A 68-year-old man with postprandial flushing and palpitations was referred for multiple hepatic lesions. Computed tomography showed hypoattenuating metastases without a detectable primary, whereas contrast-enhanced ultrasound revealed arterial hyperenhancement and Kupffer-phase defects, indicating hypervascularity typical of neuroendocrine tumors (NETs). Urinary 5-hydroxyindoleacetic acid elevation, together with liver biopsy findings, confirmed a well-differentiated NET (grade 2), presenting with carcinoid syndrome. Somatostatin receptor scintigraphy demonstrated diffuse hepatic uptake and a mesenteric focus, suggesting a small intestine origin. Lanreotide was initiated, achieving partial symptom improvement and radiologic stability. This case highlights contrast-enhanced ultrasound for demonstrating hypervascularity and somatostatin receptor scintigraphy for localizing an occult origin in NET.
{"title":"Contrast-Enhanced Ultrasound and Somatostatin Receptor Scintigraphy Unveil an Occult Neuroendocrine Tumor With Carcinoid Syndrome and Presumed Small Intestinal Origin – A Case Report","authors":"Tairyu Sato , Akira Nishio , Tadashi Kegasawa , Kazuna Hazu , Chihiro Tarumi , Koki Yamada , Yuki Nishiura , Kumi Higashihara , Shogo Nagahama , Takayuki Matsumae , Yuki Tokuda , Aya Ishimi , Satoshi Hiyama , Masafumi Ogata , Chiaki Nakai , Keitaro Masuko , Katsumi Yamamoto , Nobuyuki Tatsumi , Yasuyuki Yoshida , Kayako Isohashi , Akira Kaneko","doi":"10.1016/j.gastha.2025.100866","DOIUrl":"10.1016/j.gastha.2025.100866","url":null,"abstract":"<div><div>A 68-year-old man with postprandial flushing and palpitations was referred for multiple hepatic lesions. Computed tomography showed hypoattenuating metastases without a detectable primary, whereas contrast-enhanced ultrasound revealed arterial hyperenhancement and Kupffer-phase defects, indicating hypervascularity typical of neuroendocrine tumors (NETs). Urinary 5-hydroxyindoleacetic acid elevation, together with liver biopsy findings, confirmed a well-differentiated NET (grade 2), presenting with carcinoid syndrome. Somatostatin receptor scintigraphy demonstrated diffuse hepatic uptake and a mesenteric focus, suggesting a small intestine origin. Lanreotide was initiated, achieving partial symptom improvement and radiologic stability. This case highlights contrast-enhanced ultrasound for demonstrating hypervascularity and somatostatin receptor scintigraphy for localizing an occult origin in NET.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100866"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100875
Clive Jude Miranda, Casey Marie DeBeltz, Aun Raza Shah
{"title":"Dangers of an American Pastime: Grill Wire Bristle Ingestion Masquerading as a Bony Impaction","authors":"Clive Jude Miranda, Casey Marie DeBeltz, Aun Raza Shah","doi":"10.1016/j.gastha.2025.100875","DOIUrl":"10.1016/j.gastha.2025.100875","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100875"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100855
John M. Cormack , Hansol O. Lee , Yu-hsuan Chao , Kang Kim , Jaideep Behari
Background and Aims
Liver fibrosis assessment using transient elastography (TE) or 2-dimensional shear wave elastography (2DSWE) exhibits high rates of failure and unreliability in patients with obesity. Novel focused shear wave elastography (fSWE) aims to enhance liver stiffness measurement (LSM) in patients with obesity and MASLD by using shear waves that converge toward the LSM region, rather than diverge as in TE and 2DSWE. The aim of the present study was to demonstrate the feasibility of LSM by fSWE, with comparison to TE and 2DSWE, in a pilot cohort of MASLD patients.
Methods
We prospectively enrolled 26 adult subjects at a single clinical site. For each subject, LSM was performed using fSWE, TE, and 2DSWE and baseline clinical characteristics were obtained in a single visit. Fibrosis stage was known in 19 subjects who had prior biopsy or LSM by magnetic resonance elastography.
