Hasil untuk "Diseases of the digestive system. Gastroenterology"

Arno R. Bourgonje, Ryan C. Ungaro, Saurabh Mehandru et al.

Miguel Suárez, R. Martínez, F. González-Martínez et al.

Artificial intelligence (AI) is reshaping modern medicine, and gastroenterology and hepatology are among the specialties where its impact is becoming increasingly evident. AI has demonstrated the ability to process and analyze large amounts of clinical, radiological, endoscopic, and multi-omics data, offering unprecedented opportunities to enhance diagnostic accuracy, optimize therapeutic decision-making, and reduce variability in clinical practice. In endoscopy, computer-aided detection and diagnosis systems have shown consistent improvements in adenoma detection rates and real-time polyp characterization, while in hepatology, machine learning models outperform traditional scores for non-invasive assessment of liver fibrosis. Furthermore, multimodal approaches integrating genomics, microbiome, and imaging data are paving the way for precision medicine in inflammatory bowel disease and other complex digestive conditions. Despite these promising advances, significant barriers remain. The quality and heterogeneity of training data, the lack of rigorous external validation, and the opaque “black box” nature of many algorithms limit their clinical reliability. Ethical challenges, including accountability in case of diagnostic errors, protection of patient privacy, cost, and equitable access, also need to be addressed. This narrative review summarizes the current applications of AI in gastroenterology and hepatology, critically examines methodological and ethical challenges, and outlines future perspectives. Responsible, transparent, and equitable implementation will be essential for AI to transition from an emerging promise to a consolidated tool that improves outcomes and advances personalized digestive care.

Xue-Wen Liu, Zi-Bin Zhan, Ze-Hua Li et al.

Background/Aims Endoplasmic reticulum (ER) stress in hepatocytes plays a causative role in alcohol-associated liver disease (ALD). The incomplete inhibition of ER stress by targeting canonical ER stress sensor proteins suggests the existence of noncanonical ER stress pathways in ALD pathology. This study aimed to delineate the role of RAB25 in ALD and its regulatory mechanism in noncanonical ER stress pathways. Methods RAB25 activation was examined in liver samples from ALD patients and ethanol-fed mice. The interaction between RAB25 and GCN1 was confirmed through mass spectrometry and co-immunoprecipitation (Co-IP) assays in vitro. The role of RAB25/GCN1 in promoting noncanonical ER stress in ALD was assessed both in vitro and in vivo. Results RAB25 expression was upregulated and specifically accumulated on the ER in ALD. Mass spectrometry and Co-IP assays confirmed that RAB25 interacts with GCN1, thereby activating a noncanonical ER stress pathway that facilitates ALD progression. Further analysis revealed that RAB25 interaction with GCN1 inhibits K33-ubiquitination-mediated degradation of GCN1, promotes GCN2 phosphorylation, and subsequently activates ATF4-mediated ER stress. This activation modulates lipid metabolism, mitochondrial function, and inflammation, thereby facilitating ALD progression. Knockdown of RAB25 in hepatocytes inhibited ER stress activation and mitigated associated mitochondrial dysfunction, excessive lipid synthesis, and the exaggerated inflammatory response in an ALD model. Conclusions Our findings demonstrate a causal role for RAB25-GCN1 signaling in activating the ER stress pathway, which contributes to ALD progression. This pathway may provide a proof-of-concept target for treating ALD and associated metabolic disorders.

