Background Patients with chronic hepatitis B (CHB) with indeterminate phase make up a diverse cohort with likely different outcomes. Objective We compared the hepatocellular carcinoma (HCC) risk in indeterminate CHB with different baseline types and by phase transition. Design This was a retrospective cohort study of 1986 (94.2% Asian) patients with indeterminate CHB from nine countries/regions. Patients

With a devastating 5-year survival rate of only 8%, pancreatic ductal adenocarcinoma (PDAC) is among the deadliest cancers and is expected to become the second leading cause of cancer-related deaths in the USA by 2030.1 2 Thus, the deciphering of key events driving tumour development and progression in both early and late stages of PDAC is crucial for improving diagnosis, therapy, and potentially prevention

We would like to thank the author Xudong Zhu for his interest in our work.1 Herein, we will address the identified concerns. From the outset, the letter provides a very high level, cursory critique, without supporting data or new insights revealing numerous weaknesses to buttress the author’s arguments, while raising a number of new, unfocused questions that are beyond the scope of the article. The

Background Pancreatic cancer exhibits limited clinical responses to immunotherapy, highlighting the need for new strategies to counteract its immunosuppressive microenvironment. Although metabolic reprogramming and epigenetic changes contribute to malignancy, the impact of lactate-driven histone lactylation on the tumour microenvironment (TME) has not been fully explored. Objective This study aims

Inflammatory bowel disease (IBD) is characterised by dysregulated chronic inflammation throughout the intestinal tract with unknown causes. Aetiology of IBD is speculated to be the result of a complex interplay among genetic predisposition, dysregulated immune response, gut microbiome and environmental factors. Despite the identification of various risk genes, a substantial impact of genetic risk on

Background Prophylactic clip closure after endoscopic mucosal resection reduces delayed bleeding in large and proximal colon lesions; however, evidence regarding its effectiveness in colorectal endoscopic submucosal dissection (ESD) is lacking. Objective To compare clinically significant delayed bleeding rates between a clip closure and a control group for flat and sessile 20–50 mm colorectal polyps

Background The gut microbiota has been linked to non-communicable diseases, including chronic kidney disease (CKD). However, the relationships between gut microbiome composition changes, uraemic toxins (UTs) accumulation, and diet on CKD severity and progression remain underexplored. Objective To characterise relationships between gut microbiome composition and functionality, UTs diet, and CKD severity

A 24-year-old man presented with a 7-year history of recurrent melena, acutely worsening 3 days prior. He had undergone endoscopic band ligation and glue sclerotherapy for gastro-oesophageal varices, yet intermittent bleeding persisted without advanced aetiological evaluation beyond cirrhosis/thrombosis screening. Physical examination revealed distinctive congenital capillary abnormalities, including

We have recently reported the immune-promoting effects of butyrate in microsatellite stable (MSS) colorectal cancer (CRC) based on mouse models.1 However, its potential application in human CRC and the underlying mechanisms by which butyrate interacts with specific CD8+ T cell subsets to regulate immunity in MSS-CRC warrant further investigation. In this study, we established a co-culture system using

The intricate interplay between the gut microbiota and the GI tract has garnered significant attention, as growing evidence has identified the inflammasome as a crucial yet underexplored master regulator in microbiota-driven diseases. Triggered by a variety of dangers, inflammasomes are supramolecular complexes that regulate immune response. A large number of bacterial-derived inducers have been characterised

Background Gastrointestinal acute graft-versus-host disease (GI-aGVHD) is one of the main complications of patients undergoing allogenic haematopoietic stem cell transplantation (allo-HSCT). A deeper understanding of the mechanisms of sustaining intestinal homeostasis is essential. Objective Here, we investigated micro-organisms and microbial metabolites that were crucial for intestinal homeostasis

A 72-year-old man diagnosed with rectal adenocarcinoma underwent laparoscopic radical resection with prophylactic loop ileostomy in our department. Following the surgery, the patient completed four cycles of adjuvant chemotherapy with the XELOX regimen (capecitabine plus oxaliplatin) in accordance with the current treatment guidelines. During the scheduled stoma reversal procedure, intraoperative exploration