Results
LSM was obtained in 15 subjects by fSWE, 26 subjects by TE, and 23 subjects by 2DSWE. The correlation between TE and fSWE was 92% and between TE and 2DSWE was 67%. In the subset of subjects with body mass index >35 kg/m2 (n = 12), LSM by fSWE was obtained in 7 subjects and had correlation of 87% with TE. The area under the receiver operating characteristic curve in detecting advanced fibrosis was 0.92 for fSWE, compared to 0.89 for TE and 0.74 for 2DSWE.
Conclusion
A novel elastography technique, fSWE, exhibited high concordance with TE and better diagnostic performance than 2DSWE. If confirmed in larger prospective studies, fSWE may represent a promising screening strategy for patients with coexisting MASLD and obesity.
{"title":"Focused Shear Wave Elastography to Assess Liver Fibrosis in Metabolic Dysfunction–Associated Steatotic Liver Disease","authors":"John M. Cormack , Hansol O. Lee , Yu-hsuan Chao , Kang Kim , Jaideep Behari","doi":"10.1016/j.gastha.2025.100855","DOIUrl":"10.1016/j.gastha.2025.100855","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Liver fibrosis assessment using transient elastography (TE) or 2-dimensional shear wave elastography (2DSWE) exhibits high rates of failure and unreliability in patients with obesity. Novel focused shear wave elastography (fSWE) aims to enhance liver stiffness measurement (LSM) in patients with obesity and MASLD by using shear waves that converge toward the LSM region, rather than diverge as in TE and 2DSWE. The aim of the present study was to demonstrate the feasibility of LSM by fSWE, with comparison to TE and 2DSWE, in a pilot cohort of MASLD patients.</div></div><div><h3>Methods</h3><div>We prospectively enrolled 26 adult subjects at a single clinical site. For each subject, LSM was performed using fSWE, TE, and 2DSWE and baseline clinical characteristics were obtained in a single visit. Fibrosis stage was known in 19 subjects who had prior biopsy or LSM by magnetic resonance elastography.</div></div><div><h3>Results</h3><div>LSM was obtained in 15 subjects by fSWE, 26 subjects by TE, and 23 subjects by 2DSWE. The correlation between TE and fSWE was 92% and between TE and 2DSWE was 67%. In the subset of subjects with body mass index >35 kg/m<sup>2</sup> (n = 12), LSM by fSWE was obtained in 7 subjects and had correlation of 87% with TE. The area under the receiver operating characteristic curve in detecting advanced fibrosis was 0.92 for fSWE, compared to 0.89 for TE and 0.74 for 2DSWE.</div></div><div><h3>Conclusion</h3><div>A novel elastography technique, fSWE, exhibited high concordance with TE and better diagnostic performance than 2DSWE. If confirmed in larger prospective studies, fSWE may represent a promising screening strategy for patients with coexisting MASLD and obesity.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100855"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100868
Edward S. Huang , Joseph Wilcox , Nick Romero , Pragati Kenkare , Satish Mudiganti , Su-Ying Liang
{"title":"Using Large Language Models for Text Classification in Colonoscopy Pathology Reports","authors":"Edward S. Huang , Joseph Wilcox , Nick Romero , Pragati Kenkare , Satish Mudiganti , Su-Ying Liang","doi":"10.1016/j.gastha.2025.100868","DOIUrl":"10.1016/j.gastha.2025.100868","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100868"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100871
Dijina Swaroop , Jai Smith , Jessica Van Zuykelom , Asif Noor , Robin A. Wagner , Tamara Vu , Sarah Lee , Alexander G. Heriot , Benjamin Loveday , Kelly Waldeck , Peter D. Roselt , Benjamin Blyth , Paul S. Donnelly , Frédéric Hollande
Background and Aims
Over 40% of colorectal cancer (CRC) patients develop metastatic disease. Their survival outlook is very low, highlighting the urgent need to improve the detection and therapeutic management of metastatic colorectal cancer (mCRC), particularly when metastases are not surgically resectable. Our study aimed to characterize the preclinical utility of targeting carbonic anhydrase IX (CA-IX) for metastasis imaging and for therapeutic purposes in patients with CRC liver metastases.
Methods
CA-IX expression was characterized in 46 liver metastasis samples using RNA sequencing and immunohistochemical staining. We labeled girentuximab, a clinical grade CA-IX antibody, with zirconium-89 ([89Zr]Zr) or lutetium-177 ([177Lu]Lu), and characterized its biodistribution in vivo. Using radiolabeled girentuximab in patient-derived liver metastasis organoids (PDOs) and xenograft models, we then characterized the preclinical utility of CA-IX imaging and therapeutic targeting in mCRC.