S. A. Gardezi, Rawan Al Ghawi, T. AlAmeel et al.

ABSTRACT Artificial intelligence is rapidly reshaping gastroenterology through demonstrable gains in diagnostic precision, procedural quality, and operational efficiency. AI-assisted colonoscopy has consistently shown absolute improvements of 5%-10% in adenoma detection rates, while deep-learning systems in capsule endoscopy can reduce reading time by more than 80% without compromising diagnostic yield. Although applications in EUS, cholangioscopy, and predictive modelling for inflammatory bowel disease remain at an exploratory stage, emerging studies indicate meaningful potential in lesion characterization, risk stratification, and automated disease-activity assessment. In Saudi Arabia, adoption of these technologies is still limited; however, the Kingdom's expanding digital infrastructure, unified data-governance initiatives, and strategic direction under Vision 2030 provide a strong foundation for responsible and scalable deployment. Local disease patterns, including a rising burden of colorectal neoplasia, steatotic liver disease (SLD) and inflammatory bowel disease (IBD), further highlight the need for data-driven approaches that can enhance early detection, guide targeted interventions, and optimize long-term management. This review synthesizes global evidence and Saudi-specific healthcare priorities to outline a strategic, phased framework for integrating AI into national gastroenterology practice. Key recommendations include embedding AI literacy within clinician training, developing standardized national data pipelines, initiating pilot implementations within major tertiary centers, and establishing clear ethical and regulatory pathways for clinical approval and oversight. Through coordinated investment in education, infrastructure, and governance, Saudi Arabia is positioned to advance from early experimentation to regional leadership in AI-enabled digestive healthcare.

Zhi-Li Chen, Chao Wang, Fang Wang

Artificial intelligence (AI) is driving a paradigm shift in gastroenterology and hepatology by delivering cutting-edge tools for disease screening, diagnosis, treatment, and prognostic management. Through deep learning, radiomics, and multimodal data integration, AI has achieved diagnostic parity with expert clinicians in endoscopic image analysis (e.g., early gastric cancer detection, colorectal polyp identification) and non-invasive assessment of liver pathologies (e.g., fibrosis staging, fatty liver typing) while demonstrating utility in personalized care scenarios such as predicting hepatocellular carcinoma recurrence and optimizing inflammatory bowel disease treatment responses. Despite these advancements challenges persist including limited model generalization due to fragmented datasets, algorithmic limitations in rare conditions (e.g., pediatric liver diseases) caused by insufficient training data, and unresolved ethical issues related to bias, accountability, and patient privacy. Mitigation strategies involve constructing standardized multicenter databases, validating AI tools through prospective trials, leveraging federated learning to address data scarcity, and developing interpretable systems (e.g., attention heatmap visualization) to enhance clinical trust. Integrating generative AI, digital twin technologies, and establishing unified ethical/regulatory frameworks will accelerate AI adoption in primary care and foster equitable healthcare access while interdisciplinary collaboration and evidence-based implementation remain critical for realizing AI’s potential to redefine precision care for digestive disorders, improve global health outcomes, and reshape healthcare equity.

Stijn J M Niessen, Ellen N. Behrend, F. Fracassi et al.

Simple Summary To make progress in the field of hormonal diseases in companion animals, it helps when researchers, clinicians, and educators use the same language. Currently, there is no consensus on basic concepts such as what constitutes the correct definition of diseases affecting the adrenal glands, important hormone-producing glands situated next to the kidneys. This publication reports on the second cycle of a novel project called “Agreeing Language in Veterinary Endocrinology” (ALIVE) that brings experts and those interested in the field together to try and achieve consensus on such disease definitions. The cycle’s methods were adapted from previous ones to improve efficiency and were completed successfully, accomplishing a majority-based consensus. It also delivered agreement on diagnostic criteria for adrenal diseases in companion animals. It is hoped the work will improve education, diagnosis, and treatment in this field, ultimately leading to improvements in the quality of life of animals suffering from adrenal disease.

Atsuto Kayashima, Seiichiro Fukuhara, Kentaro Miyamoto et al.

Qianqian Chen, Yaoqian Yuan, Huikai Li et al.