Li M, Xu C, Shi J, et al . et al Fatty acids promote fatty liver disease via the dysregulation of 3-mercaptopyruvate sulfurtransferase/hydrogen sulfide pathway. Gut 2018;67:2169–80. This article has …

A 65-year-old previously well man presented with 3 weeks of generalised abdominal pain and diarrhoea up to three times per day after overseas travel. White cell count (9.6×106/L) and C-reactive protein (196 mg/L) were raised; however, comprehensive stool testing was negative for viral, bacterial and parasitic causes. Faecal calprotectin was <5 µg/g. CT demonstrated a long segment of circumferential

Commercial, regulatory-approved computer-aided detection (CADe) tools are widely used in colonoscopy; however, open-source multimodal large language models may present a promising alternative. This study compared the polyp detection performance of two such models—GPT-4o and Gemini 1.5 Pro—with ENDO-AID CADe, a commercial artificial intelligence (AI) system, using colonoscopy videos. Per-lesion sensitivities

In 2022, the gastro-oesophageal junctional zone (GOJZ) was proposed at the International Consensus Conference in Kyoto as the area extending 1 cm proximally and 1 cm distally from the gastro-oesophageal junction (GOJ), defined by the distal end of the palisade vessels (DEPV).1 2 The definition of GOJ remains a matter of debate. In the globally recognised GOJ cancer classification, a Siewert type II

Background Obesity-related cognitive decline is linked to gut microbiota dysbiosis, with emerging evidence suggesting that dietary interventions may ameliorate cognitive impairment via gut-brain axis modulation. The role of microglial cells in this process remains underexplored. Objective To investigate how diet-induced changes in gut microbiota influence cognitive function in individuals with obesity

A male patient aged 28 years with an 8-year history of ileal Crohn’s disease was started on combination therapy with infliximab and azathioprine 12 months ago. He was maintained on infliximab at a dose of 5 mg/kg administered every 8 weeks, and achieved sustained clinical remission. After receiving his sixth dose of infliximab, the patient developed intensely pruritic, erythematous papules and pustules

Background Complications of endoscopic mucosal resection (EMR) of large colorectal polyps remain a concern. Objective We aimed to compare safety and efficacy of cold EMR (without electrocautery) to hot EMR (with electrocautery) of large colorectal polyps. Design In this multicentre randomised trial, patients with any large (≥20 mm) non-pedunculated colon polyp were assigned to cold or hot EMR (primary

We are very grateful for the interest in our paper on improving colorectal cancer (CRC) risk prediction in symptomatic patients attending primary care1 expressed by Doctors Zheng and Wang,2 and they highlight some interesting points which we address in the Discussion. To date, the generalisability of Faecal Immunochemical Test (FIT)-based research conducted on a specific FIT analyser has been questioned

Background Despite the long-standing recommendations of high-protein diets for patients with cancer, the precise mechanisms of this dietary approach in benefiting tumour suppression and enhancing sensitivity to chemotherapy remain elusive. Objective To investigate the effect and underlying mechanism of high-protein diets in promoting cancer drug resistance. Characterisation of AKT regulation in this

We read with interest the recently published PURPLE trial evaluating the prophylactic use of Purastat to prevent delayed bleeding following EMR of large duodenal and colorectal lesions.1 While we acknowledge the importance of randomised trials in shaping clinical practice, several methodological concerns in this study limit the interpretability and clinical applicability of its findings. The trial

This May, the World Health Assembly (WHA) will vote on re-establishing a mandate for the WHO to address the health consequences of nuclear weapons and war.1 Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war. The first atomic bomb exploded in the New Mexico desert

Alcohol-associated hepatitis (AH) remains one of the most severe and life-threatening manifestations of alcohol-related liver disease (ALD). It is characterised by rapid onset, limited treatment options and high short-term mortality.1 One of the pathological hallmarks of AH is excessive activation of hepatic inflammatory signalling, notably accompanied by massive neutrophil infiltration in the liver