Results
CA-IX mRNA and/or protein expression was detected in 87% of CRC liver metastasis samples, with little to no expression in surrounding liver tissue. Both [89Zr]Zr- and [177Lu]Lu-girentuximab exhibited excellent biodistribution characteristics in mice xenografted with PDOs. Positron emission tomography imaging showed that [89Zr]Zr-girentuximab enabled specific and high-resolution detection of CA-IX-expressing lesions at subcutaneous and hepatic sites compared to [18F]F-fluoro deoxy-glucose. Finally, single-dose [177Lu]Lu-girentuximab treatment induced cytotoxicity in PDOs in vitro and strongly reduced tumor burden in 2 independent xenografted mouse models, with no signs of toxicity.
Conclusion
Our results demonstrate that CA-IX is a relevant target for a theragnostic strategy in mCRC, and provide the first demonstration in clinically-relevant models of metastasis that radiolabeled girentuximab can be used as a scouting agent to stratify and monitor mCRC patients and as a therapeutic alternative for patients with CA-IX-expressing tumors.
背景和目的超过40%的结直肠癌（CRC）患者发生转移性疾病。他们的生存前景非常低，突出了迫切需要改善转移性结直肠癌（mCRC）的检测和治疗管理，特别是当转移不能手术切除时。我们的研究旨在描述靶向碳酸酐酶IX （CA-IX）在CRC肝转移患者的转移成像和治疗目的中的临床前应用。方法采用RNA测序和免疫组化染色对46例肝转移组织中sca - ix的表达进行检测。我们用锆-89 （[89Zr]Zr）或镥-177 （[177Lu]Lu）标记临床级CA-IX抗体girentuximab，并表征了其在体内的生物分布。在患者源性肝转移类器官（PDOs）和异种移植模型中使用放射标记的吉伦妥昔单抗，我们随后表征了CA-IX成像和治疗靶向在mCRC中的临床前应用。结果87%的结直肠癌肝转移灶中检测到ca - ix mRNA和/或蛋白表达，而周围肝组织中很少或不表达。[89Zr]Zr-和[177Lu]Lu-girentuximab在PDOs异种移植小鼠中均表现出良好的生物分布特性。正电子发射断层成像显示，与[18F] f -氟脱氧葡萄糖相比，[89Zr]Zr-girentuximab能够特异性和高分辨率地检测皮下和肝脏部位表达ca - ix的病变。最后，单剂量[177Lu]Lu-girentuximab在体外诱导PDOs细胞毒性，并在2个独立的异种移植小鼠模型中显著降低肿瘤负荷，无毒性迹象。结论我们的研究结果表明CA-IX是mCRC治疗策略的相关靶点，并首次在临床相关的转移模型中证明放射标记的吉伦妥昔单抗可以作为一种探测剂用于分层和监测mCRC患者，并作为表达CA-IX的肿瘤患者的治疗替代方案。
{"title":"Carbonic Anhydrase-IX Is a Specific and Sensitive Theragnostic Target for Imaging and Radioimmunotherapy in Metastatic Colorectal Cancer","authors":"Dijina Swaroop , Jai Smith , Jessica Van Zuykelom , Asif Noor , Robin A. Wagner , Tamara Vu , Sarah Lee , Alexander G. Heriot , Benjamin Loveday , Kelly Waldeck , Peter D. Roselt , Benjamin Blyth , Paul S. Donnelly , Frédéric Hollande","doi":"10.1016/j.gastha.2025.100871","DOIUrl":"10.1016/j.gastha.2025.100871","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Over 40% of colorectal cancer (CRC) patients develop metastatic disease. Their survival outlook is very low, highlighting the urgent need to improve the detection and therapeutic management of metastatic colorectal cancer (mCRC), particularly when metastases are not surgically resectable. Our study aimed to characterize the preclinical utility of targeting carbonic anhydrase IX (CA-IX) for metastasis imaging and for therapeutic purposes in patients with CRC liver metastases.</div></div><div><h3>Methods</h3><div>CA-IX expression was characterized in 46 liver metastasis samples using RNA sequencing and immunohistochemical staining. We labeled girentuximab, a clinical grade CA-IX antibody, with zirconium-89 ([<sup>89</sup>Zr]Zr) or lutetium-177 ([<sup>177</sup>Lu]Lu), and characterized its biodistribution in vivo. Using radiolabeled girentuximab in patient-derived liver metastasis organoids (PDOs) and xenograft models, we then characterized the preclinical utility of CA-IX imaging and therapeutic targeting in mCRC.