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Journal of Gastrointestinal and Liver Diseases

Publisher:
—
ISSN:
1841-8724
Category:
GASTROENTEROLOGY & HEPATOLOGY
Impact factor:
2.1
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18 parsed articles

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Risk Factors Associated with Adenomas or Serrated Polyps in Patients who Underwent Screening Colonoscopy

2026-03-26

Grazia Maria Cariglia, Chiara Marzano, Angelo Zullo, Vincenzo De Francesco, Paolo Fedeli, Lorenzo Ridola, Angelo Dezi

Background and Aims: Colorectal polyps, including adenomas and serrated adenomas, are recognized as premalignant lesions responsible of a significant proportion of colorectal cancer, via the traditional adenoma-carcinoma sequence and the serrated neoplasia pathway. This study aimed to search for potential risk factors of these lesions. Methods: Demographic and clinical characteristics of consecutive subjects with positive fecal immunological test who underwent colonoscopy, as a part of regional screening program (first round), were collected. In detail, age, gender, current smoking habit, presence of blood hypertension, diabetes, hyperlipaemia, and diverticulosis were considered as potential risk factors. Data were analysed at both univariate and multivariate analysis. Results: Data of 1,499 (707 males; mean age: 62.2 ± 7.1 years) subjects were collected. At least an adenomas or serrated polyp were detected in 533 (35.5%) and 47 (3.1%) subjects, respectively. At multivariable logistic regression analysis, smoking habit (OR=1.6, 95%CI: 1.3-2.1), diverticulosis (OR=1.5, 95%CI: 1.01-1.6), male gender (OR=1.4, 95%CI: 1.1-1.9), and age (OR=1.02, 95%CI: 1.01-1.04) were significant risk factors for adenomas, whilst smoking was the lone independent risk factor for serrated lesions (OR=2.3; 95%CI: 1.2-4.5). Conclusions: In our study population, adenomas were associated with male gender, age, smoking and diverticula, whilst serrated polyp only with smoking habit. Other considered factors were not associated. Smoking avoiding or cessation could impact colon polyp development.

From Guidelines to Real-World Practice: Adherence to Prophylactic Measures for Post-ERCP Pancreatitis and ERCP Quality Monitoring in Slovakia and Czechia

2026-03-26

Branislav Kunčak, Rastislav Hustak, Jan Mares, Jan Martinek

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an established procedure for treatment of biliopancreatic disorders. However, it is associated with a risk of complications, most notably post-ERCP pancreatitis (PEP). Several evidence-based strategies have been shown to reduce this risk. These preventive measures, together with key ERCP quality indicators, are incorporated into international guidelines to enhance procedural safety and facilitate inter-center comparisons. This study aimed to evaluate the adherence of Slovak and Czech endoscopists to these recommendations. Methods: A voluntary, 20-item cross-sectional survey was conducted among selected ERCP centers in Slovakia and Czechia using a cloud-based platform between January and June 2024. Results: Twenty-six of 37 ERCP centers (70.3%, 14 from Slovakia and 12 from Czechia) responded to the survey. Post-ERCP pancreatitis and cannulation rates were systematically tracked by 53.8% and 38.5% of centers, respectively, and 42.4% applied objective measures when assessing difficult cannulation. Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) were routinely administered to unselected ERCP patients in 53.9% of centers, while 75% of the remaining centers withheld them from patients with a history of ERCP and prior papillotomy. Indomethacin was the only NSAID used. Only 26.9% of centers employed aggressive hydration according to the recommended protocol. Twelve centers (46.2%) placed prophylactic pancreatic stents during difficult cannulation when the pancreatic duct was accessible, whereas six centers (23.1%) reported using pancreatic stents only rarely. No significant differences were observed between Slovak and Czech centers. Conclusions: Current monitoring practices of key ERCP quality indicators in Slovakia and Czechia, such as PEP incidence and cannulation outcomes, fall short of recommended standards. Although most centers apply prophylactic measures, these are not used universally. This underscores the importance of implementing mandatory quality monitoring and promoting further standardization and improvement in preventive practice.