We read with interest Gisbert et al ’s report of EXIT, a randomised controlled trial (RCT) withdrawing anti-TNF in patients with inflammatory bowel disease (IBD), while continuing immunomodulators.1 EXIT found sustained clinical remission rates at 1 year were similar between those who continued or discontinued anti-TNF (84% vs 76%, p=0.2), results at odds with three previous RCTs, which all found anti-TNF

Background Non-variceal upper gastrointestinal bleeding (NVUGIB) remains a major cause of morbidity and mortality. Rebleeding rates following endoscopic treatment can reach up to 25% within 72 hours in patients with high-risk lesions. Objective To evaluate the efficacy of a haemostatic powder (Nexpowder) in reducing rebleeding rates after conventional endoscopic treatment in patients with NVUGIB. Design

### Study approach The TRINITY study was a prospective diagnostic accuracy trial conducted at the Asian Institute of Gastroenterology (Hyderabad, India), comparing triple rectal ultrasound imaging technology: transabdominal ultrasound (TAS) and transperineal ultrasound (TPUS) with endoscopic ultrasound (EUS) as the reference standard for assessing rectal inflammation in ulcerative colitis (UC). The

Background RAS mutations are frequently observed in human cholangiocarcinoma (CCA), while they are relatively rare in hepatocellular carcinoma (HCC). The role of RAS-dependent signalling pathways in CCA development is currently not well understood. Objective The objective of this study was to investigate RAS-dependent signalling pathways in CCA and their role in tumour development and differentiation

We read the study conducted by Drews et al 1 with great interest. In this prospective randomised controlled trial of patients undergoing hot-snare EMR of flat lesions in the duodenum (≥10 mm) and colorectum (≥20 mm) at 15 German centres, the authors conclude that the application of a haemostatic gel (Purastat, 3-D Matrix Europe SAS) following EMR in both locations does not reduce the rate of delayed

Background Hepatocellular carcinoma (HCC) is a significant global cancer burden, with rising incidence and lacking a unified prevention strategy due to complex aetiologies. Viral exposures may shape host immunity via specific reactive viral antigens that could induce immune responses against hepatocarcinogenesis. Objective We aimed to characterise viral exposure differences between HCC patients and

We read with great interest the recently published study by Groen et al comparing high-definition (HD) dye-based chromoendoscopy (CE) to HD white-light endoscopy (WLE) with segmental re-inspection and single-pass HD WLE in surveillance for colorectal neoplasia (CRN) in inflammatory bowel disease (IBD) patients.1 This multicentre randomised controlled trial addresses a critical clinical question. However

Liver diseases remain clinically challenging and exhibit complex cellular interactions, including liver cell–immune cell communications that can shape disease progression.1 During portal injury, biliary epithelial cells (BECs, also known as cholangiocytes) expand excessively, a process termed ‘ductular reaction (DR)’ which promotes fibrogenesis, tumourigenesis and consecutive liver disease progression

The role of the human microbiome in GI disease is an area of significant clinical and academic interest. The microbiome may well influence a number of GI diseases ranging from cancer,1 2 to IBD,3 4 to liver disease.5 6 One of the current challenges faced by microbiome researchers is the variance in terminology, methodological approaches and lack of consistency regarding outcomes. This is an issue that

Cholangiocarcinoma (CCA) is a highly aggressive adenocarcinoma of the biliary tract system with unsatisfactory therapeutic options.1 Standard frontline treatment for unresectable or metastatic CCA consisting of cisplatin and gemcitabine combined with checkpoint inhibitors targeting programmed cell death ligand 1 or programmed cell death 1 offers objective response rates of less than 30% and a median

Computer-aided detection (CADe) has increased adenoma detection in randomised trials. However, unlike other detection adjuncts, CADe is lesion specific, that is, it is trained on a specific set of lesions. If the training does not include sufficient examples of precancerous lesion subsets, CADe may not perform adequately for lesions in that subset. In a prospective assessment of a second-generation

Background and objective Gastric cancer (GC) remains a prevalent and preventable disease, yet accurate early diagnostic methods are lacking. Exosome non-coding RNAs (ncRNAs), a type of liquid biopsy, have emerged as promising diagnostic biomarkers for various tumours. This study aimed to identify a serum exosome ncRNA feature for enhancing GC diagnosis. Designs Serum exosomes from patients with GC

