Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.10.008
Daniele Mandolesi , Luigi Colecchia , Giovanni Marasco , Angelo Bruni , Chiara Castellana , Enrico Mussomeli , Vincenzo Stanghellini , Giovanni Barbara
Background
Functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) frequently coexist. Studies suggest that patients with the Epigastric Pain Syndrome (EPS) subtype of FD have higher esophageal acid exposure and respond better to proton pump inhibitors (PPIs) than those with Postprandial Distress Syndrome (PDS).
Aim
To evaluate multichannel intraluminal impedance-pH (MII-pH) monitoring findings in FD patients and assess potential overlap with GERD and esophageal disorders of gut-brain interaction (DGBI).
Methods
Patients fulfilling Rome IV criteria for EPS and PDS, both with and without suspected GERD overlap, underwent MII-pH monitoring. Parameters assessed included esophageal acid exposure time, reflux episodes (acid and non-acid), and symptom association probability. GERD was diagnosed using Lyon 2.0 criteria; esophageal DGBI were evaluated according to Rome IV.
Results
A total of 100 patients were included: 40 with FD (20 EPS, 20 PDS), 40 with FD and potential GERD overlap (20 EPS, 20 PDS), and 20 with conclusive GERD. Mean nocturnal baseline impedance (MNBI) declined progressively across groups, from PDS (2637.5 ohms) to GERD (828 ohms) (p < 0.01). Esophageal DGBI were more prevalent in PDS than EPS among patients with GERD symptoms (55 % vs 20 %, p = 0.02).
Conclusions
EPS is more strongly associated with GERD, while PDS more frequently overlaps with esophageal DGBI.
背景：功能性消化不良（FD）和胃食管反流病（GERD）经常共存。研究表明，与餐后窘迫综合征（PDS）患者相比，患有胃脘痛综合征（EPS）亚型的FD患者有更高的食管酸暴露，并且对质子泵抑制剂（PPIs）的反应更好。目的：评估FD患者的多通道腔内阻抗- ph （MII-pH）监测结果，并评估与GERD和肠脑相互作用食管疾病（DGBI）的潜在重叠。方法：满足罗马IV标准的EPS和PDS患者，无论有无疑似GERD重叠，均进行MII-pH监测。评估的参数包括食道酸暴露时间、反流发作（酸和非酸）和症状关联概率。采用里昂2.0标准诊断胃食管反流；根据Rome iv评估食管DGBI。结果：共纳入100例患者：40例FD (20 EPS, 20 PDS)， 40例FD和潜在GERD重叠（20 EPS, 20 PDS）， 20例结结性GERD。平均夜间基线阻抗（MNBI）在各组间逐渐下降，从PDS（2637.5欧姆）到GERD（828欧姆）（p < 0.01）。在有GERD症状的PDS患者中，食管DGBI比EPS更普遍（55% vs 20%, p = 0.02）。结论：EPS与胃食管反流的相关性更强，而PDS更常与食管DGBI重叠。
{"title":"Epigastric pain syndrome overlaps with gastroesophageal reflux disease, while postprandial distress syndrome with esophageal disorders of gut-brain interaction","authors":"Daniele Mandolesi , Luigi Colecchia , Giovanni Marasco , Angelo Bruni , Chiara Castellana , Enrico Mussomeli , Vincenzo Stanghellini , Giovanni Barbara","doi":"10.1016/j.dld.2025.10.008","DOIUrl":"10.1016/j.dld.2025.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) frequently coexist. Studies suggest that patients with the Epigastric Pain Syndrome (EPS) subtype of FD have higher esophageal acid exposure and respond better to proton pump inhibitors (PPIs) than those with Postprandial Distress Syndrome (PDS).</div></div><div><h3>Aim</h3><div>To evaluate multichannel intraluminal impedance-pH (MII-pH) monitoring findings in FD patients and assess potential overlap with GERD and esophageal disorders of gut-brain interaction (DGBI).</div></div><div><h3>Methods</h3><div>Patients fulfilling Rome IV criteria for EPS and PDS, both with and without suspected GERD overlap, underwent MII-pH monitoring. Parameters assessed included esophageal acid exposure time, reflux episodes (acid and non-acid), and symptom association probability. GERD was diagnosed using Lyon 2.0 criteria; esophageal DGBI were evaluated according to Rome IV.</div></div><div><h3>Results</h3><div>A total of 100 patients were included: 40 with FD (20 EPS, 20 PDS), 40 with FD and potential GERD overlap (20 EPS, 20 PDS), and 20 with conclusive GERD. Mean nocturnal baseline impedance (MNBI) declined progressively across groups, from PDS (2637.5 ohms) to GERD (828 ohms) (p < 0.01). Esophageal DGBI were more prevalent in PDS than EPS among patients with GERD symptoms (55 % vs 20 %, p = 0.02).</div></div><div><h3>Conclusions</h3><div>EPS is more strongly associated with GERD, while PDS more frequently overlaps with esophageal DGBI.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2362-2369"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.09.014