Abstract The mode of organ resection and reconstruction that has been used to treat digestive tract tumors (DTTs) can cure the disease. However, it involves the surgical resection of critical structures (such as the cardia, pylorus, and anus) and gastrointestinal reconstruction, which alter the physiological anatomy of the digestive system. These changes often lead to numerous postoperative complications and severely affect the patient’s quality of life (e.g., refractory gastroesophageal reflux following proximal gastrectomy, dumping syndrome after subtotal gastrectomy, loss of anal function after low rectal surgery). For the defect of this mode, professor Linghu Enqiang proposed the new mode that was “curing the disease and restoring normal function” in 2016, which was named as this new mode: Super Minimally Invasive Surgery (SMIS). To accomplish various types of SMIS, four operative channels were developed: the natural cavity channel, the tunnel channel, the puncture channel, and the multi-cavity channel. SMIS, with its advantages of minimal trauma and organ function preservation, has been recognized by authoritative domestic and international organizations and has developed rapidly. Based on its clinical value and the need for wider application, there is an urgent need to establish standardized guidelines to guide practice. This guideline was developed by leading organizations such as the SMIS committee of World Endoscopy Organization (WEO) and Chinese Society of Digestive Endoscopy (CSDE), in collaboration with multidisciplinary experts from gastroenterology, general surgery, and pathology. Systematic searches were conducted in nine major databases, including PubMed, Embase, and China National Knowledge Infrastructure (CNKI), for both Chinese and English literature published before 2025. Evidence from randomized controlled trials (RCTs), observational studies, and case series was included, with the quality of evidence and recommendation strength evaluated using the GRADE system (high-level evidence:RCTs; low-level evidence: observational studies). The recommendations were refined through several rounds of expert discussions and voting, and were reported following the AGREE II and RIGHT reporting standards. This guideline has been registered on the PREPARE (Practice Guideline REgistration for transPAREncy; registration number: PREPARE-2024CN1183). This guideline addresses 15 issues related to SMIS treatment for esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), their corresponding precancerous lesions, and precancerous lesions of the duodenal papilla. It provides corresponding recommendations in three main areas: (1) Definitions and principles: SMIS should meet ten core criteria, including organ preservation, complete resection (R0), and sterile procedures. It also standardizes naming conventions (e.g., “Super minimally invasive non-full-thickness resection of lower esophageal squamous carcinoma via the oral cavity”). (2) Surgical recommendations: EC: For early and precancerous lesions, SMIS of non-full-thickness resection (non-FTR) is preferred. For circumferential involvement ≥ 1/2, SMIS via tunnel channel for non-FTR is recommended. If the wound circumference is ≥ 75%, the use of corticosteroids or stents to prevent stenosis is advised. GC: For T1a-T1b stage and precancerous lesions, SMIS non-FTR or full-thickness resection (FTR) is preferred, with individualized plans based on the risk of lymph node metastasis (LNM). CRC: SMIS of non-FTR or FTR is recommended as the first-line treatment for T1a-T1b stage and precancerous lesions. For locally advanced rectal cancer (LARC) that achieves clinical remission after neoadjuvant therapy, SMIS of FTR can be considered to assess pathological remission. Duodenal papilla precancerous lesions: SMIS resection via the oral cavity is preferred. Postoperatively, whether to add pancreaticoduodenectomy and follow-up strategies should be determined based on pathology. (3) Postoperative management: A SMIS treatment cure evaluation system for early gastric cancer (EGC) was established, divided into SMIS-Cure A(cured), SMIS-Cure B (clinically cured), and SMIS-Cure C (surgical reassessment), which guides follow-up. For CRC or precancerous lesions, R0 resection is the standard for cure, and follow-up plans are developed according to risk stratification. This guideline systematically integrates the evidence from SMIS in the treatment of DTTs with expert consensus, establishing a standardized pathway centered on organ function preservation. It shifts the treatment model from “cure first” to “cure-function balance”. Its application is expected to reduce overtreatment, improve the patient’s quality of life, and provide a framework for future technological iterations and the expansion of indications. It should be continuously optimized with multicenter clinical data and long-term follow-up results to achieve more precise, individualized treatment.

Paul Tran, Rose Lee, Ali Mencin et al.

Background Ultra-slim, flexible endoscopy pioneered for the evaluation of luminal diseases of the airway, has been used for over 40 years. In the late 20th century, it was adopted in the gastrointestinal specialties for evaluation of the digestive tract with and without the need for sedation. Since the advent of this technology, numerous descriptions of its use in small anatomic areas have been described. These include stricture evaluation and therapy, ostomy evaluation, biliary interventions, and diagnostic endoscopic evaluation of pediatric patients. This manuscript reviews the availability and clinical utility of ultra-slim flexible endoscopes, describes technical approaches, and highlights the potential value the technology offers to pediatric providers and healthcare systems. Methods A comprehensive literature review was conducted on the use of ultra-slim endoscopes in the pediatric and adult gastroenterology. Expert discussions were held to evaluate current practices, indications, and equipment. The resulting expert opinion was generated to summarize pertinent information regarding key techniques, indications, and practical considerations for implementation in pediatric settings. Results Although ultra-slim endoscopes started their use in small-space adult gastroenterology procedures, they have shown significant benefit and value within pediatrics. The literature documents their use in both sedated and unsedated environments, including transnasal upper endoscopy, variceal surveillance, esophageal stricture evaluation, neonatal endoscopy, enteral tube placement, and ostomy assessment. Conclusion Ultra-slim flexible endoscopy provides pediatric gastroenterologists with a valuable diagnostic and therapeutic tool. When used appropriately, either with or without sedation, it has the potential to increase clinical efficiency, reduce procedural risk, and improve access to care.

