Objective Liver metastases are often resistant to immune checkpoint inhibitor therapy (ICI) and portend a worse prognosis compared with metastases to other locations. Regulatory T cells (Tregs) are one of several immunosuppressive cells implicated in ICI resistance of liver tumours, but the role played by Tregs residing within the liver surrounding a tumour is unknown. Design Flow cytometry and single-cell

Background and aims International endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation. In 2019, the Joint Advisory Group on GI Endoscopy (JAG) commissioned a working group to examine the evidence relating to this process for EUS. The aim of this was to develop

Objective Gut microbiota is a key player in dictating immunotherapy response. We aimed to explore the immunomodulatory effect of probiotic Lactobacillus gallinarum and its role in improving anti-programmed cell death protein 1 (PD1) efficacy against colorectal cancer (CRC). Design The effects of L. gallinarum in anti-PD1 response were assessed in syngeneic mouse models and azoxymethane/dextran sulfate

These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality

We have read with interest the excellent review by Trauner and Fuchs on the novel therapeutic approaches that are currently developed for treating non-alcoholic steatohepatitis (NASH).1 Although there are no licensed pharmacotherapies for NASH, long-acting fibroblast growth factor-21 (FGF-21) analogues are being evaluated to treat NASH because FGF-21 is a pleotropic liver-derived hormone regulating

Objective Cytotoxic agents are the cornerstone of treatment for patients with advanced intrahepatic cholangiocarcinoma (iCCA), despite heterogeneous benefit. We hypothesised that the pretreatment molecular profiles of diagnostic biopsies can predict patient benefit from chemotherapy and define molecular bases of innate chemoresistance. Design We identified a cohort of advanced iCCA patients with comparable

Eosinophilic oesophagitis (EoE) is an immune-mediated disease of uncertain aetiology. The diagnosis of EoE relies on the epithelial infiltration of eosinophils (peak eosinophil count of ≥15 per high-power field (HPF)) and on the presence of symptoms. Consequently, a combined clinical–histological endpoint has been devised to assess response to treatments in clinical trials. Recent guidelines drafted

We read the Maastricht VI/Florence consensus report published in GUT with great interest.1 The report suggested that vonoprazan-based therapy is superior, or not inferior, to conventional proton pump inhibitor (PPI)-based triple therapies for Helicobacter pylori eradication.1 However, the number of randomised controlled trials (RCTs) was small and the majority of previous trials were conducted in Japan

We thank Ludvigsson for his interest in our work and for providing additional insights. As noted, our joint works implicate the role of antibiotics in the development of inflammatory bowel disease (IBD), however, there are limitations as well as unique strengths to our study design which should be noted.1 2 Although confounding may exist, our prospective cohort study design limits this possibility

Recently, Lopes et al quantified the effect of modifiable lifestyle factors in inflammatory bowel disease (IBD) prevention using population attributable risk, and reported that 42.9% of Crohn’s disease (CD) cases and 44.4% of ulcerative colitis (UC) cases could have been prevented by lifestyle interventions. This interesting result was based on 6 prospective cohorts including 3 US cohorts with 208

Your recent ‘Chinese Consensus Report on Family-based Helicobacter pylori infection Control and management (2021 Edition)’1 and ‘Large-scale, national, family-based epidemiological study on Helicobacter pylori infection in China: the time to change practice for related disease prevention’2 will encourage more doctors in China to consider Helicobacter pylori as a curable aetiology for gastrointestinal

We read with interest the recent article by Haifer et al (Gut, 2022, 2022–3 27 742), which reported that donor gut microbiome stability and species evenness were associated with higher donor species engraftment in patients with UC following faecal microbiota transplantation (FMT). This has brought us one step closer towards the selection of optimal FMT donors. However, the high prevalence of extended‐spectrum

The role of diet in the initiation and progression of disease is one of the most exciting areas of research nowadays. Although some recommendations begin to emerge in well-defined gastrointestinal conditions, food patterns associated with diseases of the central nervous system (CNS) such as multiple sclerosis (MS) are poorly understood. The study by Zevallos et al 1 shows that amylase trypsin inhibitors

Objective The presence of intestinal metaplasia (IM) is a risk factor for gastric cancer. However, it is still controversial whether IM itself is precancerous or paracancerous. Here, we aimed to explore the precancerous nature of IM by analysing epigenetic alterations. Design Genome-wide DNA methylation analysis was conducted by EPIC BeadArray using IM crypts isolated by Alcian blue staining. Chromatin