</div></div><div><h3>Results</h3><div>CA-IX mRNA and/or protein expression was detected in 87% of CRC liver metastasis samples, with little to no expression in surrounding liver tissue. Both [<sup>89</sup>Zr]Zr- and [<sup>177</sup>Lu]Lu-girentuximab exhibited excellent biodistribution characteristics in mice xenografted with PDOs. Positron emission tomography imaging showed that [<sup>89</sup>Zr]Zr-girentuximab enabled specific and high-resolution detection of CA-IX-expressing lesions at subcutaneous and hepatic sites compared to [<sup>18</sup>F]F-fluoro deoxy-glucose. Finally, single-dose [<sup>177</sup>Lu]Lu-girentuximab treatment induced cytotoxicity in PDOs in vitro and strongly reduced tumor burden in 2 independent xenografted mouse models, with no signs of toxicity.</div></div><div><h3>Conclusion</h3><div>Our results demonstrate that CA-IX is a relevant target for a theragnostic strategy in mCRC, and provide the first demonstration in clinically-relevant models of metastasis that radiolabeled girentuximab can be used as a scouting agent to stratify and monitor mCRC patients and as a therapeutic alternative for patients with CA-IX-expressing tumors.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100871"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100852
Serach Patterson , Jacqueline Emerson , HannahSofia Brown , Priya Alagesan , Caroline Labriola , Rachel Zuzul , Allison O. Taylor , Danielle L. Mebuge , Nina R. Salama , Wai Yan Min Htike , Frances Wang , Shannon McCall , Katherine S. Garman , Meira Epplein
Background and Aims
Despite acknowledgment of the relationship between iron deficiency anemia (IDA) and Helicobacter pylori, consensus is lacking on clinical practice implications. This study sought to examine the association of iron deficiency and anemia with the precancerous lesion gastric intestinal metaplasia (GIM) in a cohort of patients with active H. pylori infection.
Methods
This retrospective cohort was assembled from adult patients diagnosed with H. pylori at endoscopy at Duke University between 2015 and 2019. Data were collected from pathology reports and electronic health records. The relationship between iron deficiency status and GIM prevalence among 422 H. pylori–positive individuals was examined using age-adjusted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs), and stratified by diagnosis of H. pylori before the diagnosis at study enrollment.
Results
Of these 422 H. pylori–positive patients, 48.6% had evidence of anemia and/or iron deficiency in the electronic health record. Compared to patients without anemia, those with IDA were more likely to have GIM (OR = 1.66; 95% CI, 1.02–2.69). Fifty-seven patients were previously positive for H. pylori, treated, and remained positive for H. pylori at the index endoscopy, of whom 40% had IDA. Among these patients, those with IDA had 4-fold increased odds of having GIM compared to patients without anemia (OR = 4.11; 95% CI, 1.10–15.32)
Conclusion
In a cohort of H. pylori–positive individuals at endoscopy, those with a history of IDA had greater odds of having GIM compared to patients without anemia. These results suggest the importance of close endoscopic evaluation and sampling of the gastric mucosa to evaluate for GIM in patients with IDA, and particularly those with a previous H. pylori diagnosis.