Dongdong Zhang, Ying Cai, Yixin Sun et al.

Famotidine is an H2 receptor antagonist and is currently used on a large scale in gastroenterology. However, Famotidine may also cause severe toxicity to organ systems, including the blood system, digestive system, and urinary system. The objective of this study was to scientifically and systematically investigate the adverse events (AEs) of Famotidine in the real world through the FDA Adverse Event Reporting System (FAERS) database. A disproportionality analysis was used to quantify the signals of AEs associated with Famotidine in FAERS data from the first quarter of 2004 to the first quarter of 2023. The clinical features, onset time, oral and intravenous administration and severe consequences of Famotidine induced AEs were further analyzed. Among the four tests, we found several AEs that were not mentioned in the drug label. For example, abdominal pain upper, abdominal discomfort, dyspepsia, liver disorder, gastrooesophageal reflux disease, and rhabdomyolysis. These AEs are consistent with the drug instructions. Interestingly, we found several unreported AEs, such as: cerebral infarction, hypocalcaemia, hallucination, visual, hypomagnesaemia, hypoparathyroidism, diabetes insipidus, vulvovaginal candidiasis, retro‐orbital neoplasm, neuroblastoma recurrent, and malignant cranial nerve neoplasm. Most of our findings are consistent with clinical observations and drug labels, and we also found possible new and unexpected AEs signals, which suggest the need for prospective clinical studies to confirm these results and explain their relationships. Our findings provide valuable evidence for further safety studies.

Jacques Gonzales, Brian D. Gulbransen

Y. Essadni, M. Salihoun, F. Bouhamou et al.

Iron-deficiency anemia is very common among patients in gastroenterology. The digestive system plays a key role in the pathophysiology of iron-deficiency. Indeed, digestive causes are one the most fequent etiology. This is why endoscopic evaluation is part of the etiological assessment of iron-deficiency anemia. The aim of this study is to investigate the usefulness of esophagogastroduodenoscopy (EGD) and histopathology in the etiological diagnosis of iron-deficiency anemias. Materials and Methods: This is a monocentric study conducted from January 2019 to December 2023. All patients with iron-deficiency anemia who underwent EGD were included. Various data were recorded, including patients' epidemiological information, laboratory findings, and results from endoscopic examinations. Results: Out of 2960 EGD, 576 (19,5%) were included in the study. The mean age of the patients was 49.81 years, ranging from 18 to 83 years. The male-to-female sex ratio was 0.67. It is notable that 47.5% of the patients had various medical histories: inflammatory bowel disease (IBD) in 19.13% of cases, history of non-steroidal anti-inflammatory drug (NSAID) use in 12.17%, coeliac disease in 6.13%, cirrhosis with portal hypertension in 8.70%. All patients underwent EGD. An abnormality was found in 63.4% of cases, including: Esophageal lesions: gastroesophageal varices in 13.3% of cases, erosive esophagitis in 7.5%, esophageal tumor in 0.6% of cases. Gastric lesions: erosive gastritis in 35% of cases, ulcerative gastritis in 22%, erythematous gastritis in 17%, gastric tumor in 15% of cases, supra-centimetric hyperplastic polyps in 5% of cases. Bulboduodenal lesions: erosive bulboduodenitis in 25% of cases, ulcerative bulboduodenitis in 18%, duodenal fold rarefaction in 16%, angiodysplasia in 3.5%. Gastric and duodenal biopsies were systematically performed. Duodenal biopsies showed a celiac disease aspect in 7.6% of cases, and nonspecific duodenitis in 4.6% of cases. Gastric biopsies revealed gastritis with Helicobacter pylori (Hp) in 57.6% of cases. Thus, the diagnostic yield of EGD was 47.33%. Conclusion: Iron deficiency anemia are common medical conditions in daily clinical practice. The multiple etiologies of iron deficiency anemia and the nonspecificity of symptoms make diagnosis difficult. Gastrointestinal lesions are frequently observed in patients with iron deficiency anemia. Digestive endoscopy has a great value in the etiological investigation of this pathology. Gastroscopy allows for the etiological diagnosis for many patients that’s why it is systematically recommended do it.

