We read with interest the Rome Consensus paper on faecal microbiota transplantation (FMT) in IBD (a refractory disease with intermittent flare-ups and remissions of intestinal inflammation) by Lopetuso et al .1 It highlights modest efficacies of FMT in treating IBD and adverse event risks caused by bacteria transplantation, according to data from clinical trials.1 Hence, further refinement of FMT is

Background Aberrant Wnt pathway activation is a key driver of colorectal cancer (CRC) and is essential to sustain tumour growth and progression. Although the downstream protein-coding target genes of the Wnt cascade are well known, the long non-coding transcriptome has not yet been fully resolved. Objective In this study, we aim to comprehensively reveal the Wnt-regulated long non-coding transcriptome

Background There is no clinically relevant serological marker for the early detection of oesophageal adenocarcinoma (EAC) and its precursor lesion, Barrett’s oesophagus (BE). Objective To develop and test a blood-based assay for EAC and BE. Design Oesophageal MicroRNAs of BaRRett, Adenocarcinoma and Dysplasia ( EMERALD ) was a large, international, multicentre biomarker cohort study involving 792 patient

We read with great interest the article by Henniger et al 1 about reducing scope 3 carbon emissions in endoscopy and would like to discuss several points. First, we commend the study’s transparency, as manufacturers provided detailed information about their fabrication and delivery processes. This collaboration exemplifies our shared goal of environmental protection. Furthermore, this is the first

Background Peritoneal metastasis is the most common metastasis pattern of gastric cancer. Patients with gastric cancer peritoneal metastasis (GCPM) have a poor prognosis and respond poorly to conventional treatments. Recently, immune checkpoint blockade (ICB) has demonstrated favourable efficacy in the treatment of GCPM. Stratification of best responders and elucidation of resistance mechanisms of

Many patients with IBD report persisting symptoms, despite resolution of the inflammatory process. Although by definition, a diagnosis of IBS cannot be made, the prevalence of ‘IBS in IBD’ surpasses the rate of IBS in the global population by fivefold. Because IBS-like symptoms are associated with a decreased quality of life and increased healthcare utilisation in IBD, diagnosis and treatment are necessary

Surgical removal is recommended for gastrointestinal stromal tumours (GISTs) larger than 3 cm due to their potential for malignancy but limited wedge resection is not possible in the proximal stomach. Endoscopic removal of larger lesions has been technically limited in complex anatomical regions such as cardia. We report two cases of large proximal (cardia/fundus) GIST tumours (51 and 60 mm) which

Background Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance. Objective To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management

Chronic hepatitis B virus (HBV) infection remains a significant global health burden, affecting over 250 million people worldwide who are at risk of developing liver cirrhosis and hepatocellular carcinoma (HCC). Currently available nucleos(t)ide analogues (NAs) are effective in controlling viraemia; however, functional cure, defined as loss of hepatitis B surface antigen (HBsAg), is rare and difficult

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the end-stage of chronic liver diseases, including metabolic-associated steatohepatitis (MASH), an advanced form of metabolic dysfunction-associated steatotic liver disease. The incidence of MASH-driven HCC is expected to continue rising throughout the world due to its association with the obesity and type 2 diabetes epidemic

Hepatocellular carcinoma (HCC) is a significant global health problem, and its incidence is expected to exceed 1 million new HCC annually by 2025.1 The reported 3-year survival rate for advanced-stage HCC is less than 17%, while 70% of patients diagnosed with early-stage HCC can achieve 5-year survival.2 Despite well-established guidelines and the clear benefits of early detection, the meta-analysis

Endoscopic full-thickness suturing has multiple potential therapeutic applications, including bariatric procedures and gastrointestinal (GI) wall defect closure; previous suturing devices have been complex or of unknown or limited efficacy. We present animal results of a new device (the Su2ura GI) used through one instrumentation channel of a conventional endoscope with a 3.2 mm channel. Six animal

