The implantation of uncovered self-expanding metal stents (UCSEMS) is an established method for the palliative treatment of malignant hilar biliary obstruction (MHBO). However, with advances in chemotherapy extending patient survival, individuals treated primarily with UCSEMS increasingly encounter overgrowth of the tumour in the stent lumen and occlusion. In this study, we aimed to compare various methods of managing occluded UCSEMS.

Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population. It is characterized by symptomatic enlargement and displacement of anal cushions, frequently associated with pain, bleeding, and reduced quality of life. The pathophysiology of HD includes vascular congestion, venous stasis, and vascular dilatation, promoted by increased nitric oxide activity. Inflammatory responses are considered crucial in HD, with NF-κB playing a major role. Treatment strategies for HD vary from conservative approaches to office-based and surgical interventions. Conservative therapies, such as topical agents and flavonoid-based systemic treatments, serve as the mainstay of low-grade HD management, while invasive procedures are reserved for refractory cases. Topical formulations containing fluocinolone acetonide (FLA) and ketocaine hydrochloride (KH) combine anti-inflammatory and anesthetic effects, providing rapid and sustained relief from pain, itching, and inflammation. FLA exerts potent anti-inflammatory effects by inhibiting NF-κB and induces vasoconstrictive activity by reducing nitric oxide levels, while KH provides localized analgesia by blocking sodium channels. Collectively, these agents mitigate vascular congestion, inflammation, and HD symptoms. Clinical evidence supports the efficacy of this combination in alleviating acute symptoms, reducing recurrence, and improving patient outcomes. The FLA/KH formulation provides targeted local action with minimal systemic absorption and predominantly mild and transient adverse events. Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD. Furthermore, its combination with flavonoid-based supplements, which improve venous tone and reduce capillary permeability, may aid in preventing recurrence. This combined approach leverages the rapid symptom relief provided by topical agents and the long-term benefits of systemic therapies, promoting comprehensive HD management and reducing the risk of recurrence.

Gut microbiota (GM) is a complex microenvironment characterised by intricate interactions, which might play a pivotal role in the pathogenesis of many autoimmune diseases, including celiac disease (CD). DDysbiosis of gut bacteria can have a wide range of effects; however, whether it is a cause or a consequence of certain diseases and how it evolves during disease progression remains an area of active research. Celiac disease patients appear to have characteristic microbiota patterns, including low levels of beneficial species and high levels of potentially pathogenic species. The use of pro-, pre-, syn- and post-biotics to modulate the GM requires more systematic investigation, to determine the impact of specific species, the optimal dosage and the treatment duration needed to achieve desired results without adverse reactions. Additionally, osteoporosis in the course of CeD ease warrants further investigation. Many factors may contribute to its pathogenesis, including GM. This review summarizes recent literature concerning the role of GM in CeD, highlighting both consistent findings and areas of ongoing debate.

Vonoprazan (Vo) and amoxicillin (Amx) dual therapy has shown promising results for Helicobacter pylori (H. pylori) eradication. However, its efficacy needs to be verified in an area with a high prevalence of both H. pylori and gastric cancer. It is also unknown if the modified Vo-Amx plus bismuth (Bis) regimen might increase the eradication rate. We aimed to investigate the efficacy and safety of Vo-Amx and Vo-Amx-Bis regimens, compared to bismuth-containing quadruple therapy (BQT) for H. pylori eradication, as well as factors that affect the curing rate.

Fatty liver disease (FLD) is a prevalent condition linked to metabolic disorders and can progress to severe liver diseases. Alterations in apolipoprotein (Apo) levels may provide valuable insights for diagnosing and managing FLD. This systematic review and meta-analysis evaluates these changes across different FLD phenotypes to evaluate their potential as diagnostic biomarkers.

Inflammatory and fibrotic strictures are common in inflammatory bowel diseases (IBD) and are challenging conditions to manage. Endoscopic stricturotomy (ESt) is considered as an emerging treatment option. We aimed to summarise evidence on the efficacy of ESt for the treatment of IBD-associated strictures.