Promoting Self-Care in Individuals with Inflammatory Bowel Disease: A Scoping Review

2026-03-26

Ilaria Milani, Daniele Napolitano, Monica Petralito, Stefano Romano Capatti, Elena Gennari, Simone Amato, Viviana Di Cosimo, Giulia Petruccini, Nicoletta Orgiana, Mattia Bozzetti, Alessio Lo Cascio, Rosario Caruso

Background and Aims: Self-care has emerged as a pivotal component in the long-term management of inflammatory bowel disease, yet the literature remains fragmented regarding educational interventions supporting its implementation. This scoping review aims to systematically map existing educational strategies designed to promote self-care among individuals with inflammatory bowel disease and to identify barriers, facilitators, and implications for nursing practice. Methods: Following the Joanna Briggs Institute methodology, a scoping review was conducted across five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) with no date restrictions. Eligible studies focused on educational interventions targeting at least one of the following dimensions of self-care: maintenance, monitoring, or management. Data extraction and synthesis were guided by a theoretical model of self-care. Findings were narratively synthesized and supported by summary tables and conceptual mapping. Results: Fourteen studies published over the past seventeen years were included. Interventions ranged from cognitive-behavioral therapy and digital health tools to structured group education programs. Most were implemented in high-income countries and delivered by multidisciplinary teams. Key barriers included time constraints, limited financial and human resources, and patient reluctance to adopt active roles. Facilitators encompassed the use of smartphone applications, teach-back methods, and communication tools such as patient passports. Reported outcomes included improvements in treatment adherence, psychological well-being, and patient engagement. Conclusions: Educational interventions, particularly when grounded in self-care theory and delivered by nursing professionals, can enhance autonomy and quality of life in individuals with inflammatory bowel disease. Future programs should emphasize personalization, inclusiveness, and long-term behavioral change, supported by robust evidence and sustainable implementation models.

Future Global Outlook in Gastrointestinal and Liver Disorders: Consensus and Perspectives from the Leaders of Member Societies of the World Gastroenterology Organization

2026-03-26

Nashrulhaq Tagiling, Daniel M. Simadibrata, Govind K. Makharia, Anahita Sadgehi, Leticia Moreira, Wai K. Leung, Gilaad G. Kaplan, Desmond Leddin, Geoffrey Metz, Alan N. Barkun, Yeong Yeh Lee

Background and Aims: Gastrointestinal (GI) and liver diseases are common and remain major contributors to global morbidity and mortality, with disease patterns increasingly shifting toward metabolic and functional etiologies. Anticipating these evolving challenges, the World Gastroenterology Organization (WGO), comprising 121 national and regional societies, undertook a global initiative to identify key GI and liver health areas across its member countries over the next five years (2025-2030). Methods: A 77-item structured questionnaire was developed by the WGO Clinical Research Committee, encompassing four core domains: general priorities, research, patient care, and education/teaching. The survey was pilot-tested and refined before online dissemination to leaders of WGO-affiliated GI societies. Responses were collected anonymously and rated using a 5-point Likert scale. Consensus levels were defined a priori and categorized as strong, moderate, modest, or no consensus. Results: Thirty-one GI leaders from 25 countries completed the survey. Consensus was achieved in nearly 60% of statements. Fatty liver disease was the only item that reached a strong consensus. Research domains had the highest agreement (78.6%), followed by general issues (58.3%), patient care (52.6%), and education/teaching (50%). Key areas of moderate consensus included the need for guideline implementation, public education, and expanded research opportunities. Barriers included insufficient funding, limited government support, and inconsistent access to training resources. Conclusions: This global consensus highlights priority areas and barriers in GI and liver health for the next five years. Addressing metabolic liver disease, strengthening research infrastructure, enhancing endoscopic standards, and improving education will require coordinated international policy, funding, and capacity-building efforts.

Long-term Effect of Helicobacter pylori Eradication on Risk Factors for Cardiovascular Disease – Is there a Connection?