{"title":"Iron Deficiency Anemia is Associated With Gastric Intestinal Metaplasia in Patients With Helicobacter pylori Infection","authors":"Serach Patterson , Jacqueline Emerson , HannahSofia Brown , Priya Alagesan , Caroline Labriola , Rachel Zuzul , Allison O. Taylor , Danielle L. Mebuge , Nina R. Salama , Wai Yan Min Htike , Frances Wang , Shannon McCall , Katherine S. Garman , Meira Epplein","doi":"10.1016/j.gastha.2025.100852","DOIUrl":"10.1016/j.gastha.2025.100852","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Despite acknowledgment of the relationship between iron deficiency anemia (IDA) and <em>Helicobacter pylori,</em> consensus is lacking on clinical practice implications. This study sought to examine the association of iron deficiency and anemia with the precancerous lesion gastric intestinal metaplasia (GIM) in a cohort of patients with active <em>H. pylori</em> infection.</div></div><div><h3>Methods</h3><div>This retrospective cohort was assembled from adult patients diagnosed with <em>H. pylori</em> at endoscopy at Duke University between 2015 and 2019. Data were collected from pathology reports and electronic health records. The relationship between iron deficiency status and GIM prevalence among 422 <em>H. pylori</em>–positive individuals was examined using age-adjusted logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs), and stratified by diagnosis of <em>H. pylori</em> before the diagnosis at study enrollment.</div></div><div><h3>Results</h3><div>Of these 422 <em>H. pylori</em>–positive patients, 48.6% had evidence of anemia and/or iron deficiency in the electronic health record. Compared to patients without anemia, those with IDA were more likely to have GIM (OR = 1.66; 95% CI, 1.02–2.69). Fifty-seven patients were previously positive for <em>H. pylori,</em> treated, and remained positive for <em>H. pylori</em> at the index endoscopy, of whom 40% had IDA. Among these patients, those with IDA had 4-fold increased odds of having GIM compared to patients without anemia (OR = 4.11; 95% CI, 1.10–15.32)</div></div><div><h3>Conclusion</h3><div>In a cohort of <em>H. pylori</em>–positive individuals at endoscopy, those with a history of IDA had greater odds of having GIM compared to patients without anemia. These results suggest the importance of close endoscopic evaluation and sampling of the gastric mucosa to evaluate for GIM in patients with IDA, and particularly those with a previous <em>H. pylori</em> diagnosis.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100852"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100854
Jashdeep Bhattacharjee , Linda X. Wang , Brianna Meneses , Juliet A. Emamaullee , Mark R. Frey , Rohit Kohli
{"title":"MAM and LDL Receptor Class A Domain Containing 1 Deficiency Aggravates Hepatic Fibrosis in Diet-Induced Metabolic Dysfunction-Associated Steatohepatitis","authors":"Jashdeep Bhattacharjee , Linda X. Wang , Brianna Meneses , Juliet A. Emamaullee , Mark R. Frey , Rohit Kohli","doi":"10.1016/j.gastha.2025.100854","DOIUrl":"10.1016/j.gastha.2025.100854","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 2","pages":"Article 100854"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100853
Vincent Pedulla , Alyson Kaplan
Alcohol-associated liver disease (ALD) is now the primary indication for liver transplantation (LT) in the United States. While outcomes after LT for ALD are generally excellent, the possibility of post-LT alcohol relapse raises ongoing clinical, ethical, and psychosocial challenges. Relapse is shaped by multiple factors, including young age, comorbid substance use or psychiatric history, lack of social support or engagement, and broader social determinants of health such as education, race, socioeconomic status, and geography. These influences are often difficult to capture through traditional psychosocial assessment alone, and program-level variation in evaluation practices may exacerbate disparities in access to LT. Several relapse prediction tools, including the Sustained Alcohol Use Post-Liver Transplant and Stanford Integrated Psychosocial Assessment for Transplant, have been developed to aid in candidate evaluation. While these tools provide structured approaches, their predictive accuracy remains limited. Biomarkers of alcohol use have emerged as valuable adjuncts to the psychosocial assessment, with phosphatidylethanol showing the greatest promise due to its high sensitivity and specificity and ability to detect alcohol use over a longer period of time. Post-transplant multidisciplinary treatment of alcohol use disorder is also important, including pharmacotherapy and addiction care. Ultimately, optimizing relapse prediction and management requires a framework that accounts not only for individual risk factors but also for structural inequities that shape access to transplantation. Efforts to combine clinical, biological, and social data into unified risk models may provide a more equitable and evidence-based approach to evaluating and supporting patients with ALD before and after LT.