Shuang Wu, Hu Yu, Ying Liu et al.

Background Small Bowel Adenocarcinoma (SBA) is rare, occult and life-threatening malignancy in digestive system. Given low incidence and nonspecific symptoms, SBA is frequently detected in later stages. Double contrast enhanced ultrasound (DCEUS) is an innovative imaging technique applied to visualize the gastrointestinal tract, merging intravenous contrast-enhanced ultrasound with oral contrast-enhanced ultrasound. In this case, DCEUS was utilized and successfully detected an SBA of the jejunum. Case presentation A Chinese woman, aged 64, sought consultation in the gastroenterology department at our hospital, reporting symptoms of abdominal pain. Three months before entering the hospital, she underwent gastroscopy and colonoscopy which suggested chronic gastritis, and she was treated with oral drugs. However, her symptoms were not relieved, and even worsened. To further investigate, DCEUS was performed. The oral contrast agent dilated the luminal space of the upper gastrointestinal tract, resolving the hindrance caused by gas in the gastrointestinal tract and creating an acoustic window for scanning. Through this acoustic window, oral agent contrast-enhanced ultrasound (OA-CEUS) revealed a localized thickening of jejunal intestinal wall measuring 4x3 cm. Following intravenous injection of ultrasound contrast agent, the jejunal lesion exhibited faster enhancement and heterogeneous hyper-enhancement. Finally, the patient underwent jejunal tumor resection. Pathological examination revealed a jejunal adenocarcinoma. Conclusion The timely diagnosis of SBA can be challenging. DCEUS may have the potential to contribute to diagnosis and detailed evaluation of SBA, particularly in cases involving jejunum. Further researches are needed to fully explore the benefits of DCEUS in the standard diagnostic approach for small bowel diseases.

Jing Ma, Suthat Liangpunsakul, Hui Gao et al.

Alcohol-associated liver disease (ALD) is a growing global health concern and its prevalence and severity are increasing steadily. While bacterial endotoxin translocation into the portal circulation is a well-established key factor, recent evidence highlights the critical role of sterile inflammation, triggered by diverse stimuli, in alcohol-induced liver injury. This review provides a comprehensive analysis of the complex interactions within the hepatic microenvironment in ALD. It examines the contributions of both parenchymal cells, like hepatocytes, and non-parenchymal cells, such as hepatic stellate cells, Kupffer cells, neutrophils, and liver sinusoidal endothelial cells, in driving the progression of the disease. Additionally, we explored the involvement of key mediators, including cytokines, chemokines and inflammasomes, which regulate inflammatory responses and promote liver injury and fibrosis. A particular focus has been placed on extracellular vesicles (EVs) as essential mediators of intercellular communication both within and beyond the liver. These vesicles facilitate the transfer of signalling molecules, such as microRNAs and proteins, which modulate immune responses, fibrogenesis and lipid metabolism, thereby influencing disease progression. Moreover, we underscore the importance of organ-to-organ crosstalk, particularly in the gut-liver axis, where dysbiosis and increased intestinal permeability lead to microbial translocation, exacerbating hepatic inflammation. The adipose-liver axis is also highlighted, particularly the impact of adipokines and free fatty acids from adipose tissue on hepatic steatosis and inflammation in the context of alcohol consumption.

Semvua B. Kilonzo, Eliud Kamala, Hyasinta Jaka et al.

