequently, lateral internal sphincterotomy for chronic fissures. Anorectal biofeedback therapy is effective for managing DD and, together with bowel modifiers tailored to the specific symptoms (ie, constipation and/or diarrhea), is also used for FI. Biofeedback therapy is not widely accessible, and many patients are treated by pelvic floor physical therapists. For FI, minimally invasive options include sacral neuromodulation and anal dextranomer injection, with colostomy or anal sphincteroplasty now rarely required. Surgical interventions must balance long-term effectiveness with potential risks. Key topics for future research are proposed.

Although Helicobacter pylori screen-and-treat has demonstrated effectiveness in preventing gastric cancer (GC), the impact on other diseases, such as peptic ulcer disease (PUD), dyspepsia, and gastric lymphomas, is often overlooked in guidelines and policy-analyses. This study quantifies the disease burden attributable to H pylori beyond GC.

Neuroendocrine tumors (NETs) represent a heterogeneous group of neoplasms with diverse biological and clinical behavior, and gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are the most common subtype. This review provides an overview of GEP-NETs, with a focus on incidence trends, pathologic classification, diagnostic strategies, therapeutic advances, and the role of endoscopy in diagnosis and management of GEP-NETs. Incidence rates of GEP-NETs have significantly increased over recent decades, largely due to improved diagnostic modalities and increased use of endoscopy, although environmental factors may be at play as well. Pathologic grading and classification, based on the 2022 World Health Organization criteria, remain essential in defining prognosis and therapeutic options, and advanced imaging modalities like somatostatin receptor positron emission tomography scans enable precise localization and staging. Therapeutic approaches vary by tumor grade, stage, and localization, from an increasing role for endoscopic management of indolent tumors to surgical resection for certain higher-risk subtypes and for resectable metastatic disease. Novel treatments, including somatostatin analogs, radioligand therapy, mammalian target of rapamycin inhibitors, and antiangiogenic agents, have shown significant efficacy in advanced and metastatic disease. Future research is needed to identify molecular markers to refine diagnostic accuracy and personalize treatment strategies, thereby improving long-term outcomes for GEP-NET patients. Additionally, research is needed to better define GEP-NET subtypes that are appropriate for endoscopic therapy as well as to understand long-term outcomes after endoscopic resection. Given the important role that endoscopy has in the diagnosis and management of GEP-NETs, increased recognition of and knowledge about these tumors is critical for the gastroenterology community.

Plentiful studies have reported that preoperative gamma-glutamyltransferase (GGT) had a strong relationship with the prognosis of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). Nevertheless, due to the small sample size and contradictory conclusions, the predictive function remains indefinite. To investigate the relationship between pretreatment GGT value and clinical outcomes in HCC patients undergoing TACE, a meta-analysis including 10 articles was constructed.

With the development of comfortable medical care, the application of intravenous anesthesia in painless gastroscopy is becoming increasingly widespread. However, anesthetic drugs may have adverse effects on postoperative cognitive function, and the risk of postoperative cognitive dysfunction (POCD) is particularly worthy of attention in the elderly population. Our aim is to evaluate the effect of intravenous anesthesia on postoperative cognitive function (POCF) in patients undergoing painless gastroscopy, with a focus on identifying potential risks of POCD and guiding clinical anesthesia practices.

The object of this study was to explore the risk factors for incomplete excision of colorectal polyps (CP) through a systematic review and meta-analysis.

This study aimed to systematically evaluate the effects of Enhanced Recovery After Surgery (ERAS) nursing protocols on patients undergoing laparoscopic colectomy.

Chronic hepatitis B (CHB) remains a leading cause of liver disease worldwide, with liver fibrosis being a key determinant of long-term prognosis. This narrative review provides a detailed examination of the pathogenesis, diagnosis, and management of liver fibrosis associated with CHB. The review outlines the complex mechanisms driving fibrosis, including viral replication, immune response, and hepatic stellate cell activation, which collectively contribute to liver damage. It also evaluates current diagnostic techniques, such as non-invasive biomarkers, imaging modalities, and liver biopsy, emphasizing their clinical utility and accuracy in assessing the fibrosis stage. The management section covers antiviral therapies, their role in halting disease progression, and emerging antifibrotic agents to reverse fibrosis. Additionally, the review discusses the importance of early detection and tailored treatment strategies in improving patient outcomes. By synthesizing the latest evidence, this review provides insights into the evolving landscape of chronic hepatitis B-related liver fibrosis and highlights ongoing challenges in its diagnosis and management.