2026-03-26

Katja Tepes, Sitke Aygen, Gorazd Avgustin, Rok Orel, David Stubljar, Bojan Tepes

Background and Aims: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Beyond traditional risk factors, chronic inflammation is increasingly recognized in its pathogenesis. Helicobacter pylori (H. pylori) infection has been proposed as a potential contributor. This study aimed to investigate the long-term effects of successful H. pylori eradication on selected CVD risk factors. Methods: Seventy-two patients were enrolled between July 2020 and November 2022 and randomized to two 14-day regimens (group 1: esomeprazole, amoxicillin, clarithromycin; group 2: esomeprazole, amoxicillin, metronidazole, colloidal bismuth subcitrate). Outcomes included homeostatic model assessment of insulin resistance (HOMA-IR) index, lipid profiles and subfractions, and urinary trimethylamine N-oxide (TMAO), assessed by nuclear magnetic resonance spectroscopy. Assessments were performed at baseline, two months, and one year after confirmed H. pylori eradication. Results: Of the 72 enrolled patients, 13.9% (10/72) were lost to follow-up. Baseline CVD risk factors did not differ significantly between groups. After successful eradication, both groups demonstrated significant reductions in total cholesterol (p=0.003), low-density lipoprotein cholesterol (p=0.010), small dense lipoprotein particles (p=0.037), and marginal decrease in TMAO concentrations (p=0.048). No significant changes were observed in body mass index (p=0.799), waist circumference (p=0.305), or HOMA-IR index (p=0.275). Conclusions: Successful eradication of H. pylori infection was associated with favorable changes in lipid metabolism and marginal decrease in TMAO levels. These findings suggest that H. pylori may contribute to CVD risk by modulating lipoprotein profiles and systemic inflammation.

Beyond the Hype: Understanding the Limits, Errors and Risk Areas of Artificial Intelligence in Gastroenterology

2026-03-26

Stefan Lucian Popa

Abstract Artificial intelligence (AI) has rapidly expanded across gastroenterology, enabling advances in real-time endoscopic detection, radiologic interpretation, digital pathology, multimodal prognostication, and electronic health record–based decision support. Despite strong performance in controlled studies and increasing regulatory adoption, the clinical integration of AI remains challenged by limitations that threaten reliability, safety, and equitable deployment. This editorial synthesizes the major sources of vulnerability across current AI applications in gastroenterology, including dataset bias, limited generalizability, annotation variability, underrepresentation of rare lesions, and performance degradation in real-world environments. Endoscopic AI systems—the most mature applications—face persistent false positives, false negatives, alert fatigue, and operator deskilling, while most algorithms lack explainability and fail to incorporate essential clinical context. Predictive models based on EHR or imaging data are hindered by data noise, evolving clinical practices, and susceptibility to model drift. Additional risks arise from automation bias, suboptimal workflow integration, and unresolved ethical, regulatory, and liability considerations. Ensuring safe and meaningful clinical deployment requires continuous post-deployment monitoring, rigorous external validation, improved interpretability, and the development of multimodal systems that integrate imaging with clinical and biological data. Equally critical is clinician education to preserve human oversight and prevent overreliance on algorithmic output. By recognizing and addressing these limitations, the field can move beyond accuracy-focused evaluation toward designing AI systems that are robust, transparent, and capable of improving patient-centered outcomes in diverse real-world settings.

Glymphatic Dysfunction in Hepatic Encephalopathy: A Novel Pathogenetic Pathway and Potential Target for New Therapeutic Opportunities

2026-03-26

Efthymios – Leonidas Kaltsounis, Nikolaos Karakousis, George Pavlidis, Theodoros Androutsakos, Dimitrios S. Karagiannakis

Hepatic encephalopathy (HE) is a common complication of decompensated liver cirrhosis and acute-on-chronic liver failure. It encompasses a range of symptoms, from minimal cognitive impairments to severe personality changes and even coma. Liver dysfunction, coupled with the development of portosystemic shunting (PSS), leads to the accumulation of toxic substances in the brain, adversely affecting its function. Common precipitating factors for HE include variceal bleeding, infections, and electrolyte imbalances. However, other mechanisms likely contribute to the onset of HE, as some patients experience episodes without identifiable predisposing factors. These patients may remain in a chronic state of latent HE or have increasingly frequent episodes of HE. One potential contributing factor to HE is dysfunction of the glymphatic system (GS), which clears metabolic waste from the brain. This review aims to highlight the mechanisms underlying GS dysfunction in individuals with liver cirrhosis and explore how it may relate to the development of HE. Additionally, it will provide information on therapeutic interventions that target glymphatic dysfunction, potentially offering new treatment options for HE in the future.