Abstract Background Non-alcoholic fatty liver disease (NAFLD), which is closely associated with metabolic syndrome (MetS), is rarely reported in Tanzania, where MetS is prevalent. The purpose of this study was to determine the prevalence and associated factors of this condition in overweight and obese individuals and to correlate standard ultrasound diagnosis with triglyceride-glucose index (TyG) and TyG-body mass index (TyG-BMI). Methods A cross-sectional analysis was performed in 181 adult outpatients attending a general medical clinic. The presence of fatty liver was detected by ultrasound. Demographic, clinical, and laboratory data were collected and analyzed using STATA 15. To compare categorical variables, a chi-square test was employed, while a Student’s t-test was used to compare continuous variables. Additionally, a multivariate regression analysis was conducted to identify the determinants of NAFLD. A significance level was set at p < 0.05. The discriminatory power of TyG and TyG-BMI for diagnosing NAFLD was evaluated using Receiver Operating Characteristic (ROC) Curve analysis and the Area Under the ROC Curve (AUC) was reported. Results The overall prevalence of NAFLD was 30.4% (55/181). The prevalence’s of NAFLD in patients with class III obesity, class II obesity, class I obesity and overweight were 50.0% (12/24),, 38% (19/50), 23.7% (18/76), and 19.5% (6/31),respectively. NAFLD was strongly predicted by hyperuricemia (≥ 360 μmol/L) (p = 0.04) and TyG ≥ 8.99 (p = 0.003). The best cut-off values of TyG and TyG-BMI to predict NAFLD were 8.99 [AUC 0.735; sensitivity 70.9%, specificity 79.3%] and 312 [AUC 0.711; sensitivity 60% and specificity 75.4%] respectively. Conclusions The prevalence of NAFLD is high among people with overweight and obesity in Tanzania. We did not find sufficient evidence to recommend the use of TyG and TyG-BMI as surrogates for hepatic ultrasound in detecting NAFLD, and further evaluation is recommended.

I. Maev, K. Velikolug

AIM To highlight the relevance of gastrointestinal manifestations of cytomegalovirus infection (CMVI), to highlight the main risk factors for the development of this pathology, current trends in diagnosis and treatment. KEY POINTS CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The "gold standard" in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation. CONCLUSION Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.

Amtiaz Ahmad, Ali Hyder, Attique Abou Bakr et al.

Introduction: Celiac disease (CD) is a chronic inflammatory disorder affecting mainly the digestive system and accounts for more than 50% of adult cases presenting to the gastrointestinal clinic with chronic diarrhea. Therefore, in our study, we aimed to determine the prevalence of CD in patients presenting with chronic diarrhea at the gastroenterology outpatient department of Jinnah Hospital, Lahore. Methods: This cross-sectional study was conducted from December 9, 2021, to June 8, 2022, and included 140 patients aged 18 to 50 years with chronic diarrhea. Exclusion criteria were lack of informed consent and history of abdominal trauma or surgery. Data collected included age, gender, family history of CD, and clinical symptoms. Diagnostic measures involved serum tissue transglutaminase antibody IgA and IgG levels, endoscopy, and duodenal biopsy. Statistical analysis was performed using SPSS version 23 (IBM Corp, Armonk, NY), with a p-value of ≤0.05 considered significant. Results: Among the 140 patients, 80 (57.14%) were males, with a mean age of 21 ± 4.35 years. Common symptoms included weight loss (73.5%), abdominal pain (20.7%), and stunted growth (5.7%). A family history of CD was reported in 14.29% of patients. Endoscopy findings included fissuring of the duodenal mucosa (77.9%), decreased height of duodenal folds (15.7%), and nodularity (6.4%). Histopathological examination revealed Marsh III b (65%), Marsh III c (21.4%), and Marsh III a (9.3%). CD was diagnosed in 23.57% of patients. Significant associations were found between CD and female gender, family history of CD, weight loss, stunted growth, and Marsh III c histopathology. Conclusion: CD was diagnosed in 23.57% of patients with chronic diarrhea. It was more prevalent in females and those with a family history of CD. These findings emphasize the need for considering CD in the differential diagnosis of chronic diarrhea to ensure early detection and management.