Objective Puerarin (PU) is a natural compound that exhibits limited oral bioavailability but has shown promise in the treatment of atherosclerosis (AS). However, the precise mechanisms underlying its therapeutic effects remain incompletely understood. This study aimed to investigate the effects of PU and its mechanisms in mitigating AS in both mice and humans. Design The impact of PU on AS was examined

Objective Potential coeliac disease (PCD) is characterised by positive serological and genetic markers of coeliac disease with architecturally preserved duodenal mucosa. The clinical outcomes and rates of progression to overt coeliac disease in patients with PCD remain uncertain. In this systematic review and meta-analysis, we aimed to evaluate the clinical outcomes of patients with PCD. Design We

Objective IBD is characterised by dysbiosis, but it remains unclear to what extent dysbiosis develops in unaffected at-risk individuals. To address this, we investigated age-related patterns of faecal and serum markers of dysbiosis in high-risk multiplex IBD families (two or more affected first-degree relatives). Design Faecal and serum samples were collected from multiplex IBD and control families

Objective In patients with Crohn’s disease (CD) on combination therapy (infliximab and immunosuppressant) and stopping infliximab (cohort from the study of infliximab diSconTinuation in CrOhn’s disease patients in stable Remission on combined therapy with Immunosuppressors (STORI)), the risk of short-term (≤6 months) and mid/long-term relapse (>6 months) was associated with distinct blood protein profiles

Background and aim Randomised trials show improved polyp detection with computer-aided detection (CADe), mostly of small lesions. However, operator and selection bias may affect CADe’s true benefit. Clinical outcomes of increased detection have not yet been fully elucidated. Methods In this multicentre trial, CADe combining convolutional and recurrent neural networks was used for polyp detection. Blinded

Objective The objective of this study is to improve the efficacy of CLDN18.2/CD3 bispecific T-cell engagers (BiTEs) as a promising immunotherapy against pancreatic ductal adenocarcinoma (PDAC). Design Humanised hCD34+/hCD3e+, Trp53R172HKrasG12DPdx1-Cre (KPC), pancreas-specific Cldn18.2 knockout (KO), fibroblast-specific Fcgr1 KO and patient-derived xenograft/organoid mouse models were constructed.

Objective Pancreatic ductal adenocarcinoma (PDAC) stands as one of the most lethal cancers, marked by its lethality and limited treatment options, including the utilisation of checkpoint blockade (ICB) immunotherapy. Epigenetic dysregulation is a defining feature of tumourigenesis that is implicated in immune surveillance, but remains elusive in PDAC. Design To identify the factors that modulate immune

Objective Achieving HBV cure will require novel combination therapies of direct-acting antivirals and immunomodulatory agents. In this context, the toll-like receptor 8 (TLR8) agonist selgantolimod (SLGN) has been investigated in preclinical models and clinical trials for chronic hepatitis B (CHB). However, little is known regarding its action on immune effectors within the liver. Our aim was to characterise

Objective Squalene epoxidase (SQLE) promotes metabolic dysfunction-associated steatohepatitis-associated hepatocellular carcinoma (MASH-HCC), but its role in modulating the tumour immune microenvironment in MASH-HCC remains unclear. Design We established hepatocyte-specific Sqle transgenic (tg) and knockout mice, which were subjected to a choline-deficient high-fat diet plus diethylnitrosamine to induce

Background Hepatocellular carcinoma (HCC) is plagued by failures across the cancer care continuum, leading to frequent late-stage diagnoses and high mortality. We evaluated the effectiveness of mailed outreach invitations plus patient navigation to promote HCC screening process completion in patients with cirrhosis. Methods Between April 2018 and September 2021, we conducted a multicentre pragmatic

Background There are limited prospective data among overweight and obese individuals on the prevalence of advanced fibrosis, and cirrhosis using advanced MRI-based methods in the USA. The aim of this study was to fill that gap in knowledge by prospectively determining the MRI-based prevalence of steatotic liver disease (SLD) and its subcategories, advanced fibrosis and cirrhosis among overweight and

Objective Type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease (diabetic MASLD) frequently coexist and worsen liver and non-liver outcomes, but effective pharmacological therapies are limited. We aimed to evaluate the long-term effect of sodium-glucose cotransporter-2 inhibitor (SGLT-2i) on liver and non-liver outcomes among patients with diabetic MASLD. Design This

