The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update is to facilitate understanding and improve clinical management of patients with hepatitis delta virus infection.

Several studies have shown a connection between periodontal diseases and conditions such as heart disease, diabetes, and pregnancy. This study aimed to investigate the relationship between inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn's disease (CD), and periodontitis.

Care for patients with inflammatory bowel disease (IBD) has traditionally relied on in-person visits for disease management. However, technological advances have paved the way for innovation in healthcare delivery in the IBD space, most notably through mobile health applications (apps). These apps have many capabilities including, but not limited to, helping patients track symptoms and food intake, communicating with medical providers, connecting with nutritionists, providing access to mental health resources, and providing education about IBD. Given the ubiquity of smartphones and increasing prevalence of technology involvement in healthcare, there is a plethora of apps available for personal and professional use in IBD care. We reviewed and compared some of the most studied and popular apps available on the marketplace to help clinicians understand the state of mobile technologies for IBD and see the potential value of integrating apps in the traditional IBD care model. Furthermore, we review the current state of wearable technology and explore next steps in technology development to further augment care for patients with IBD. IBD is a lifelong disease, without a cure, and a multidisciplinary management approach is critical. Health apps offer unique opportunities for an integrated management strategy, empowering patients to have more involvement in their care, and providing clinicians with real-time clinical data to tailor more personalized treatment plans.

Global plastic waste production remains a critical environmental issue. Microplastics (MPs), plastic particles less than 5 mm, are now pervasive across ecosystems. Humans are exposed to MPs via ingestion, inhalation, and dermal contact raising concerns about their health impacts. This systematic review investigates the influence of MPs on the human gut microbiome, focusing on changes in microbial composition, diversity, and metabolic pathways based on 12 studies identified through Scopus and PubMed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings show that exposure to MPs such as polyethylene (PE), polystyrene (PS), polyethylene terephthalate (PET), polyvinyl chloride (PVC), and polylactic acid (PLA), induces gut dysbiosis, marked by a loss of beneficial genera, and enrichment of pathogenic species. MPs also impair short-chain fatty acid (SCFA) production, alter metabolic functions, and modulate immune pathways, contributing to intestinal diseases, metabolic syndrome, and chronic inflammation. The extent of disruption is influenced by MP-specific properties such as type, size, and concentration. These results suggest that MPs are emerging environmental risk factors with tangible implications for human health. To fully understand the health concerns associated with MPs long-term, human-relevant studies with standardized methodologies are urgently needed to define safe exposure levels and guide policies aimed at reducing MP-related health risks.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths globally, and researchers continue to explore its underlying factors. This systematic review and meta-analysis study aimed to clarify the prevalence and potential association between intestinal parasitic infections (IPIs) and CRC.

Transcatheter arterial chemoembolization (TACE) is a fundamental treatment for unresectable hepatocellular carcinoma despite its tendency to induce postembolization syndrome (PES), which can negatively impact the quality of life and treatment outcomes of patients. This study aimed to evaluate the efficacy of prophylactic dexamethasone in reducing PES following TACE.

Colon cancer (CC) is the third most diagnosed malignancy and second leading cause of cancer mortality globally, with ~ 1.9 million new cases and 903,859 deaths annually (Bray et al. in CA Cancer J Clin 68(6):394-424, 2018). Diet represents a key modifiable risk factor for CC pathogenesis (Herr and Buchler in Cancer Treat Rev 36:377-383, 2010). Cruciferous vegetables (CV)-rich in glucosinolates that hydrolyze into bioactive isothiocyanates (Willett in Cancer Epidem Biomar 10:3-8, 2001; Murillo and Mehta in Nutr Cancer. 41(1-2):17-28, 2001; Higdon et al. in Pharmacol Res 55:224-36, 2007)-exhibit chemopreventive properties through carcinogen detoxification, apoptosis induction, and cell cycle arrest (Zhang et al. in Proc Nutr Soc 65:68-75, 2006). While prior meta-analyses report an inverse association between CV intake and CC risk (Tse and Eslick in Nutr Cancer 66(1):128-39, 2014), the quantitative dose-response relationship remains uncharacterized, limiting translational insights for dietary guidance.

Nonvariceal, nonpeptic ulcer bleeding, arising from etiologies such as malignant tumors, Mallory-Weiss tears (MWTs), Dieulafoy's lesions, and gastric antral vascular ectasia, constitutes a significant and increasing proportion of upper gastrointestinal bleeding cases. These evidence-based guidelines, developed by the Canadian Association of Gastroenterology with international collaboration, are the first to specifically address the endoscopic management of these conditions, aiming to support patients, clinicians, and others in making informed decisions.

Liver injury is associated with cholelithiasis, with changes in liver enzyme levels potentially influencing cholelithiasis risk. This study investigates the shared genetic basis between serum levels of four liver enzymes and cholelithiasis using summary data from large-scale genome-wide association studies (GWAS).

