Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) are associated with adverse clinical outcomes, impaired health-related quality of life, and significant economic burden. The growing burden of MASLD and MASH has led to the publication of a large number of MASLD/MASH guidelines by national and international societies. However, important differences among the recommendations have created confusion, contributing to a low implementation rate and suboptimal management of MASLD and MASH. Creating a consensus recommendation has become more important since the approval of a selective agonist of thyroid hormone β receptor (resmetirom) for MASH treatment in the United States. We built a consensus among the most recently published recommendations for MASLD/MASH.

Perforated peptic ulcer (PPU) is a surgical emergency condition associated with substantial mortality and morbidity. Despite scattered studies, there exists a gap in comprehensive evidence on management outcomes of this condition in Ethiopia. Hence, this review aimed to assess the pooled mortality and complication rates along with their predictors in patients treated for PPU.

Probiotic supplementation has been proposed as a preventive measure for necrotizing enterocolitis (NEC) in preterm infants. This umbrella meta-analysis assesses the effects of probiotics, including single-strain and multi-strain formulations, on NEC and related mortality.

Constipation-predominant irritable bowel syndrome (IBS-C) and functional constipation (FC) are prevalent disorders with overlapping and fluctuating symptoms, which pose challenges for accurate diagnosis. This study aimed to assess the consistency of diagnostic criteria for IBS-C and FC in adults across clinical practice guidelines (CPGs).

Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease. Some patients with PBC do not adequately respond to Ursodeoxycholic acid (UDCA) as a first-line treatment, putting them at an increased risk of disease progression. Peroxisome Proliferator-Activated Receptor (PPAR) agonists are emerging as promising therapeutic options for PBC. We aim to investigate the efficacy and safety of PPAR agonists in treating PBC patients.

This meta-analysis aimed to evaluate the factors influencing enteral nutrition feeding intolerance in critically ill patients.

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive bile duct destruction, leading to cholestasis and, if untreated, liver failure. Although ursodeoxycholic acid (UDCA) remains the first-line treatment, many patients exhibit an inadequate response, necessitating alternative therapeutic options. Seladelpar, a peroxisome proliferator-activated receptor delta (PPAR-δ) agonist, has emerged as a promising alternative due to its anti-inflammatory and anti-fibrotic properties.

Barrett's esophagus (BE) is a premalignant columnar metaplasia of the esophagus that predisposes victims to esophageal adenocarcinoma (EAC). Depending on differences in the study population and risk factors, the prevalence of BE may vary, from 0.4 to 20% globally. The current study aimed to systematically review and analyse the prevalence of BE in in patients with gastrointestinal symptoms in Iran. Furthermore, gastrointestinal malignancies are among the most common tumours in Iran, making this study even more significant.

Helicobacter pylori (H. pylori) infection is the main cause of the most frequent gastroduodenal diseases and gastric atrophy, with or without intestinal metaplasia, which predisposes to gastric cancer development. Gastric juice analysis may be useful in diagnosing these conditions, revealing the H. pylori infection and hypochlorhydria status by measuring ammonium concentrations and pH levels. EndoFaster® is a device introduced to perform these analyses on gastric juice in real-time. The available data showed very high negative predictive values in ruling out the infection and corpus atrophic gastritis, thereby potentially reducing the need for gastric biopsies when test results are negative. This review aims to assess the potential role of EndoFaster® in supporting the diagnosis of H. pylori infection, detecting gastric precancerous lesions, and other specific clinical applications, potentially reducing unnecessary gastric biopsies.