Gastric cancer (GC) is one of the most common malignancies and a prominent cause of cancer mortality worldwide. A distinctive characteristic of GC is its intimate association with commensal microbial community. Although Helicobacter pylori is widely recognised as an inciting factor of the onset of gastric carcinogenesis, increasing evidence has indicated the substantial involvement of microbes that

The absolute number of annual cases of gastric cancer in Europe is rising. The Council of the European Union has recommended implementation of gastric cancer screening for countries or regions with a high gastric cancer incidence and death rates. However, as of 2024 no organised gastric cancer screening programme has been launched in Europe. There are several ways to decrease gastric cancer burden

A 21-year-old woman presented at our hospital with recurrent fever and abdominal pain. Due to this, the patient has been hospitalised over 100 times. Initially, she was diagnosed with tuberculous peritonitis, yet showed poor response to antituberculosis medication. Besides, exploratory laparotomy at age 5 years revealed no evidence of tuberculosis. Further treatment for Crohn’s disease with infliximab

We read Arnold et al ’s article1 with interest and wanted to extend this work to Africa. A high incidence of oesophageal squamous cell carcinoma (OSCC) has been reported in African countries from Kenya to South Africa2 where early-onset (age <45 years) OSCC accounts for 30% of cases in the region. As such, we examined the cumulative lifetime and age-specific incidences of OSCC in Africa. We identified

With great interest, we read the paper by Ammer-Hermenau et al , which features a multicentre microbiome study that included buccal and rectal samples taken at admission from 450 patients with acute pancreatitis.1 Severe acute pancreatitis was post hoc defined as persistent organ failure and/or collections that required drainage. These patients were propensity score matched with patients with mild

We read with great interest the population-based cohort study by Abrahami D et al ,1 in which they found that the use of proton pump inhibitors (PPIs) was not associated with an increased risk of inflammatory bowel disease (IBD). However, the assessment of causality in observational studies is often challenging due to the presence of multiple confounding factors. The existence of a causal relationship

We appreciate the constructive dialogue from Cheng on our study’s findings.1 We agree that any clinical database study has limitations that necessitate careful interpretation of results. Manual medical records review is a logical next step to mitigate these shortcomings and allow a more thorough examination of each patient’s course. Nevertheless, we re-analysed our data in response to points raised

The recent study by Djinbachian et al comparing accuracy of intracolonoscopic to pathology-based assessment of colorectal polyp size is of considerable interest.1 The authors reported that pathology sizing is often not possible because of piecemeal polyp resection or fragmentation during retrieval and, for intact polypectomy specimens, pathology accuracy is limited by formalin-related shrinkage. 78%

We would like to congratulate Adams et al on the paper addressing the important issue regarding the development of prognostic clinical indexes for patients with acute severe ulcerative colitis (ASUC) leading to the development of the ADMIT-ASC score.1 Although we acknowledge the initiative, the development of a static prognostic index might be reconsidered with the increased availability and use of

We write in response to the Letter to the Editor by van den Berg et al 1 commenting on our recent article ‘Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis’.2 We greatly appreciate the interest in our work and are grateful to clarify some aspects of the study. The primary endpoint of our study investigated whether microbial compositions can be employed as

We read with great interest the paper by Bang et al ,1 reporting their single-centre retrospective experience in 25 patients with acute cholecystitis, who were deemed at increased surgical risk and treated by EUS-guided gallbladder drainage (EUS-GBD) using LAMS. Three patients underwent surgery because of persistent biliary-type symptoms, but the presence of LAMS precluded successful laparoscopic cholecystectomy

The effect of the gut microbiome on the bioavailability and efficacy of orally administered drugs is of considerable importance for personalised medicine.1 We, therefore, read with great interest the ‘GI highlights from the literature’ focussing on gut microbial metabolism of 5-aminosalicylic acid (5-ASA) in inflammatory bowel disease (IBD), originally published in the journal Nature Medicine .2 3