Zaheer Nabi , Gaurav Patil , Rajesh Puri , Truptesh Kothari , Sukrit Sud , Radhika Chavan , Sridhar Sundaram , Nikhil Sonthalia , Jimmy Narayana , Jayanta Samanta , Jahnvi Dhar , Sanjay Rajput , Vikas Singla , Jeff George , Pankaj Dhawan , Rajesh Goud , Pradev Inavolu , Amit P. Maydeo , Randhir Sud , Mahesh Goenka , D. Nageshwar Reddy
Background and aim
Device-assisted full-thickness resection (DA-EFTR) has emerged as a promising therapeutic modality for challenging colorectal neoplasms. More recently, the development of a dedicated full-thickness resection device has expanded its application to upper gastrointestinal (GI) lesions. This study aims to evaluate the clinical outcomes of DA-EFTR for subepithelial lesions (SELs) localized in the stomach and duodenum.
Methods
This study was a multicenter, retrospective analysis conducted across 14 centers in India. Consecutive cases with gastroduodenal SELs who underwent EFTR using a dedicated full thickness resection device from April 2021 to Aug 2024 were enrolled in the study. The main outcome was rate of technical success (macroscopically complete resection). Additional outcomes included histologically complete (R0) resection, procedure time and adverse events.
Results
131 cases (58y, 82 males) underwent DA-EFTR during the study period. Majority of the SELs were located in duodenum (79.1 %) followed by stomach (20.9 %). Median size of the SELs was 12 mm (IQR 10–16) and majority (60.2 %) were submucosal in origin. Technical success was achieved in 123 (94 %) cases. Overall, histologically complete resection (R0) was achieved in 77.9 % cases. In duodenal neuroendocrine tumors, R0 resection was achieved in 87.2 % cases. On multivariate analysis, increased procedure duration was an independent predictor of histological incomplete resection. Adverse events included mild or moderate in 13 (9.9 %) patients and severe (massive bleeding) in one case.
Conclusion
DA-EFTR is a safe and effective treatment modality for upper GI SELs especially duodenal neuroendocrine tumors. Prospective studies are required to confirm its role in minimally invasive management strategies for SELs in the upper GI tract.
背景和目的：器械辅助全层切除（DA-EFTR）已成为一种有前景的治疗结直肠肿瘤的方式。最近，一种专用的全层切除装置的发展已经扩大了它在上胃肠道（GI）病变中的应用。本研究旨在评价DA-EFTR治疗胃和十二指肠上皮下病变（sel）的临床效果。方法：本研究是一项在印度14个中心进行的多中心回顾性分析。从2021年4月至2024年8月，使用专用全层切除装置进行EFTR的连续胃十二指肠SELs病例被纳入研究。主要观察指标为技术成功率（宏观完全切除）。其他结果包括组织学完全切除（R0）、手术时间和不良事件。结果：131例（58岁，82名男性）在研究期间接受了DA-EFTR。主要位于十二指肠（79.1%），其次为胃（20.9%）。SELs的中位大小为12 mm (IQR 10-16)，大多数（60.2%）起源于粘膜下。技术成功123例（94%）。总体而言，77.9%的病例实现了组织学完全切除（R0）。在十二指肠神经内分泌肿瘤中，R0切除率为87.2%。在多变量分析中，增加手术时间是组织学不完全切除的独立预测因子。不良事件包括轻度或中度13例（9.9%）患者和重度（大出血）1例。结论：DA-EFTR是治疗上消化道SELs特别是十二指肠神经内分泌肿瘤安全有效的方法。需要前瞻性研究来证实其在上消化道SELs微创治疗策略中的作用。
{"title":"Outcomes of device assisted endoscopic full thickness resection in gastroduodenal submucosal lesions: A large, multicentre study (with videos)","authors":"Zaheer Nabi , Gaurav Patil , Rajesh Puri , Truptesh Kothari , Sukrit Sud , Radhika Chavan , Sridhar Sundaram , Nikhil Sonthalia , Jimmy Narayana , Jayanta Samanta , Jahnvi Dhar , Sanjay Rajput , Vikas Singla , Jeff George , Pankaj Dhawan , Rajesh Goud , Pradev Inavolu , Amit P. Maydeo , Randhir Sud , Mahesh Goenka , D. Nageshwar Reddy","doi":"10.1016/j.dld.2025.09.014","DOIUrl":"10.1016/j.dld.2025.09.014","url":null,"abstract":"<div><h3>Background and aim</h3><div>Device-assisted full-thickness resection (DA-EFTR) has emerged as a promising therapeutic modality for challenging colorectal neoplasms. More recently, the development of a dedicated full-thickness resection device has expanded its application to upper gastrointestinal (GI) lesions. This study aims to evaluate the clinical outcomes of DA-EFTR for subepithelial lesions (SELs) localized in the stomach and duodenum.