Pub Date : 2026-01-30DOI: 10.1136/gutjnl-2025-337812
David Bergman,Soran Rabin Bozorg,Andreas Munch,Jonas F Ludvigsson
{"title":"Real-world treatment patterns in microscopic colitis: a nationwide study from Sweden.","authors":"David Bergman,Soran Rabin Bozorg,Andreas Munch,Jonas F Ludvigsson","doi":"10.1136/gutjnl-2025-337812","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-337812","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"51 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDGastric cancer, with disproportionately higher incidence in East Asia, arises from complex host-microbiome-environment interactions beyond Helicobacter pylori (HP) infection. However, the molecular architecture linking environmental carcinogens, microbial succession and host response remains unclear.OBJECTIVETo delineate multifactorial aetiologies and clinically actionable subtypes/biomarkers of gastric cancer through integrative proteogenomic, microbial and environmental exposure profiling.DESIGNWe established a multiomics atlas of paired tumour, adjacent mucosa tissues and blood from 154 treatment-naïve Taiwanese patients, integrating whole-exome sequencing, RNA-seq, proteome and phosphoproteome profiling with carcinogen signatures, HP status, microbiome composition and refined anatomical mapping. Cell-based functional assays tested carcinogen effects. Microbial subtype was assessed in an independent cohort.RESULTSA polycyclic-aromatic-hydrocarbon signature, dibenz[a,h]acridine, emerged as a high-risk exposure promoting invasion, immune suppression and poor survival, significantly exceeding nitrosamine-linked risk in this cohort. Multilayer integration defined three initiation ecologies: HP-driven inflammatory, non-HP microbiome-enriched immune-silent and HP-free microbially depleted states. Among HP-negative tumours, a Streptococcus-enriched subtype associated with tight-junction (CLDN18.2/ZO-1/OCLN) disruption and epithelial-mesenchymal transition, whereas a subset of clinically aggressive cases retained CLDN18.2-high epithelial-stable subtype for therapeutic accessibility. An independent cohort revealed gastric juice-derived Streptococcus anginosus abundance inversely correlated with tight-junction proteins. Anatomical mapping reveals location-specific, sex-specific, subtype-specific oncogenic networks and kinase activity, including CDK4 activation in clinical biomarker-negative tumours. Decision-tree models combining exposure and proteome-immune states refined recurrence and survival prediction beyond stage.CONCLUSIONThis proteogenomic framework defines exposure-informed and microbiome-informed gastric cancer subtypes, providing a molecular schema for patient stratification, prevention and actionable therapeutic vulnerabilities.
Pub Date : 2026-01-30DOI: 10.1136/gutjnl-2026-338216
Sherlot Juan Song,Yiwei Liu,Vincent Wai-Sun Wong,Terry Cheuk-Fung Yip
{"title":"Challenges in defining MASLD in lean individuals: the impact of the Fatty Liver Index on phenotypic characterisation.","authors":"Sherlot Juan Song,Yiwei Liu,Vincent Wai-Sun Wong,Terry Cheuk-Fung Yip","doi":"10.1136/gutjnl-2026-338216","DOIUrl":"https://doi.org/10.1136/gutjnl-2026-338216","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"3 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1136/gutjnl-2025-336994
Uri Ladabaum,Rebeca Font Marimon,Xavier Castells Olivera,Francesc Balaguer,María Pellisé,Judit Sola,Josep Alfons Espinàs Piñol,Antoni Castells
BACKGROUNDLong-term adherence and results with faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening are poorly characterised.OBJECTIVETo characterise adherence and results through seven rounds in an organised biennial FIT-based CRC screening programme.DESIGNWe determined per-round FIT-completion, FIT-positivity, CRC and high-risk-CRC precursor positive predictive values (PPVs) and CRC detection/1000-FIT-participants for all invitees versus an adherent cohort (entry 50-51 years; 66-100% rounds completed) versus comparable-age first-ever screenings from 2010 to 2023. Joinpoint and multivariable logistic regression analyses identified trends.RESULTSAdherence was consistent, frequent, occasional, infrequent and never (defined as 100%, 66-99%, 33-65%, 1-32%, 0% of rounds offered) in 29.2%, 8.6%, 11.5%, 4.5% and 46.2% of 2.81 million individuals, respectively. In both the all-invitee population and the adherent cohort, the first round yielded the highest FIT positivity (5.8%, 4.4%), PPVs for CRC (5.1%, 3.3%) and high-risk precursors (20.4%, 13.1%), and CRC detection rates (2.65, 1.30 per 1000 participants), respectively. Beyond three rounds, outcomes stabilised at levels substantially lower than those observed in first-time screeners of the same age (eg, CRC-PPV in seventh round: 1.6-2.2% at median age 62-65 vs 6.6% for new screeners aged 62-63). Colonoscopy completion after a positive FIT was high (87.3%).CONCLUSIONAfter an initial round with the highest FIT-positivity and detection rates, screening outcomes stabilise at lower levels reflecting neoplasia removal and subsequent selection of a lower-risk population. Because detection rates remain clinically relevant even in an adherent cohort, early screening cessation after a sequence of normal biennial FITs is not justified.