We read with interest the publication by Sándor and Sahin-Tóth, which classifies CPA1 missense variants based on functional data.1 Previous analyses of variants strongly associated with chronic pancreatitis (p.N256K, p.S282P and p.K374E) have demonstrated that pathogenic CPA1 variants result in proenzyme misfolding, leading to subsequent endoplasmic reticulum (ER) stress.2–6 In examining 50 CPA1 missense

Dinis-Ribeiro M, Shah S, El-Serag H, et al . The road …

Background The microbiota is emerging as a key factor in the predisposition to insulin resistance and obesity. Objective To understand the interplay among gut microbiota and insulin sensitivity in multiple tissues. Design Integrative multiomics and multitissue approach across six studies, combining euglycaemic clamp measurements (used in four of the six studies) with other measurements of glucose metabolism

We appreciate the positive remarks from Quach and colleagues in response to our manuscript.1 2 The authors propose that endoscopic staging should replace non-targeted mapping biopsies in individuals at increased risk of harbouring gastric intestinal metaplasia (GIM), citing that endoscopic staging using the endoscopic grading of GIM (EGGIM) score (1) is a more resource-sensitive approach; (2) avoids

Objective To examine the hepatic effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) through a head-to-head comparison with glucagon-like peptide-1 receptor agonists (GLP-1RA) or thiazolidinediones (TZD) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Design This population-based cohort study was conducted using a nationwide healthcare claims database

Background PARP inhibitors (PARPi) have been licensed for the maintenance therapy of patients with metastatic pancreatic cancer carrying pathogenic germline BRCA1/2 mutations. However, mutations in BRCA1/2 are notably rare in pancreatic cancer. Objective There is a significant unmet clinical need to broaden the utility of PARPi. Design RNA sequencing was performed to screen potential targets for PARPi

We read with interest the findings by Zhou et al that identified the microbiota-induced S100A11-RAGE axis as a basis for immune evasion in proximal colorectal cancer (CRC), the targeting potential of this pathway in enhancing the efficacy of anti-PD-1 therapy.1 Currently, despite showing a response more favourably in hypermutated tumours, the effectiveness of immunotherapy in microsatellite stable

The remarkable success of direct-acting antivirals in curing hepatitis C led to concerted efforts in developing a cure for hepatitis B. Unlike hepatitis C, it is accepted that a sterilising cure is not feasible in the foreseeable future. Instead, functional cure defined as hepatitis B surface antigen (HBsAg) loss (below detection) and HBV DNA suppression (below quantification) sustained for at least

Background Genomic screening uncovered interferon-gamma (IFNγ) pathway defects in tumours refractory to immune checkpoint blockade (ICB). However, its non-mutational regulation and reversibility for therapeutic development remain less understood. Objective We aimed to identify ICB resistance-associated druggable histone deacetylases (HDACs) and develop a readily translatable combination approach for

We read with interest the letter from Han et al about our study1 and we thank those authors for underlining points to be discussed about the real place of single use and reusable endoscope strategies. Although the benefits for reducing cross-infections seem significant, assessing the positive indirect environmental impact is difficult, as the number of patients involved in high-infection risk2 care

Cirrhosis marks the advanced stage of chronic liver disease characterised by sustained inflammation leading to the loss of hepatocytes and the progression of fibrosis. These structural and functional alterations profoundly impact blood flow within the hepatic microcirculation, potentially culminating in portal hypertension over time. Traditionally, the evolution of cirrhosis has been divided into two

Although numerous compounds that target individual or multiple cells or pathways have demonstrated antifibrotic potential, the reality is that only a small number of candidates have progressed successfully to the clinical trials phase. It seems plausible that the development of antifibrotic therapies focusing on the removal of fibrosis-causing agents and factors affecting hepatic stellate cell (HSC)

Objective Extracellular matrix protein 1 (ECM1) serves as a gatekeeper of hepatic fibrosis by maintaining transforming growth factor-β1 (TGF-β1) in its latent form. ECM1 knockout (KO) causes latent (L) TGF-β1 activation, resulting in hepatic fibrosis with rapid mortality. In chronic liver disease (CLD), ECM1 decreases with increasing CLD severity. We investigate the regulatory role of ECM1 in TGF-β1