Advanced liver disease is a global health challenge which requires a timely and accurate diagnosis for optimal patient management. Traditionally, liver biopsy has been the gold standard for diagnosing and staging liver diseases; however, its invasiveness and associated risks, including bleeding, infection, and sampling errors, limit its utility. Non-invasive tests (NITs) have emerged as critical tools in liver disease evaluation, offering safe and effective alternatives to biopsy. This review explores the spectrum of NITs, highlighting their benefits, limitations, and clinical applications in specific liver diseases. NITs have demonstrated significant utility in monitoring chronic viral hepatitis, metabolic-associated steatotic liver disease (MASLD), and cholestatic liver diseases, reducing the need for invasive procedures. While further refinement and validation are needed, NITs represent a major advancement in liver disease management, enhancing early diagnosis, monitoring treatment response, and improving patient outcomes. This review delves into the various non-invasive tests employed in liver disease evaluation, emphasizing their benefits, limitations, and clinical applications. By examining the current landscape of NITs, we aim to elucidate how these advancements are revolutionizing the diagnosis and management of liver diseases, ultimately enhancing patient care and outcomes.

Artificial intelligence (AI) will fundamentally improve how we perform clinical trials by addressing issues of standardizing disease scoring, improving the sensitivity and precision of activity and phenotype assessments, and automating laborious and time-consuming study functions. Progress in AI image analysis is quickly proving to replicate expert judgment in endoscopy, histology, and cross-sectional imaging with speed, reproducibility, and reduced bias. However, AI analytics offer the ability to quantify disease characteristics with more detail and precision than human experts. Large language models and generative AI are automating the collection of high-quality data from electronic records and improving our ability to predict patient outcomes. This narrative review will focus on AI tools available today, their expected implementation, and future-facing opportunities for AI to reimagine inflammatory bowel disease clinical trials.

Artificial intelligence (AI) is set to rapidly transform gastroenterology, particularly in the field of endoscopy, where algorithms have demonstrated efficacy in addressing human operator variability. However, implementing AI in clinical practice presents significant challenges. The regulatory landscape for AI as a medical device continues to evolve with areas of uncertainty. More robust studies generating real-world evidence are required to ultimately demonstrate impacts on patient outcomes. Cost-effectiveness data and reimbursement models will be pivotal for widespread adoption. Novel challenges are posed by emerging technologies, such as generative AI. Ethical and medicolegal concerns exist relating to data governance, patient harm, liability, and bias. This review provides an overview for clinical implementation of AI in gastroenterology and offers potential solutions to current barriers.

This American Gastroenterological Association (AGA) guideline is intended to provide an overview of the evidence and support endoscopists and patients on the use of computer-aided detection (CADe) systems for the detection of colorectal polyps during colonoscopy.

Hepatic stellate cells (HSCs) play a crucial role in the pathogenesis of liver fibrosis in metabolic dysfunction-associated steatohepatitis (MASH), a condition characterized by excessive fat accumulation in the hepatocytes, unrelated to alcohol consumption. In a healthy liver, HSCs are quiescent, store vitamin A, and function as pericytes. However, in response to liver injury and inflammation, HSCs become activated. In MASH, HSC activation is driven by metabolic stress, lipotoxicity, and chronic inflammation. Injured hepatocytes, recruited macrophage, capillarized sinusoidal endothelial cells, and permeable intestinal epithelium may each contribute to activating HSCS. This leads to a unique inflammatory environment that promotes fibrosis. MASH HSCs change their metabolism to favor glycolysis, glutaminolysis, and lactate generation. Activated HSCs transform into myofibroblast-like cells, producing excessive extracellular matrix components that result in fibrosis. In addition, HSCs in MASH have inflammatory and intermediate activated phenotypes. This fibrotic process is a key feature of MASH, which can lead to cirrhosis and liver cancer. Understanding the mechanisms of HSC activation and their role in MASH progression is essential for developing targeted therapies to treat and prevent liver fibrosis in affected individuals.