{"title":"Effect of long-term adherence on faecal immunochemical test positivity rate, positive predictive value and detection rate in organised population-based colorectal cancer screening.","authors":"Uri Ladabaum,Rebeca Font Marimon,Xavier Castells Olivera,Francesc Balaguer,María Pellisé,Judit Sola,Josep Alfons Espinàs Piñol,Antoni Castells","doi":"10.1136/gutjnl-2025-336994","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-336994","url":null,"abstract":"BACKGROUNDLong-term adherence and results with faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening are poorly characterised.OBJECTIVETo characterise adherence and results through seven rounds in an organised biennial FIT-based CRC screening programme.DESIGNWe determined per-round FIT-completion, FIT-positivity, CRC and high-risk-CRC precursor positive predictive values (PPVs) and CRC detection/1000-FIT-participants for all invitees versus an adherent cohort (entry 50-51 years; 66-100% rounds completed) versus comparable-age first-ever screenings from 2010 to 2023. Joinpoint and multivariable logistic regression analyses identified trends.RESULTSAdherence was consistent, frequent, occasional, infrequent and never (defined as 100%, 66-99%, 33-65%, 1-32%, 0% of rounds offered) in 29.2%, 8.6%, 11.5%, 4.5% and 46.2% of 2.81 million individuals, respectively. In both the all-invitee population and the adherent cohort, the first round yielded the highest FIT positivity (5.8%, 4.4%), PPVs for CRC (5.1%, 3.3%) and high-risk precursors (20.4%, 13.1%), and CRC detection rates (2.65, 1.30 per 1000 participants), respectively. Beyond three rounds, outcomes stabilised at levels substantially lower than those observed in first-time screeners of the same age (eg, CRC-PPV in seventh round: 1.6-2.2% at median age 62-65 vs 6.6% for new screeners aged 62-63). Colonoscopy completion after a positive FIT was high (87.3%).CONCLUSIONAfter an initial round with the highest FIT-positivity and detection rates, screening outcomes stabilise at lower levels reflecting neoplasia removal and subsequent selection of a lower-risk population. Because detection rates remain clinically relevant even in an adherent cohort, early screening cessation after a sequence of normal biennial FITs is not justified.","PeriodicalId":12825,"journal":{"name":"Gut","volume":"3 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1136/gutjnl-2026-338222
Guang Wu,Guo-Ming Zhang
{"title":"Clarifying the decision rules and implementation boundaries for risk-based HCC surveillance in MASLD.","authors":"Guang Wu,Guo-Ming Zhang","doi":"10.1136/gutjnl-2026-338222","DOIUrl":"https://doi.org/10.1136/gutjnl-2026-338222","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"82 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1136/gutjnl-2025-336509
Giovanni Marasco,Max Schmulson,Uday C Ghoshal,Rutaba Khatun,Shrikant I Bangdiwala,Cesare Cremon,Olafur S Palsson,Ami D Sperber,Giovanni Barbara
BACKGROUNDPost-infection disorders of gut-brain interaction (PI-DGBI) are a subset of chronic gastrointestinal disorders triggered by acute infectious gastroenteritis. These conditions impose a significant burden on patients' quality of life.OBJECTIVESThis study aimed to determine the prevalence of PI-DGBI and assess associated risk factors among participants in the Rome Foundation Global Epidemiology Study.DESIGNData were extracted from an online survey involving 54 127 participants across 26 countries. PI-DGBI were diagnosed based on self-reported gastrointestinal symptoms following acute gastroenteritis. Statistical analyses included multivariate logistic regression to identify factors associated with PI-DGBI and comparisons with DGBI not associated with infection.RESULTSOf 21 713 individuals with at least one DGBI, 987 (10.5%) were classified as having PI-DGBI. PI-DGBI prevalence varied geographically, with the highest rates in Asia (7.1%) and Latin America (6.4%). Younger age, male sex, urban residence, anxiety and higher somatic symptom scores were positively associated with subjects reporting PI-DGBI, while female sex and rural living had negative associations. Subjects with PI-DGBI reported more severe psychological and physical health impairments and distinct gastrointestinal profiles, including higher rates of functional dyspepsia (32.2%), irritable bowel syndrome (23.5%) and anorectal disorders (35.3%).CONCLUSIONSPI-DGBI represents a significant subset of DGBI, with distinct sociodemographic and clinical characteristics. These findings highlight the role of acute gastroenteritis in triggering the onset of long-term gastrointestinal disorders and underscore the need for targeted interventions to mitigate its impact on patient health.
