2026-03-31
Juan Pablo García-Marmolejo, Juan Samuel Hernández-Meza, Maria Ximena Corredor-Gaitan, Fredy Ávila-Almanza, Carmen Yanette Suárez-Quintero
Background Autoimmune liver diseases, including primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH), are rare chronic conditions with significant morbidity. However, population-based epidemiological data from Latin America remain limited. This study aimed to describe the geographic distribution and demographic patterns of PBC and AIH in Colombia between 2018 and 2024. Methods A descriptive, cross-sectional population-based study was conducted using data from the Comprehensive Social Protection Information System (SISPRO) of the Colombian Ministry of Health. Individuals with at least 1 recorded diagnosis coded as K74.3 (PBC) or K75.4 (AIH) according to the International Classification of Diseases, 10th Revision (ICD-10), were identified. Administrative prevalence estimates were calculated per 100,000 population, using official population projections from the National Administrative Department of Statistics (DANE). Age- and sex-specific distributions were analyzed, and geographic variation was visualized using choropleth maps at the regional level. Results A total of 6504 PBC cases and 11,225 AIH cases were identified. The estimated national administrative prevalence was 14.7 per 100,000 population for PBC and 17.0 per 100,000 for AIH. Both conditions showed marked female predominance. PBC was more frequent in women aged 50-69 years. However, AIH demonstrated a broader age distribution, affecting individuals from young adulthood to older age. Higher prevalence estimates were observed in multiple northern regions, particularly in the Caribbean region. Conclusions This first nationwide administrative assessment of PBC and AIH in Colombia demonstrates marked sex differences and regional variation, highlighting the need to improve diagnostic awareness and strengthen epidemiological surveillance of autoimmune liver diseases in Latin America. Keywords Primary biliary cholangitis, autoimmune hepatitis, epidemiology, administrative prevalence, Colombia Ann Gastroenterol 2026; 39 (2): 208-213
2026-03-31
Sharada Wali, Rohan Srinivas Patel, Maria Julia Moura Nascimento Santos, Anirudha Chatterjee, Sophia Chenyu Fan, Sean Ngo, Tanvi Gupta, Kian Abdul Baki, Lucie Heinzerling, Bryan J. Schneider, Kathryn Bollin, Jessica Philpott, Anusha Thomas, Yinghong Wang
Background Immune checkpoint inhibitors (ICIs) commonly cause colitis, but isolated immunemediated enteritis (IMEN) is poorly characterized. This study describes the clinical features, diagnostic findings, and outcomes of IMEN. Method We retrospectively identified adults with cancer who developed IMEN within one year of ICI initiation, confirmed as duodenitis, ileitis, or both. Results Among 20,991 ICI-treated patients, 30 (0.143%) developed isolated IMEN. Median age was 69.5 years; 73.3% were male, and 80% white. The most common malignancies were gastrointestinal/hepatobiliary (26.7%) and melanoma (23.3%). Presenting symptoms included nausea (66.7%), diarrhea (53.3%), and vomiting (46.7%); 62.5% of patients with diarrhea had grade ≥2 severity. Disease involved duodenitis plus ileitis in 50%, isolated duodenitis in 30%, and isolated ileitis in 20%. Median fecal calprotectin levels were highest in duodenitis plus ileitis (1335.5 μg/g), followed by ileitis (319 μg/g) and duodenitis (78 μg/g). Endoscopy showed nonulcerative inflammation in 60% and ulceration in 20%. Hospitalization was longest in duodenitis plus ileitis (median 13.5 days). Corticosteroids were required in 66.7% of ileitis cases; additional immunosuppression was needed in 33.3% of ileitis and 66.7% of duodenitis plus ileitis. Isolated duodenitis improved with supportive therapy alone. Remission occurred in 63.3% overall. ICI therapy was resumed in 12.5%, exclusively in patients with isolated duodenitis. Complications included fistula formation (10%); all-cause mortality was 36.7%. Conclusions IMEN is a rare but clinically significant ICI-related toxicity. Fecal calprotectin correlates with ileitis severity and not duodenitis, and small-bowel endoscopy facilitates diagnosis and management. Keywords Immune checkpoint inhibitor, diarrhea, enteritis, duodenitis, ileitis Ann Gastroenterol 2026; 39 (2): 262-269