The need for objective diagnostic tools in people with alcohol intake abuse is one of the major needs in daily clinical practice. Determination of blood alcohol concentration is commonly used in cases of suspected acute alcohol intoxication, especially in the emergency room. A dose-dependent correlation between alcohol consumption and mean corpuscular volume (MCV) is a known index of excessive alcohol intake. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are frequently elevated (2-4 times above normal) in patients with alcohol use disorder and an AST/ALT ratio >2 is indicative of alcohol-related liver disease. Several studies highlighted a positive correlation between alcohol consumption and serum gamma-glutamyl transferase (γGT) levels, with increased values in about 75% of patients drinking >60 g/day of ethanol for at least 5 weeks. Also, 60-80 g of alcohol per day for a minimum of 2 weeks can result in increased carbohydrate-deficient transferrin (CDT) levels (normally less than 2% of total transferrin). Complete abstinence from alcohol leads to a normalization of CDT values in approximately 2-3 weeks. Ethyl glucuronide (EtG) is detectable in urine from a minimum of 6 hours up to a maximum of 100 hours after alcohol intake. In-vitro studies showed that the levels of phosphatidylethanol (PEth) in human red blood cells were proportional to ethanol concentration and exposure time, suggesting an important role in differentiating abstinence from unhealthy drinking. γGT and CDT are the most useful markers for monitoring chronic alcohol abstinence, whereas blood alcohol concentration and urinary EtG are the most valuable indexes of acute alcohol consumption. In conclusion, no specific laboratory marker alone is reliable to identify patients with alcohol abuse, thus the best diagnostic strategy includes combined index use in addition to other screening tools (i.e., clinical history/context and questionnaires).

Helicobacter pylori is responsible for several gastrointestinal disorders, of which gastric cancer is the most concerning. Given the racial and ethnic disparities seen with H. pylori infection and gastric cancer in the U.S., certain populations (immigrants, non-white racial groups) remain at high-risk. While several guidelines recommend screening for H. pylori in these high-risk groups, specific guidance on how to implement population screening and the cost-effectiveness of this approach is lacking. Here we discuss several controversies including the cost-effectiveness and implementation of a population-based H. pylori screening program, empiric vs. tailored therapy based on antibiotic susceptibility, and the role of potassium-competitive acid blockers (PCABs) in H. pylori treatment. With the rapidly changing landscape of H. pylori management, here we review the latest studies and guidelines for practical clinical application.

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 on the incorporation of the functional lumen imaging probe (FLIP) into clinical practice, specifically its utility in the evaluation of esophageal symptoms, esophageal motor dysfunction, gastroesophageal reflux disease, and eosinophilic esophagitis.

The aim of this systematic review and meta-analysis was to assess the association between serum neuregulin 4 (Nrg4) levels and non-alcoholic fatty liver disease (NAFLD).

This meta-analysis aims to evaluate the efficacy and safety of ultrasound-guided percutaneous microwave ablation (MWA) for hepatocellular carcinoma (HCC) located at specific anatomical sites of the liver compared with non-specific sites.

The long-term impact of acute pancreatitis (AP) on quality of life (QoL) remains inconclusive. This systematic review and meta-analysis aimed to evaluate long-term QoL outcomes in patients after AP.

Endoscopy is a critical tool in the management of acute variceal bleeding (AVB). However, the optimal timing for its implementation remains controversial, with varying recommendations across different clinical guidelines. This study aims to evaluating the impact of endoscopy timing on patient outcomes.

Neuroendocrine carcinoma of the esophagus is a highly aggressive and rare type of cancer, making diagnosis and treatment challenging for clinicians. The current guidelines provide conflicting recommendations, and no standardized treatment protocol is available. We aim to deliver a systematic review of esophageal neuroendocrine carcinoma, including patient characteristics, treatment options, and prognostic factors.

Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with poorer prognosis of gastric cancer (GC) patients and may guide treatment decisions. This meta-analysis aims to evaluate the impact of NLR and PLR on the prognosis of GC patients undergoing neoadjuvant chemotherapy (NAC).

A defunctioning ileostomy is frequently created to avert the implications of a colo-rectal anastomotic dehiscence in rectal cancer surgery. The timing of closure of the ileostomy remains debatable as it is believed that early closure (EC) may be beneficial to most patients than the standard practice of late closure (LC). This meta-analysis was performed to compare surgical outcomes in patients who underwent EC versus LC.

Ulcerative colitis (UC) is a serious inflammatory bowel disease with significant morbidity and mortality. Infliximab (IFX), a TNF-alpha antagonist, is recommended by the American Gastroenterological Association, but its clinical effectiveness and safety are based on limited studies. This meta-analysis of randomized controlled trials (RCTs) evaluates the efficacy and safety of IFX in moderate-to-severe active UC, providing evidence for its clinical application.