Ian A. Rowe, Vincent Wai-Sun Wong, Rohit Loomba

Claire E. O’Hanlon, Arpan A. Patel

The relentless consolidation of the US health care industry [1] has spread to the practice of gastroenterology, which, despite previous resistance [2] and persistent fragmentation [3], is belatedly being consolidated. In this issue of Digestive Diseases and Sciences, the authors of “Gastroenterology Practice Consolidation Between 2012 and 2020” [4] report that practice consolidation in gastroenterology has increased precipitously in recent years. Despite a 9% increase in the number of gastroenterology physicians in practice from 2012 to 2020, the total number of practices has decreased by 14%. Importantly, these trends, observable in every region of the country, are expected to continue [5]. For gastroenterology practices, organizational leaders, and policymakers, understanding the causes and effects of consolidation are critical. Though this study was not designed to understand why gastroenterology practice consolidation is occurring, the authors commented on a few perceived benefits to physicians that may drive it. The most obvious benefit is the economies of scale—as reporting and reimbursement complexity has increased, it makes more sense to spread administrative costs over a larger number of physicians. Other benefits might be considered physician “lifestyle” benefits, such as making it easier to take time off by sharing caseloads and on-call duties. Pressures created by reimbursement cuts and valuebased payment models [6] may also drive decisions toward consolidation; such pressures have likely been exacerbated during the COVID-19 pandemic [7]. Increasing practice size improves physicians’ bargaining position with payers when negotiating reimbursement rates for services, enabling them to charge higher prices [5]. Though the benefits to physicians are clear, the benefits of consolidation to patients and society are less so. A large body of research has demonstrated that consolidation between close competitors increases prices without improvements in quality or efficiency, with inferior patient outcomes where there is a lack of competition [1]. Furthermore, health care consolidation can negatively impact access to care for vulnerable individuals when physicians become bound by the policies of their physician group. In contrast with other industrialized nations with nationalized health care systems and social benefit programs, the social safety net in the USA consists of a patchwork of programs (e.g., Medicaid), laws (e.g., EMTALA [Emergency Medical Treatment and Labor Act]), and facilities (e.g., Federally Qualified Health Centers [FQHCs]) to try to maintain access to care for lowincome and uninsured people. Specialty, non-emergency care—much of the care provided by gastroenterologists— is an area in which patient care navigators at FQHCs may rely on personal relationships with physicians who provide occasional free or discounted care, since it is otherwise difficult to obtain. When physicians cede ownership or governance of their practice, these relationships can be disrupted. Indeed, qualitative analysis of the impacts of consolidation performed by one of the authors of this editorial (C.E.O.), identified screening colonoscopies, a service rendered by gastroenterologists, as a service that became more difficult to obtain for FQHC patients due to health care consolidation, since physicians whose practices were acquired by a large health care system were prohibited from using its equipment and staff to serve patients who were unable to pay [8]. Disclaimer: The views expressed are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Xiaoyu Xiong, Zhongkun Bao, Yanhong Mi et al.

Objective. Necrotizing enterocolitis (NEC) is one of the commonest gastrointestinal critical diseases in newborns. Several researches have proven the efficacy of melatonin (MEL) on NEC, but the latent mechanisms were ambiguous. We designed the current research to evaluate the function and mechanism of MEL on NEC in a neonatal mouse model. Methods. The newborn mice were subjected to formula milk containing LPS and hypoxia to establish a NEC model and also intraperitoneally injected with MEL. During the experiment, all mice were closely monitored and weighed. The effect of MEL on the histopathological injury of the terminal ileum tissues, inflammation, and oxidative stress of serum in NEC mice was examined by hematoxylin-eosin (H&E) staining and ELISA. The effect of MEL on the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome was assessed via quantitative real-time PCR and Western blot. Results. MEL intensified the survival rate and body weight in NEC mice. The H&E staining illustrated that MEL improved the histopathological injury in NEC mice. Moreover, MEL repressed the IL-1β, TNF-α, and MDA levels of serum and enhanced the SOD and GSH-Px levels of serum in NEC mice. We also discovered that MEL attenuated the mRNA and protein levels of NLRP3, Toll-like Receptor 4 (TLR4), NF-κB, and caspase-1 of the terminal ileum tissues in NEC mice. Conclusion. Our research illuminated that MEL attenuated the severity of NEC via weakening the activation of the NLRP3 inflammasome.