Background Treatment strategies for Crohn’s disease (CD) suppress diverse inflammatory pathways but many patients remain refractory to treatment. Autologous haematopoietic stem cell transplantation (SCT) is an emerging therapy for medically refractory CD though the mechanisms through which it circumvents refractory pathophysiology are unknown. Objective The objective of this study is to understand

Background Oat ingestion in coeliac disease (CD) is generally regarded as safe but can trigger enteropathy and T cells specific for oat avenin in the gut and blood of some individuals. Objective To correlate immune and clinical outcomes to oats, purified avenin and oat feeding studies were performed to examine symptoms, T-cell immunity and intestinal histology in CD. Design 33 treated HLA-DQ2.5+ adult CD

Background A large proportion of individuals with coeliac disease (CeD) remain undiagnosed. Objective The aim of this study was to assess serological screening for CeD in the adult general population. Design The study was based on the fourth Trøndelag Health Study, a population-based study performed 2017–2019 in Nord-Trøndelag County, Norway, including 56 042 participants >20 years of age (54% participation

Background Given the imperative to combat climate change, reducing the healthcare sector’s implications on the environment is crucial. Objective This study aims to offer a comprehensive assessment of the environmental impact of gastrointestinal endoscopy (GIE) procedures, specifically focusing on greenhouse gas (GHG) emissions and waste generation. Design A prospective study was conducted at the Asian

Background Chronic restraint stress (CRS) is a tumour-promoting factor. However, the underlying mechanism is unknown. Objective We aimed to investigate whether CRS promotes head and neck squamous cell carcinoma (HNSCC) by altering the oral microbiota and related metabolites and whether kynurenine (Kyn) promotes HNSCC by modulating CD8+ T cells. Design 4-nitroquinoline-1-oxide (4NQO)-treated mice were

Background GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15–64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being. Objective To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP. Design The 2021 Global

Background Early detection of colorectal cancer (CRC) is crucial for improving the survival rates of patients. Objective We aimed to develop a novel strategy for early CRC detection using the fragmentomic features of circulating cell-free mitochondrial DNA (ccf-mtDNA). Design Here, a total of 1147 participants, including 478 healthy controls (HCs), 112 patients with advanced adenomas (AAs) and 557

Background Cyst size, its growth rate, and diameter of the main pancreatic duct (MPD) are all associated with pancreatic carcinoma prevalence in intraductal papillary mucinous neoplasms (IPMNs). Objective To examine the above factors in relation to future risk of incident pancreatic carcinoma in individuals with IPMNs harbouring no high-risk stigmata. Design In a prospective longitudinal cohort, we

Background Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. The combination of tremelimumab and durvalumab is now a standard treatment option for advanced HCC. Objective To study immune responses in HCC patients treated with tremelimumab and durvalumab. Design We treated 28 HCC patients with durvalumab, tremelimumab and locoregional therapies. We performed a high-dimensional

Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated condition characterised by eosinophilic infiltration of the oesophagus, leading to significant morbidity due to oesophageal dysfunction. The pathogenic course of EoE begins with tissue injury, marked by the intricate interplay of oesophageal barrier dysfunction and T helper 2-mediated inflammation. In response to tissue damage, a subsequent

Chronic liver disease is a cluster of disorders associated with complex haemodynamic alterations, which is characterised by structural and functional disruptions of the intrahepatic and extrahepatic vasculature. ‘Vasomics’ is an emerging omics discipline that comprehensively analyses and models the vascular system by integrating pathophysiology of disease, biomechanics, medical imaging, computational

We read with interest the recently published randomised controlled trial (RCT) ‘SPHINX’,1 addressing the role of endoscopic sphincterotomy (ES) with fully covered s metal stent (FCSEMS) placement in preventing post-ERCP pancreatitis (PEP). Although this is the largest RCT on the topic, several concerns warrant discussion. Published data report variable rates of PEP after SEMS ranging from 0% to 26