{"title":"Post-infection disorders of gut-brain interaction: results of the Rome Foundation Global Epidemiology Study.","authors":"Giovanni Marasco,Max Schmulson,Uday C Ghoshal,Rutaba Khatun,Shrikant I Bangdiwala,Cesare Cremon,Olafur S Palsson,Ami D Sperber,Giovanni Barbara","doi":"10.1136/gutjnl-2025-336509","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-336509","url":null,"abstract":"BACKGROUNDPost-infection disorders of gut-brain interaction (PI-DGBI) are a subset of chronic gastrointestinal disorders triggered by acute infectious gastroenteritis. These conditions impose a significant burden on patients' quality of life.OBJECTIVESThis study aimed to determine the prevalence of PI-DGBI and assess associated risk factors among participants in the Rome Foundation Global Epidemiology Study.DESIGNData were extracted from an online survey involving 54 127 participants across 26 countries. PI-DGBI were diagnosed based on self-reported gastrointestinal symptoms following acute gastroenteritis. Statistical analyses included multivariate logistic regression to identify factors associated with PI-DGBI and comparisons with DGBI not associated with infection.RESULTSOf 21 713 individuals with at least one DGBI, 987 (10.5%) were classified as having PI-DGBI. PI-DGBI prevalence varied geographically, with the highest rates in Asia (7.1%) and Latin America (6.4%). Younger age, male sex, urban residence, anxiety and higher somatic symptom scores were positively associated with subjects reporting PI-DGBI, while female sex and rural living had negative associations. Subjects with PI-DGBI reported more severe psychological and physical health impairments and distinct gastrointestinal profiles, including higher rates of functional dyspepsia (32.2%), irritable bowel syndrome (23.5%) and anorectal disorders (35.3%).CONCLUSIONSPI-DGBI represents a significant subset of DGBI, with distinct sociodemographic and clinical characteristics. These findings highlight the role of acute gastroenteritis in triggering the onset of long-term gastrointestinal disorders and underscore the need for targeted interventions to mitigate its impact on patient health.","PeriodicalId":12825,"journal":{"name":"Gut","volume":"180 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDThe optimal surgical strategy for adenocarcinoma of oesophagogastric junction (AEG) remains debated, particularly regarding lymphadenectomy extent, gastrectomy type and surgical approach, with real-world prospective evidence being scarce.OBJECTIVETo map lymph node metastasis (LNM) patterns and assess surgical outcomes in a large multicentre cohort of patients with AEG undergoing radical resection.DESIGNThe Chinese League of Adenocarcinoma of Esophagogastric Junction (CLAEG) registry, initiated in 2022 across 44 high-volume Chinese centres, prospectively enrolled AEG patients. This analysis included 2044 radical resections, with LNM assessed by station, stratified by Siewert type and neoadjuvant therapy. Surgical outcomes were compared between total versus proximal gastrectomy and laparoscopic versus open resection.RESULTSMost tumours were Siewert type II (64.6%) or III (33.4%). LNM was substantially higher in abdominal than mediastinal stations; category-1 nodes (metastasis, >10%) comprised stations 1, 2, 3, 4, 7, 8a, 9 and 11p. The LNM rates for mediastinal stations were 2.77% (No. 110), 0.71% (No. 111) and 0.68% (No. 112). Patients who received neoadjuvant therapy had lower LNM rates, indicating nodal downstaging. Among those undergoing gastrectomy, patients who underwent total gastrectomy had a lower postoperative complication rate than those who underwent proximal gastrectomy (14.8% vs 21.0%; p=0.001) and achieved more extensive lymphadenectomy. Compared with open surgery, patients who underwent laparoscopic resection experienced faster postoperative recovery without higher complication rates (16.5% vs 17.3%). No perioperative mortality occurred.CONCLUSIONThe CLAEG study shows that abdominal lymphadenectomy should be prioritised in AEG, with neoadjuvant therapy, total gastrectomy and laparoscopy associated with favourable short-term outcomes.