Up to 1 in 6 patients will experience an unplanned hospitalization after endoscopic retrograde cholangiopancreatography (ERCP), largely for the evaluation and management of adverse events. Therefore, a commitment to the prevention, early recognition, and effective rescue of complications related to ERCP is critical toward improving outcomes. ERCP is most often complicated by acute pancreatitis, bleeding, infection, or perforation, although myriad other adverse events may occur. The prevention of post-ERCP pancreatitis has been the area of greatest interest and progress in the last decade, but the application of evidence-based prophylactic measures remains inconsistent. Innovations in stent, hemostasis, and perforation closure technology now allow effective and efficient endoscopic management of several important nonpancreatitis complications. Overall, our ability to prevent and treat ERCP-related adverse events has improved substantially, amplifying the importance of a high level of suspicion for and a thorough understanding of these events.

The gut microbiome is involved in human health and disease, and its comprehensive understanding is necessary to exploit it as a diagnostic or therapeutic tool. Multi-omics approaches, including metagenomics, metatranscriptomics, metabolomics, and metaproteomics, enable depiction of the gut microbial ecosystem's complexity. However, these tools generate a large data stream in which integration is needed to produce clinically useful readouts, but, in turn, might be difficult to carry out with conventional statistical methods. Artificial intelligence and machine learning have been increasingly applied to multi-omics datasets in several conditions associated with microbiome disruption, from chronic disorders to cancer. Such tools have potential for clinical implementation, including discovery of microbial biomarkers for disease classification or prediction, prediction of response to specific treatments, and fine-tuning of microbiome-modulating therapies. The state of the art, potential, and limits, of artificial intelligence and machine learning in the multi-omics approach to gut microbiome are discussed.

Small bowel strictures secondary to either benign or malignant causes are associated with significant morbidity and impaired quality of life. Symptoms and their severity are dependent on the location and the degree of stenosis which, in addition to the etiology, dictate the approach to treatment. Endoscopic management of small bowel strictures include endoscopic balloon dilation, enteral stenting, endoscopic ultrasound-guided gastroenterostomy (EUS-GE), and stricturotomy. The introduction of the cautery-enhanced lumen-apposing metal stent has streamlined EUS-GE and has brought it to the forefront especially for select patients with malignant gastric outlet obstruction (GOO) with acceptable survival. This review will summarize the literature regarding the aforementioned interventions and will focus on EUS-GE and how it compares with traditional use of enteral stents and surgical gastrojejunostomy in the management of malignant GOO.

Spontaneous portosystemic shunts (SPSSs) are common among patients with liver cirrhosis. These vascular structures are collateral veins that directly connect the portal vein system with the systemic circulation. The prevalence increases as cirrhosis worsens. Published studies exist investigating the possible association between presence and extension of SPSSs and clinical manifestation of liver cirrhosis, however some issues continue to be debated. Recent research on this topic has extended knowledge and brought out interesting new aspects. The aim of this review is to provide a comprehensive and updated revision of the role of SPSSs in liver cirrhosis, from pathophysiology to clinical and therapeutic considerations, specifically addressing the most controversial and emerging findings. On this purpose PubMed and Medline were used as data sources and an extensive review of the literature, including the most recent and relevant published studies, was performed. The presence of SPSSs, especially if multiple and/or large, is associated with an increased risk of developing several complications of liver cirrhosis. Patients with higher MELD have larger SPSSs with negative impact on survival. Regarding hepatocellular carcinoma, there is evidence suggesting a potential tumorigenic effect associated with SPSSs, but further investigations on humans are needed. In the context of liver transplantation, the negative effect of SPSSs on graft function and patients' survival is a matter of debate, with no consensus on their surgical management. Currently, several interventional treatments have been proposed for SPSSs that have demonstrated excellent outcomes in selected populations.

Pembrolizumab, a PD-1 inhibitor, has shown potential for treating advanced gastric and gastroesophageal junction (GEJ) cancer. This meta-analysis evaluates its efficacy and safety, alone or combined with chemotherapy, in this population.

White light (conventional) colonoscopy (WLC) is widely used for colorectal cancer screening, diagnosis and surveillance but endoscopists may fail to detect adenomas. Our goal was to assess and synthesize overall and subgroup-specific adenoma miss rates (AMR) of WLC in daily practice.