{"title":"Alcohol Relapse After Liver Transplantation: Advances in Risk Stratification, Biomarker Integration, and Post-Transplant Care","authors":"Vincent Pedulla , Alyson Kaplan","doi":"10.1016/j.gastha.2025.100853","DOIUrl":"10.1016/j.gastha.2025.100853","url":null,"abstract":"<div><div>Alcohol-associated liver disease (ALD) is now the primary indication for liver transplantation (LT) in the United States. While outcomes after LT for ALD are generally excellent, the possibility of post-LT alcohol relapse raises ongoing clinical, ethical, and psychosocial challenges. Relapse is shaped by multiple factors, including young age, comorbid substance use or psychiatric history, lack of social support or engagement, and broader social determinants of health such as education, race, socioeconomic status, and geography. These influences are often difficult to capture through traditional psychosocial assessment alone, and program-level variation in evaluation practices may exacerbate disparities in access to LT. Several relapse prediction tools, including the Sustained Alcohol Use Post-Liver Transplant and Stanford Integrated Psychosocial Assessment for Transplant, have been developed to aid in candidate evaluation. While these tools provide structured approaches, their predictive accuracy remains limited. Biomarkers of alcohol use have emerged as valuable adjuncts to the psychosocial assessment, with phosphatidylethanol showing the greatest promise due to its high sensitivity and specificity and ability to detect alcohol use over a longer period of time. Post-transplant multidisciplinary treatment of alcohol use disorder is also important, including pharmacotherapy and addiction care. Ultimately, optimizing relapse prediction and management requires a framework that accounts not only for individual risk factors but also for structural inequities that shape access to transplantation. Efforts to combine clinical, biological, and social data into unified risk models may provide a more equitable and evidence-based approach to evaluating and supporting patients with ALD before and after LT.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100853"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100870
Bita Shahrvini , Andrew Chang , Alexandra C. Greb , Mark Baniqued , Divya P. Prajapati , Rhett Harmon , Sureya F. Hussani , Nirupama Bonthala , Gaurav Syal , Jenny S. Sauk , Folasade P. May , Berkeley N. Limketkai
Background and Aims
Patients with inflammatory bowel disease (IBD) are at increased risk of malnutrition, which is associated with worse outcomes and has prompted recommendations for regular nutrition screening. This study details a current state analysis of outpatient gastroenterology (GI) malnutrition screening practices for patients with IBD and evaluates risk factors for lack of screening.
Methods
This retrospective cohort study included adults with IBD on advanced therapies seen at the University of California, Los Angeles, between 2018 and 2024. Patient data were abstracted from outpatient GI encounters via electronic medical records. A root cause analysis for lack of malnutrition screening was created using a Gemba walk and stakeholder interviews. Multivariable logistic regression evaluated risk factors for lack of screening.
Results
Of 283 included patients, the mean age was 44.4, mean body mass index was 25.9, 53.7% were female, 62.9% were White, and 50.0% had Crohn’s disease. Most (70.7%) had their GI encounters via telehealth. Malnutrition screening was performed at 56% of encounters. When patients were screened, a validated screening tool was used in 12% of encounters. Screening identified malnutrition risk in 11% of encounters and prompted ordering of registered dietician referrals 44% and nutrition labs 56% of the time. Malnutrition screening was less likely if the encounter was via telehealth (vs in-person, odds ratio 0.43, confidence interval [0.23–0.80]).
Conclusion
Improved malnutrition screening among GI physicians for IBD patients is needed. Given telehealth visits were strongly associated with lack of screening, strategies to address this care gap are needed since telehealth has become more common.
{"title":"Current State Analysis of Malnutrition Screening for Ambulatory Patients With Inflammatory Bowel Disease Reveals Low Screening Rates and Telehealth as a Risk Factor","authors":"Bita Shahrvini , Andrew Chang , Alexandra C. Greb , Mark Baniqued , Divya P. Prajapati , Rhett Harmon , Sureya F. Hussani , Nirupama Bonthala , Gaurav Syal , Jenny S. Sauk , Folasade P. May , Berkeley N. Limketkai","doi":"10.1016/j.gastha.2025.100870","DOIUrl":"10.1016/j.gastha.2025.100870","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Patients with inflammatory bowel disease (IBD) are at increased risk of malnutrition, which is associated with worse outcomes and has prompted recommendations for regular nutrition screening. This study details a current state analysis of outpatient gastroenterology (GI) malnutrition screening practices for patients with IBD and evaluates risk factors for lack of screening.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults with IBD on advanced therapies seen at the University of California, Los Angeles, between 2018 and 2024. Patient data were abstracted from outpatient GI encounters via electronic medical records. A root cause analysis for lack of malnutrition screening was created using a Gemba walk and stakeholder interviews. Multivariable logistic regression evaluated risk factors for lack of screening.</div></div><div><h3>Results</h3><div>Of 283 included patients, the mean age was 44.4, mean body mass index was 25.9, 53.7% were female, 62.9% were White, and 50.0% had Crohn’s disease. Most (70.7%) had their GI encounters via telehealth. Malnutrition screening was performed at 56% of encounters. When patients were screened, a validated screening tool was used in 12% of encounters. Screening identified malnutrition risk in 11% of encounters and prompted ordering of registered dietician referrals 44% and nutrition labs 56% of the time. Malnutrition screening was less likely if the encounter was via telehealth (vs in-person, odds ratio 0.43, confidence interval [0.23–0.80]).</div></div><div><h3>Conclusion</h3><div>Improved malnutrition screening among GI physicians for IBD patients is needed. Given telehealth visits were strongly associated with lack of screening, strategies to address this care gap are needed since telehealth has become more common.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100870"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.gastha.2025.100874
Kyung-Pil Ko , Jie Zhang , Sohee Jun , Jae-Il Park
Background and Aims
Understanding the cells of origin is essential for overcoming therapy resistance and improving early intervention strategies in esophageal squamous cell carcinoma (ESCC). Despite recent advances in genomic profiling, the precise cellular hierarchies and molecular programs driving ESCC initiation remain poorly defined.