We recently read with great interest the article by Devin Abrahami et al .1 We would like to raise some concerns that warrant further discussion. The association between proton pump inhibitors (PPIs) and the risk of inflammatory bowel disease (IBD) remains a debate, the authors mostly focus on the protopathic bias introduced by study design. However, in this study, the authors used histamine-2 receptor

We read with great interest the recent article by Antonelli et al 1 on the quality assessment for artificial intelligence in digestive endoscopy (QUAIDE) framework, which enhances the quality and reproducibility of artificial intelligence (AI)-based gastrointestinal endoscopy research. While QUAIDE provides a solid foundation for pre-clinical research design, we see opportunities for further improvement

I read with interest the recent article of Wilkinson-Smith and colleagues on the assessment of colonic motility by means of MRI and high-resolution colonic manometry (HRCM),1 showing that patients with constipation and irritable bowel syndrome (IBS) may display some abnormalities when such investigated. I would like to make some observations on this study. Since HRCM probes were positioned 35 cm from

We thank Ramchandani et al for their letter on the SPHINX trial and appreciate the opportunity to address their points.1 2 The SPHINX trial aimed to assess whether endoscopic sphincterotomy (ES) could reduce post-ERCP pancreatitis (PEP). However, quantifying this effect proved difficult due to conflicting results from previous, heterogeneous randomised controlled trials (RCTs), which differed in sample

We read with great interest the recent publication by Lou et al ,1 which addressed the challenge of false positives in next-generation sequencing (NGS) due to highly homologous PRSS1 paralogs.2 3 PRSS1 was the first gene linked to chronic pancreatitis,4 with p.Arg122His (c.365G>A) and p.Asn29Ile (c.86A>T) being the most common mutations associated with the Mendelian form of the disease. Accurate identification

We read with great interest the study by Danpanichkul et al ,1 which assessed the global burden of gastrointestinal cancers, including oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers, from 2000 to 2021. The study revealed that the burden of all types of cancers varies across geographical and socioeconomic levels. The incidence rates of some types of gastrointestinal cancer

We read with great interest the article by Coté et al titled ‘Sphincterotomy for biliary sphincter of Oddi disorder and idiopathic acute recurrent pancreatitis: the RESPOnD longitudinal cohort’ published in Gut.1 The study aimed to measure the benefit of sphincterotomy for suspected sphincter of Oddi disorder (SOD) and provided valuable insights into the management of this contentious condition. While

Thanks to Dr Zeng for his insightful comments1 about our recent publication on 12-month outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for sphincterotomy for sphincter of Oddi disorders (SOD).2 Many of the comments were addressed in the discussion of the paper, especially the significance of the unmeasured placebo response and greater importance of patient characteristics such as

A 71-year-old man presented with a 2-months history of arrhythmia of undetermined cause, dysphagia, vomiting and 10 kg weight loss. The patient’s history was unremarkable except for multinodular goitre and hypertension. Laboratory exams did not demonstrate significant alterations, white cell count was 7.8×109/L (ref range: 4.0–10.0), haemoglobin 16.2 g/L (ref range: 12.0–15.0), platelet 281×109/L (ref

Patients with inflammatory bowel disease (IBD) remain at increased risk for colorectal cancer and death from colorectal cancer compared with the general population despite improvements in inflammation control with advanced therapies, colonoscopic surveillance and reductions in environmental risk factors. This guideline update from 2010 for colorectal surveillance of patients over 16 years with colonic

Background IBD is a chronic inflammatory condition driven by complex genetic and immune interactions, yet preclinical models often fail to fully recapitulate all aspects of the human disease. A systematic comparison of commonly used IBD models is essential to identify conserved molecular mechanisms and improve translational relevance. Objective We performed a multimodel transcriptomic analysis of 13

Background There is no effective drug treatment for the organ failure (OF) caused by severe acute pancreatitis (SAP). Objective We aimed to evaluate the efficacy of cyclooxygenase-2 inhibitors (COX-2-Is) on the treatment of SAP and its safety. Design In this multicentre, double-blind, randomised, placebo-controlled, investigator-initiated trial, 348 patients with acute pancreatitis aged 18–75 years