</div></div><div><h3>Methods</h3><div>This study was a multicenter, retrospective analysis conducted across 14 centers in India. Consecutive cases with gastroduodenal SELs who underwent EFTR using a dedicated full thickness resection device from April 2021 to Aug 2024 were enrolled in the study. The main outcome was rate of technical success (macroscopically complete resection). Additional outcomes included histologically complete (R0) resection, procedure time and adverse events.</div></div><div><h3>Results</h3><div>131 cases (58y, 82 males) underwent DA-EFTR during the study period. Majority of the SELs were located in duodenum (79.1 %) followed by stomach (20.9 %). Median size of the SELs was 12 mm (IQR 10–16) and majority (60.2 %) were submucosal in origin. Technical success was achieved in 123 (94 %) cases. Overall, histologically complete resection (R0) was achieved in 77.9 % cases. In duodenal neuroendocrine tumors, R0 resection was achieved in 87.2 % cases. On multivariate analysis, increased procedure duration was an independent predictor of histological incomplete resection. Adverse events included mild or moderate in 13 (9.9 %) patients and severe (massive bleeding) in one case.</div></div><div><h3>Conclusion</h3><div>DA-EFTR is a safe and effective treatment modality for upper GI SELs especially duodenal neuroendocrine tumors. Prospective studies are required to confirm its role in minimally invasive management strategies for SELs in the upper GI tract.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2435-2440"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.08.079
Zhiyao Shi , Kai Feng , Xiaokun Yang , Yu Gao , Xixing Wang
{"title":"Comment on “Population stratification using MASLD polygenic risk score improves severe liver disease prediction by clinical fibrosis scores”","authors":"Zhiyao Shi , Kai Feng , Xiaokun Yang , Yu Gao , Xixing Wang","doi":"10.1016/j.dld.2025.08.079","DOIUrl":"10.1016/j.dld.2025.08.079","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2505-2506"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.08.068
Hao Lin , Lianyi Bao
{"title":"Comment on ‘Environmental enteropathy and inflammatory bowel disease are not mutually exclusive’","authors":"Hao Lin , Lianyi Bao","doi":"10.1016/j.dld.2025.08.068","DOIUrl":"10.1016/j.dld.2025.08.068","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2485-2486"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.09.033
Chaowapong Jarasvaraparn , Brendan P. Anderson , Kyla Tolliver , Kathryn H. Adams , Molly Bozic , Jean P Molleston
Background
Liver biopsy is the gold standard for fibrosis evaluation. We investigated the correlation of biomarkers such as AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and liver stiffness measurement (LSM) from FibroScan with severity of fibrosis on liver biopsy in children with liver disease.
Methods
We performed a retrospective analysis of children who underwent FibroScan. Advanced liver disease (aLD) was defined as fibrosis score 3–4 on liver biopsy.
Results
A total of 1004 children were included in this analysis. The two most common diagnoses were metabolic associated steatotic liver disease (MASLD) 658 (65.5 %) with liver biopsies in 136 (20.6 %), and liver transplant (LT) 74 (7.4 %) with liver biopsies in 45 (60.8 %). The APRI, FIB-4, and LSM were significantly correlated with fibrosis scores (Pearson correlation 0.25, p = 0.006, 0.19, p = 0.04, 0.50, p < 0.001, respectively) in MASLD. In LT, or autoimmune hepatitis (AIH), only LSM had significant correlation with fibrosis score. LSM greater than 8.5 kPa predicted aLD in MASLD, LT, and AIH. LSM, APRI, and FIB-4 did not change significantly during the approximate annual follow-up.