The Influence of Epigenetic Mechanisms on the Development of Metabolic Dysfunction Associated Steatotic Liver Disease: A Review

2026-03-26

Natalia Zhelezniakova, Tetiana Aleksandrova

Metabolic dysfunction-associated steatotic liver disease (MASLD) occupies a leading place in the structure of modern hepatology. A growing body of literature identifies MASLD as a global epidemic. Accumulated data from studies in the field of hepatology support the idea that MASLD is a hepatic manifestation of a systemic metabolic disease. MASLD is a multifactorial metabolic disease associated with the presence of insulin resistance, abdominal obesity, oxidative stress, endothelial dysfunction and a systemic inflammatory response. Current scientific data demonstrate the existence of a relationship between MASLD and an increased risk of developing cardiovascular disease, regardless of traditional risk factors such as diabetes mellitus, dyslipidemia, obesity and hypertension. The pathogenesis of MASLD includes the development of hepatic steatosis with subsequent progression to metabolic dysfunction-associated steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Epigenetics, a new field of biology that studies the influence of external factors on gene activity without changing in deoxyribonucleic acid (DNA) sequences, offers a new perspective on the pathogenesis of MASLD. This review summarizes current knowledge on the epigenetic determinants of MASLD, such as DNA methylation, histone modifications, noncoding ribonucleic acids (RNAs) and N6-methyladenosine in patients with MASLD which may also contribute to the development of preventive or therapeutic strategies for MASLD-associated complications.

Endoscopic Submucosal Dissection for Colorectal Lesions in a Community-based European Hospital: Experience and Learning Curve

2026-03-26

Thomas Balanis, Gerhard Rogler, Radu Tutuian

Background and Aims: Endoscopic submucosal dissection (ESD) has become an established technique for en-bloc resection of large or complex colorectal lesions. However, conventional ESD (C-ESD) can be technically challenging and time-consuming. For non-malignant lesions, ESD with snaring [hybrid ESD (H-ESD)] can facilitate lesion removal and to save time. We report the experience and learning curve in a regional hospital setting in Switzerland. Methods: We retrospectively evaluated the outcomes of all ESD procedures performed between 2018 and 2024 in our hospital. Primary outcome was the recurrence rate at the first follow-up endoscopy. Secondary outcomes included en-bloc resections, procedural time and complication rates stratified by periods in the learning curve. Results: Ninety patients (42 women; mean age 67 ± 12 years) were included in the study of which 51 underwent C-ESD and 39 H-ESD. The recurrence rate at first follow-up endoscopy was 8.8% (6/68) with no difference (p>0.05) between C-ESD (8.1%; 3/37) and H-ESD (9.7%; 3/31). The overall en-bloc resection rate was 63%, significantly higher (p<0.001) in the C-ESD group (98%) vs H-ESD (18%). Similarly, R0 resection rates were significantly (p<0.001) higher in C-ESD (86%) vs H-ESD (18%) groups. Procedural times were similar in the C-ESD (86 ± 44 min) and H-ESD (88 ± 45 min) groups. All parameters improved as the learning curve advanced. Complications requiring surgical intervention occurred in two cases (2.2%) one in the C-ESD and one in the H-ESD group. Conclusions: Colorectal ESD is a feasible and can be self-taught in non-tertiary hospitals, achieving outcomes comparable to those reported in specialized centers, under appropriate case selection. Although conventional ESD achieves higher en-bloc and R0-resections than hybrid ESD, the latter may serve as a rescue option in selected cases.