Endoscopic retrograde cholangiopancreatography (ERCP) is a widely utilized procedure for diagnosing and treating biliary and pancreatic disorders. However, it carries a risk of post-ERCP pancreatitis (PEP). N-Acetylcysteine (NAC) has been proposed as a potential prophylactic agent due to its antioxidant properties, yet its efficacy remains debated. This systematic review and meta-analysis aimed to evaluate the effectiveness of NAC in preventing PEP in patients undergoing ERCP.

The number of risk prediction models for lymph node metastasis in early gastric cancer is increasing, but the quality and applicability of these models in clinical practice and future research remain unknown.

The worldwide increase in acute diverticulitis (AD) prevalence and the resulting growing economic burden on the healthcare system have driven the scientific community towards standardizing a methodological approach to obtain a prompt diagnosis, optimized treatment, and thus containing costs. By the analysis of currently available evidence, this review could provide effective strategies for efficient AD clinical management and highlights possible innovative therapeutic strategies.

Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, characterized by heterogeneous manifestations with significant morbidities. Diagnosing and managing CD remains challenging due to its variable clinical presentation, complexities in assessing disease extent and activity, and lack of a definitive diagnostic marker. Over the last years, there has been a switch towards a treat-to-target approach in the management of inflammatory bowel disease (IBD). Capsule endoscopy (CE) has emerged as a non-invasive, complementary tool for CD diagnosis and monitoring. CE is patient friendly being wireless and enables direct visualization of the entire small bowel in one sitting. CE plays a role in the diagnostic workup of suspected CD and in cases of in IBD unclassified (IBDU). In established CD, CE plays a role in monitoring mucosal healing, a key therapeutic target linked to improved long-term outcomes. CE findings significantly influence treatment strategies, leading to therapy escalation, adjustment, or avoidance of unnecessary surgical interventions. Moreover, CE disease activity assessment by means of the Lewis score is able to predict disease flares, thus having also a prognostic role. In conclusion, the non-invasive nature of CE, combined with its diagnostic, prognostic, and therapeutic implications, establishes it as an essential tool in the comprehensive management of CD across all disease stages. This review provides a comprehensive update on CE's evolving role in optimizing care of patients with CD.

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects up to 30% of the global population, yet effective pharmacological treatments remain limited. This systematic review and meta-analysis evaluated the efficacy of GLP-1 receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists in managing MAFLD.

We compared the efficacy of four treatment strategies for chronic hepatitis B (CHB): tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), tenofovir amibufenamide (TMF), and TDF-to-TAF switch strategies strategy. We conducted a network meta-analysis to provide evidence-based clinical guidance.

Barrett's esophagus (BE) is the only identifiable precursor to esophageal adenocarcinoma (EAC). Endoscopic surveillance has been proposed for early detection of BE-related neoplasia and reducing EAC mortality. This clinical practice guideline aims to inform clinicians and patients by providing evidence-based practice recommendations for surveillance in patients with BE.

T1 colorectal cancer (CRC), defined as tumor invasion confined to the submucosa, has traditionally been managed by surgery. Advances in endoscopic resection techniques, coupled with an improved understanding of tumor biology and risk of lymph node metastasis and recurrence, have expanded our treatment armamentarium for these lesions. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Commentary is to review the definition of T1 CRC, discuss the role of endoscopic resection for these lesions, review factors associated with risk of recurrence and metastasis, and discuss post-resection management, including surveillance or adjuvant surgery. The target audience for this commentary includes primary care, gastroenterology, pathology, and surgical health care professionals.

We performed an updated systematic review and network meta-analysis to inform the 2025 American Gastroenterological Association Clinical Guidelines on the management of moderate-to-severe Crohn's disease (CD).

The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to summarize the available evidence and offer expert Best Practice Advice (BPA) on the management of ascites, hepatic hydrothorax, volume overload, and hyponatremia in patients with cirrhosis.