Metabolic dysfunction-associated steatotic liver disease (MASLD), is closely linked to type 2 diabetes (T2D).1 2 This strong association is due to shared pathophysiological pathways, including insulin resistance, mitochondrial dysfunction, adipose tissue dysfunction, low-grade inflammation and dysbiosis.3 The coexistence of MASLD and T2D affects the prognosis of both diseases in a bidirectional manner

Background Colonic motility in constipation can be assessed non-invasively using MRI. Objective To compare MRI with high-resolution colonic manometry (HRCM) for predicting treatment response. Design Part 1: 44 healthy volunteers (HVs), 43 patients with irritable bowel syndrome with constipation (IBS-C) and 37 with functional constipation (FC) completed stool diaries and questionnaires and underwent

Background The elevation of IQGAP3 expression in diverse cancers indicates a key role for IQGAP3 in carcinogenesis. Although IQGAP3 was established as a proliferating stomach stem cell factor and a regulator of the RAS-ERK pathway, how it drives cancer growth remains unclear. Objective We define the function of IQGAP3 in gastric cancer (GC) development and progression. Design We studied the phenotypic

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with a dismal 5-year survival rate of less than 10%.1 Despite significant advances in cancer treatment over the past decades, PDAC has stubbornly defied progress, with most patients showing limited response to standard chemotherapy regimens. Perhaps most disappointingly, the revolutionary success of immunotherapy in

Artificial intelligence (AI) holds significant potential for enhancing quality of gastrointestinal (GI) endoscopy, but the adoption of AI in clinical practice is hampered by the lack of rigorous standardisation and development methodology ensuring generalisability. The aim of the Quality Assessment of pre-clinical AI studies in Diagnostic Endoscopy (QUAIDE) Explanation and Checklist was to develop

Background The determinants of the response to checkpoint immunotherapy in hepatocellular carcinoma (HCC) remain poorly understood. The organisation of the immune response in the tumour microenvironment (TME) is expected to govern immunotherapy outcomes but spatial immunotypes remain poorly defined. Objective We hypothesised that the deconvolution of spatial immune network architectures could identify

We have read with interest the article by Bonfils et al , which explores the impact of parental IBD on offspring risk using a large Danish cohort.1 Their findings underscore the significance of genetic predisposition and shared environmental factors, with maternal IBD diagnosis before childbirth showing the highest risk (adjusted HR 6.27) and a similar pattern observed with paternal IBD (adjusted HR

Background The potency of T cell-mediated responses is a determinant of immunotherapy effectiveness in treating malignancies; however, the clinical efficacy of T-cell therapies has been limited in hepatocellular carcinoma (HCC) owing to the extensive immunosuppressive microenvironment. Objective Here, we aimed to investigate the key genes contributing to immune escape in HCC and raise a new therapeutic

Stricturing Crohn’s disease (CD) is characterised by transmural intestinal fibrosis accompanied with creeping fat (CrF) formation.1 Such pathological features were successfully recapitulated in a mouse model for the first time by Xiong et al 2 who performed repeated endoscopy-guided forceps biopsies on mouse colon. This method, although effective, requires specific training to use small animal endoscopes

Background Endoscopic retrograde cholangiopancreatography (ERCP) with fully covered self-expandable metal stent (FCSEMS) placement is the preferred approach for biliary drainage in patients with suspected distal malignant biliary obstruction (MBO). However, FCSEMS placement is associated with a high risk of post-ERCP pancreatitis (PEP). Endoscopic sphincterotomy prior to FCSEMS placement may reduce

Background The impact of nucleos(t)ide analogues on intrahepatic viral burden and immune microenvironment in patients with chronic hepatitis B (CHB) is not clear. Objective We aimed to characterise the effects of tenofovir disoproxil fumarate (TDF) on intrahepatic viral burden and the liver immune microenvironment in patients with CHB. Design Core liver biopsies were collected at baseline and year