2026-03-31
Sheza Malik, Renisha Redij, Dushyant Singh Dahiya, Chengu Niu, Douglas G. Adler
Background The heterogeneity of inflammatory bowel disease (IBD) and its unpredictable course have always been a challenge for gastroenterologists, with regard to predicting the disease response using endoscopic techniques. Machine learning (ML) models have shown some early promise in predicting treatment response in IBD patients. Methods We conducted a systematic review of studies investigating the application of ML to predict treatment response and remission in IBD patients. We used the CHARMS checklist for data extraction. Bias was assessed with the PROBAST tool. Results We included in our review 6 studies that evaluated numbers of IBD patients ranging from 67 to 3004. ML models demonstrated low to moderate predictive accuracy for treatment response and remission (area under the receiver operating characteristic curve: 0.489-0.811; sensitivity: 0.46-0.96; specificity: 0.56-0.98). The studies that utilized ML models with more input variables performed better. Furthermore, only 2 studies performed external validation, and half of the studies demonstrated a substantial risk of bias due to missing data/overfitting, and variability in outcome definition Conclusions ML models show considerable promise in predicting treatment outcomes and remission in IBD. However, given the substantial bias in studies so far, future studies should use a standardized methodology, external validation, and an interpretable broader input variable. Keywords Machine learning, inflammatory bowel disease, treatment, monitoring, response Ann Gastroenterol 2026; 39 (2): 247-253
2026-03-31
Stavros Dimitriadis, Stamatina Vogli, Gianluca Adrisani, George Tribonias, Domenico Galasso, Shaimaa Elkholy, Shivam Khare, Juliette Leroux, Harold Eduardo Benites Goñi, Stefan Seewald, Khanh Do-Cong Pham, Pedro J. Rosón Rodriguez, Ahmad Madkour, Sandro Sferrazza, Hany Shehab, Sridhar Sundaram, Mihai Ciocîrlan, Amr Fouly, Luis Marín Calderón, Paulo Bardalez Cruz, Hany Hagag, Mohamed El-Sherbiny, Kareem Essam, Rossella Maresca, Jijo Varghese, Frederico Barbaro, Cristiano Spada, Matteo Marasco, Francesco Maria Di Matteo, Maria Zachou, Georgios Mavrogenis
Background Gastric subepithelial lesions (SELs) from the muscularis propria are usually managed surgically or with surveillance. Advances in endoscopic techniques now permit safe en bloc resection, even for lesions with extraluminal growth, but data from outside East Asia are scarce. Methods We performed a multicenter retrospective study across 18 centers in Europe, the Middle East, South America and South Asia, including patients with gastric SELs from the muscularis propria resected by endoscopic submucosal dissection (ESD) or submucosal tunneling endoscopic resection (STER) between 2017 and 2024. Outcomes included en bloc resection, safety, complications, and recurrence. Results Eighty-two patients (62.2% women; median age 59 years) were included. Median lesion size was 2 cm (range 0.6-8). Lesions were located in the cardia (18.3%), fundus (18.3%), body (40.2%), and antrum (23.2%). Histology showed gastrointestinal stromal tumors in 78.0%, leiomyomas in 19.5%, and schwannomas in 2.5%. Most were endoluminal (80.5%), 19.5% were extraluminal, and 7.3% extended beyond the serosa. ESD was performed in 65.9% and STER in 34.1%. Median procedure time was 120 min. Deliberate perforation was performed in 31.7%, while 92.3% were managed endoscopically. En bloc resection was achieved in 96.3%, with defect closure in 90.2%. Complications occurred in 7%, with no mortality. Local relapse occurred in 2.5% after a median 9-month follow up. One-third of procedures took place in non-academic centers. Conclusions ESD and STER are safe and effective alternatives to surgery or surveillance for gastric SELs from the muscularis propria, including lesions with extraluminal growth. Longterm, comparative studies alongside laparoscopic surgery are warranted. Keywords Subepithelial lesion, endoscopic submucosal dissection, submucosal tunneling endoscopic resection, gastrointestinal stromal tumor, submucosal tumor Ann Gastroenterol 2026; 39 (2):254-261