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 32.4% of the global population and is a major cause of chronic liver disease and cardiometabolic complications. Early detection is challenging due to limitations of conventional obesity indices like body mass index (BMI) and waist circumference (WC), which do not account for age- and sex-specific adiposity variations. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index, integrating BMI, age, and gender, may offer a better measure of body fat percentage, but its utility in MASLD prediction is unexplored. We aimed to evaluate the predictive value of the CUN-BAE index for MASLD and to compare it with conventional obesity indices.

The therapeutic application of Pancrelipase spans several key gastroenterological conditions, ranging from chronic pancreatitis to genetic disorders such as cystic fibrosis. Consequently, pancreatic enzyme replacement therapy (PERT) is applicable in a variety of clinical settings, managing pancreatic insufficiency. Beyond chronic pancreatitis, PERT has also shown effectiveness in addressing malabsorption associated with pancreatic surgery, gastrointestinal malignancies, and various dysmetabolic conditions. This review aims to provide a comprehensive overview of the therapeutic applications of PERT and its clinical role in managing both surgical and non-surgical conditions, beyond chronic pancreatitis. PERT has proven crucial in improving patient outcomes, addressing gastrointestinal symptoms, and supporting long-term health in patients with pancreatic insufficiency. While more research, particularly from randomized controlled trials, is required to optimize dosing strategies and establish standardized PERT protocols, clinicians should consider tailoring PERT to individual patient needs based on the available evidence across various clinical scenarios.

Functional Gastrointestinal Disorders (FGIDs), including conditions such as irritable bowel syndrome (IBS) and functional dyspepsia, affect millions worldwide, significantly impairing quality of life and increasing healthcare utilization. These disorders are multifactorial and complex, with several subtypes, making diagnosis and management challenging. This review explores the emerging role of digital health technologies and artificial intelligence(AI) in transforming FGID diagnosis and treatment. We focus on wearable devices, capsule-based diagnostics, mobile health applications, and AI-powered virtual assistants, highlighting how these innovations address the limitations of traditional investigative and management approaches. Additionally, we assess the impact of these digital advancements on patient outcomes, healthcare efficiency, and real-time symptom monitoring. Finally, we examine the challenges associated with data privacy, accuracy, and reliability in digital health solutions and propose future directions for technological advancements in FGID management.

It is not known whether the gut microbiota (GM) may vary according to the endoscopic severity of diverticular disease (DD). We aimed to profile the GM in DD patients according to the severity of the diverticular inflammation and complication assessment (DICA) classification (DICA 1 vs. DICA 2 vs. DICA 3).

Esophagojejunal (EJ) anastomoses are integral to gastrointestinal reconstructive surgeries following procedures such as gastrectomy, particularly in cases of cancer or Roux-en-Y reconstruction. However, the traditional surgical EJ anastomosis approach can pose challenges with notable risks such as anastomotic leakage, stricture, or fistula formation. Endoscopic interventions have been employed for managing these adverse outcomes through stent placement, but a primarily endoscopic EJ anastomosis technique has not yet been described. This retrospective case series details five patients who underwent delayed endoscopic EJ anastomosis, with each patient under differing circumstances of instability necessitating this emergent alternative to standard surgical reconstruction. This approach involved the placement of a lumen-apposing metal stent between the esophagus and jejunum. Successful endoscopic EJ anastomosis was achieved in all cases, with hospital stays ranging from 6-13 days. Adverse events included stent migration, dysphagia, and stricture. Subsequent management strategies for these adverse events included stent removal and exchange, balloon dilation, triamcinolone injection, and appropriate follow-up. Follow-up evaluations revealed successful outcomes with no mortalities or anastomotic leaks. Primarily endoscopic EJ anastomosis for delayed reconstruction emerges as an advanced, minimally invasive alternative in complex patients deemed unsuitable for conventional surgical reconstruction secondary to instability or critical conditions. Within the literature, this is the first human case series description of an endoscopic EJ anastomosis with stent placement between the esophagus and jejunum. This novel technique offers the potential in improving patient outcomes which warrants further investigation to optimize these endoscopic techniques and assess its long-term efficacy across a larger patient cohort.