Methods
We utilized machine learning-based single-cell trajectory analysis on 4-nitroquinoline 1-oxide–induced murine models and genetically engineered organoids to identify cellular lineages during tumorigenesis. Combined with gene regulatory network analysis, we identified transcriptional drivers of tumor initiation and employed transcriptome-based drug repurposing to predict compounds targeting these initiating populations.
Results
Our analyses revealed multiple distinct epithelial clusters that function as cellular origins of ESCC, exhibiting diverse stem and progenitor signatures. Gene regulatory network analysis of these populations indicated activation of stem/progenitor cell regulators, including CEBPβ and TFAP2A/C. Translating these findings, a transcriptome-based drug repurposing screen identified 5 chemical candidates, 4 of which are potent cyclin-dependent kinase inhibitors, aligning with the frequent loss-of-function mutations in TP53 and CDKN2A observed in ESCC. Notably, CDK inhibitors markedly inhibit ESCC cell proliferation.
Conclusion
This research delineates the potential cellular origins of ESCC and their key regulons, thereby pioneering a single-cell-derived therapeutic strategy that exposes vulnerabilities in tumor-initiating cells.
{"title":"Single-Cell Lineage Trajectory Defines Cyclin-Dependent Kinase Inhibitor–Sensitive Cells-of-Origin in Esophageal Squamous Cell Carcinoma","authors":"Kyung-Pil Ko , Jie Zhang , Sohee Jun , Jae-Il Park","doi":"10.1016/j.gastha.2025.100874","DOIUrl":"10.1016/j.gastha.2025.100874","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Understanding the cells of origin is essential for overcoming therapy resistance and improving early intervention strategies in esophageal squamous cell carcinoma (ESCC). Despite recent advances in genomic profiling, the precise cellular hierarchies and molecular programs driving ESCC initiation remain poorly defined.</div></div><div><h3>Methods</h3><div>We utilized machine learning-based single-cell trajectory analysis on 4-nitroquinoline 1-oxide–induced murine models and genetically engineered organoids to identify cellular lineages during tumorigenesis. Combined with gene regulatory network analysis, we identified transcriptional drivers of tumor initiation and employed transcriptome-based drug repurposing to predict compounds targeting these initiating populations.</div></div><div><h3>Results</h3><div>Our analyses revealed multiple distinct epithelial clusters that function as cellular origins of ESCC, exhibiting diverse stem and progenitor signatures. Gene regulatory network analysis of these populations indicated activation of stem/progenitor cell regulators, including CEBPβ and TFAP2A/C. Translating these findings, a transcriptome-based drug repurposing screen identified 5 chemical candidates, 4 of which are potent cyclin-dependent kinase inhibitors, aligning with the frequent loss-of-function mutations in <em>TP53</em> and <em>CDKN2A</em> observed in ESCC. Notably, CDK inhibitors markedly inhibit ESCC cell proliferation.</div></div><div><h3>Conclusion</h3><div>This research delineates the potential cellular origins of ESCC and their key regulons, thereby pioneering a single-cell-derived therapeutic strategy that exposes vulnerabilities in tumor-initiating cells.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"5 3","pages":"Article 100874"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号