背景食管胃结腺癌（AEG）的最佳手术策略仍然存在争议，特别是关于淋巴结切除术的范围，胃切除术的类型和手术入路，现实世界的前瞻性证据很少。目的：在一组接受根治性切除的AEG患者中，绘制淋巴结转移（LNM）模式并评估手术结果。中国食管胃交界腺癌联盟（CLAEG）注册于2022年在中国44个高容量中心启动，前瞻性地纳入了AEG患者。该分析包括2044例根治性切除，LNM按站位评估，按Siewert类型和新辅助治疗分层。比较全胃切除术与近端胃切除术、腹腔镜手术与开放式胃切除术的手术结果。结果大多数肿瘤为siwert II型（64.6%）或III型（33.4%）。腹部的LNM明显高于纵隔站；1类淋巴结（转移，>10%）包括1、2、3、4、7、8a、9和11p。纵隔站的LNM率分别为2.77%（110号）、0.71%（111号）和0.68%（112号）。接受新辅助治疗的患者有较低的LNM率，表明淋巴结分期降低。在胃切除术患者中，全胃切除术患者术后并发症发生率低于近端胃切除术患者（14.8% vs 21.0%, p=0.001），且淋巴结切除术范围更广。与开放手术相比，腹腔镜切除术患者术后恢复更快，并发症发生率更高（16.5% vs 17.3%）。无围手术期死亡发生。结论CLAEG研究表明，AEG应优先考虑腹部淋巴结切除术，新辅助治疗、全胃切除术和腹腔镜手术可获得较好的短期预后。
{"title":"Prospective evaluation of radical surgery for adenocarcinoma of oesophagogastric junction: real-world insights from the CLAEG study.","authors":"Jiabin Zheng,Yuanfang Li,Lin Fan,Chaohui Zheng,Su Yan,Ziyu Li,Hao Chen,Wenqing Hu,Jiangpeng Wei,Quan Wang,Zhi Li,Wenbin Zhang,Weidong Zang,Wenbin Yu,Lei Lian,Zhaojian Niu,Yongyou Wu,Yigao Wang,Jia-Ming Zhu,Shengxun Mao,Bo Wei,Changqing Jing,Kuan Wang,Wei Wang,Linghua Zhu,Kewei Jiang,Bo Wei,Zhengrong Li,Jun You,Bo Yi,Jian Zhang,Lu Zang,Hua Huang,Shaobin Duan,Gaoping Zhao,Guoqiang Wang,Pin Liang,Wu Song,Fanghai Han,Hankun Hao,Fenglin Liu,He Huang,Qingxing Huang,Yong Li","doi":"10.1136/gutjnl-2025-337393","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-337393","url":null,"abstract":"BACKGROUNDThe optimal surgical strategy for adenocarcinoma of oesophagogastric junction (AEG) remains debated, particularly regarding lymphadenectomy extent, gastrectomy type and surgical approach, with real-world prospective evidence being scarce.OBJECTIVETo map lymph node metastasis (LNM) patterns and assess surgical outcomes in a large multicentre cohort of patients with AEG undergoing radical resection.DESIGNThe Chinese League of Adenocarcinoma of Esophagogastric Junction (CLAEG) registry, initiated in 2022 across 44 high-volume Chinese centres, prospectively enrolled AEG patients. This analysis included 2044 radical resections, with LNM assessed by station, stratified by Siewert type and neoadjuvant therapy. Surgical outcomes were compared between total versus proximal gastrectomy and laparoscopic versus open resection.RESULTSMost tumours were Siewert type II (64.6%) or III (33.4%). LNM was substantially higher in abdominal than mediastinal stations; category-1 nodes (metastasis, >10%) comprised stations 1, 2, 3, 4, 7, 8a, 9 and 11p. The LNM rates for mediastinal stations were 2.77% (No. 110), 0.71% (No. 111) and 0.68% (No. 112). Patients who received neoadjuvant therapy had lower LNM rates, indicating nodal downstaging. Among those undergoing gastrectomy, patients who underwent total gastrectomy had a lower postoperative complication rate than those who underwent proximal gastrectomy (14.8% vs 21.0%; p=0.001) and achieved more extensive lymphadenectomy. Compared with open surgery, patients who underwent laparoscopic resection experienced faster postoperative recovery without higher complication rates (16.5% vs 17.3%). No perioperative mortality occurred.CONCLUSIONThe CLAEG study shows that abdominal lymphadenectomy should be prioritised in AEG, with neoadjuvant therapy, total gastrectomy and laparoscopy associated with favourable short-term outcomes.","PeriodicalId":12825,"journal":{"name":"Gut","volume":"82 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1136/gutjnl-2025-337281
Markus Cornberg,Pietro Lampertico
{"title":"Real-world evidence supports earlier treatment in HBeAg-positive but not HBeAg-negative chronic hepatitis B virus infection.","authors":"Markus Cornberg,Pietro Lampertico","doi":"10.1136/gutjnl-2025-337281","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-337281","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"37 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1136/gutjnl-2025-337583
Matam Vijay-Kumar,Beng San Yeoh,Andrew T Gewirtz
{"title":"Hydroxylation matters! Microbial bile acid metabolism and colorectal cancer.","authors":"Matam Vijay-Kumar,Beng San Yeoh,Andrew T Gewirtz","doi":"10.1136/gutjnl-2025-337583","DOIUrl":"https://doi.org/10.1136/gutjnl-2025-337583","url":null,"abstract":"","PeriodicalId":12825,"journal":{"name":"Gut","volume":"31 1","pages":""},"PeriodicalIF":24.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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