2026-03-31
Giorgos Bamias, Smaragdi Fessatou, Christina Kapizioni, Konstantina Kitsou, Gergios Kokkotis, Afroditi Kourti, Panagiotis Markopoulos, Elina Orfanoudaki, Spyridon Siakavellas, Maria Tzouvala
Fecal calprotectin (FC) has become an indispensable tool in everyday clinical practice for the diagnosis and management of inflammatory bowel disease (IBD). Nonetheless, specific and clear recommendations for its use are scarce. On behalf of the Hellenic Group for the Study of IBD (EOMIFNE), a group of experts have formulated 18 statements with the aim to provide evidence for the best use of FC and offer practical guidance in common clinical scenarios. Statements address issues for the proper application of FC measurement in the diagnostic workup of patients with gastrointestinal symptoms, and as a screening tool for the management of established IBD, including pediatric patients. Thus, the present manuscript aims to propose a standardized approach for the optimal use of FC in patient care, also taking into account non-medical concerns. Keywords Fecal calprotectin, inflammatory bowel disease, EOMIFNE, guidelines Ann Gastroenterol 2026; 39 (2): 161-173
2026-03-31
Anouk Voutaz, Elodie Romailler, Mariola Marx, Meddy Dalex, Marie Philippart, Domenico Galasso, Sébastien Godat
Background Obstruction of the main pancreatic duct (MPD) may result in severe pain, recurrent pancreatitis, and pancreatic insufficiency. Endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct cannulation and stent placement is the standard first-line approach, yet it sometimes fails or is not feasible. Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) has emerged as a surgical alternative. We assessed the long-term outcomes, safety, and technical aspects of EUS-PDD. Methods We retrospectively reviewed all adult patients who underwent EUS-PDD at a tertiary referral center between April 2016 and November 2022. Only patients who underwent pancreatogastrostomy or pancreatojejunostomy and had at least 12 months of follow up were included. Clinical success was defined as a residual visual analog scale score ≤2 without obstructive pancreatitis recurrence. Adverse events, reinterventions, and long-term outcomes were analyzed. Results Thirty-five patients (mean age 58±11 years; 74% male) were included, with a mean follow up of 23±19 months. Chronic pancreatitis accounted for 54% of indications. Technical success was achieved in all patients. Overall clinical success was 80% (95% confidence interval [CI] 64-91%). Adverse events occurred in 17% (95%CI 7-33%), including severe events in 6%. Reintervention was required in 29% of patients, mainly because of stent dysfunction. During follow up, 26% experienced pancreatitis, most commonly related to stent dysfunction. Two deaths occurred, unrelated to pancreatic disease or the procedure. Conclusion EUS-guided pancreatic duct drainage is a safe and effective long-term treatment option in selected patients with MPD obstruction or disruption when ERCP is not feasible, providing durable symptom control with acceptable morbidity. Keywords Endoscopic ultrasound-guided pancreatic duct drainage, endoscopic retrograde cholangiopancreatography, pancreatic duct cannulation, stent placement Ann Gastroenterol 2026; 39 (2): 214-220
2026-03-31
Jannis Kountouras, Stergios A. Polyzos, Ioannis S. Papanikolaou, Michael Doulberis, Christos Liatsos, Elisabeth Vardaka