Conclusions
LSM correlates better with aLD than APRI and FIB-4 on liver biopsy in children with MASLD, LT, and AIH. FibroScan can be useful to screen for aLD in children with liver disease.
背景：肝活检是评价肝纤维化的金标准。我们研究了生物标志物，如ast -to-血小板比值指数（APRI）、FibroScan的纤维化-4 （FIB-4）和肝硬度测量（LSM）与肝病儿童肝活检纤维化严重程度的相关性。方法：我们对接受纤维扫描的儿童进行回顾性分析。晚期肝病（aLD）定义为肝活检纤维化评分3-4分。结果：本分析共纳入1004名儿童。两种最常见的诊断是代谢性脂肪变性肝病（MASLD） 658例（65.5%）合并肝活检136例（20.6%），肝移植（LT） 74例（7.4%）合并肝活检45例（60.8%）。MASLD患者的APRI、FIB-4和LSM与纤维化评分显著相关（Pearson相关系数分别为0.25,p = 0.006, 0.19, p = 0.04, 0.50, p < 0.001）。在LT或自身免疫性肝炎（AIH）中，只有LSM与纤维化评分有显著相关性。LSM大于8.5 kPa预测MASLD、LT和AIH的aLD。LSM、APRI和FIB-4在大约每年随访期间没有显著变化。结论：在MASLD、LT和AIH患儿肝活检中，LSM与aLD的相关性优于APRI和FIB-4。纤维扫描可用于筛查儿童肝病aLD。
{"title":"The accuracy of Fibrosis score from FibroScan in diverse pediatric liver diseases at a single tertiary center","authors":"Chaowapong Jarasvaraparn , Brendan P. Anderson , Kyla Tolliver , Kathryn H. Adams , Molly Bozic , Jean P Molleston","doi":"10.1016/j.dld.2025.09.033","DOIUrl":"10.1016/j.dld.2025.09.033","url":null,"abstract":"<div><h3>Background</h3><div>Liver biopsy is the gold standard for fibrosis evaluation. We investigated the correlation of biomarkers such as AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and liver stiffness measurement (LSM) from FibroScan with severity of fibrosis on liver biopsy in children with liver disease.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of children who underwent FibroScan. Advanced liver disease (aLD) was defined as fibrosis score 3–4 on liver biopsy.</div></div><div><h3>Results</h3><div>A total of 1004 children were included in this analysis. The two most common diagnoses were metabolic associated steatotic liver disease (MASLD) 658 (65.5 %) with liver biopsies in 136 (20.6 %), and liver transplant (LT) 74 (7.4 %) with liver biopsies in 45 (60.8 %). The APRI, FIB-4, and LSM were significantly correlated with fibrosis scores (Pearson correlation 0.25, <em>p</em> = 0.006, 0.19, <em>p</em> = 0.04, 0.50, <em>p</em> < 0.001, respectively) in MASLD. In LT, or autoimmune hepatitis (AIH), only LSM had significant correlation with fibrosis score. LSM greater than 8.5 kPa predicted aLD in MASLD, LT, and AIH. LSM, APRI, and FIB-4 did not change significantly during the approximate annual follow-up.</div></div><div><h3>Conclusions</h3><div>LSM correlates better with aLD than APRI and FIB-4 on liver biopsy in children with MASLD, LT, and AIH. FibroScan can be useful to screen for aLD in children with liver disease.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2428-2434"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.08.065
Xin Xu
{"title":"Comment on “Environmental enteropathy and inflammatory bowel disease are not mutually exclusive”","authors":"Xin Xu","doi":"10.1016/j.dld.2025.08.065","DOIUrl":"10.1016/j.dld.2025.08.065","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Page 2484"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Therapeutic adherence and self-care in IBD: A new behavioral paradigm","authors":"Daniele Napolitano , Piergiorgio Martella , Franco Scaldaferri","doi":"10.1016/j.dld.2025.09.012","DOIUrl":"10.1016/j.dld.2025.09.012","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2512-2514"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.09.005
Jianhuang Su , Yijun Chen , Chuntao Liu, Can Sun
{"title":"A rare case of metastatic papillary thyroid carcinoma to the esophagus treated by endoscopic submucosal dissection","authors":"Jianhuang Su , Yijun Chen , Chuntao Liu, Can Sun","doi":"10.1016/j.dld.2025.09.005","DOIUrl":"10.1016/j.dld.2025.09.005","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2478-2479"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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