Background Shorter half-life glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying (DGE) more than GLP-1 RAs with longer half-lives. DGE is a known risk factor for gastro-oesophageal reflux disease (GERD) and its complications. Aim To determine whether short-acting or long-acting GLP-1 RAs are associated with an increased risk of new GERD or GERD-related complications Design

Objectives To identify indolepropionate (IPA)-predicting gut microbiota species, investigate potential diet–microbiota interactions, and examine the prospective associations of circulating IPA concentrations with type 2 diabetes (T2D) and coronary heart disease (CHD) risk in free-living individuals. Design We included 287 men from the Men’s Lifestyle Validation Study, a substudy of the Health Professionals

The recent publication by Ng et al titled ‘Gut microbiota composition is associated with SARS-CoV-2 vaccine immunogenicity and adverse events’ provides valuable insights on gut microbiota in modulating immune responses to both inactivated (CoronaVac) and mRNA (BNT162b2) SARS-CoV-2 vaccines. The authors identified specific gut microbiota markers influenced immunity and vaccine efficacy, suggesting that

Smart capsules are developing at a tremendous pace with a promise to become effective clinical tools for the diagnosis and monitoring of gut health. This field emerged in the early 2000s with a successful translation of an endoscopic capsule from laboratory prototype to a commercially viable clinical device. Recently, this field has accelerated and expanded into various domains beyond imaging, including

Objective Chronic gastro-oesophageal reflux disease, where acidic bile salts (ABS) reflux into the oesophagus, is the leading risk factor for oesophageal adenocarcinoma (EAC). We investigated the role of ABS in promoting epithelial-mesenchymal transition (EMT) in EAC. Design RNA sequencing data and public databases were analysed for the EMT pathway enrichment and patients’ relapse-free survival. Cell

The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively

Background and aims Deregulation of RNA N6-methyladenosine (m6A) modification in intestinal epithelial cells (IECs) influences intestinal immune cells and leads to intestinal inflammation. We studied the function of fat mass-and obesity-associated protein (FTO), one of the m6A demethylases, in patients with ulcerative colitis (UC). Methods We analysed colon tissues of Ftoflox/flox; Villin-cre mice

Objective Symptoms in gastroparesis (Gp) and functional dyspepsia (FD) overlap; using egg protein substitute to measure gastric emptying of solids (GES), ~40% of patients are reclassified from Gp to FD, and vice versa. Our aim was to assess inter-individual and intra-individual coefficients of variation (COV) in GES in symptomatic patients with Gp or FD with documented slow or normal GES, respectively

We read with interest the recent paper by Vich Vila et al , which discussed alterations in the metabolome of patients with inflammatory bowel disease (IBD).1 Here, the authors described >300 molecules that were differentially abundant in the faeces of 424 patients with IBD compared with 255 healthy controls, analysed with liquid chromatography with tandem mass spectrometry as well as genome-wide association

Background This study investigates sex disparities in clinical outcomes and tumour immune profiles in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent upfront resection or resection preceded by gemcitabine-based neoadjuvant chemoradiotherapy (nCRT). Methods Patients originated from the PREOPANC randomised controlled trial. Upfront surgery was performed in 82 patients, and 66 received

Eosinophilic oesophagitis (EoE) is characterised by an abundance of oesophageal epithelial eosinophils.1 There is strong rationale that supports the eosinophil as central to the pathophysiology of EoE. In histology, the eosinophil is numerically the dominant inflammatory cell. Moreover, the eosinophil is capable of producing inflammation and tissue remodelling in human tissue. On degranulation, multiple

Objective Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy. Differentiation from chronic pancreatitis (CP) is currently inaccurate in about one-third of cases. Misdiagnoses in both directions, however, have severe consequences for patients. We set out to identify molecular markers for a clear distinction between PDAC and CP. Design Genome-wide variations of DNA-methylation, messenger

We thank Vanella et al for their interest in our paper and for pointing out additional details and perspectives.1 2 In our study, we randomised patients with large pancreatic walled-off necrosis (WON) and a need for transgastric drainage to either a 20 mm lumen apposing metal stent (LAMS) or double pigtail stent (DPT) and found no superiority of the LAMS in terms of number of necrosectomies, clinical

The use of faecal immunochemical testing (FIT) for patients with features of possible colorectal cancer (CRC) has increased significantly over recent years. The UK has been slower to adopt FIT than several other countries, especially in Scandinavia.1 Colonoscopy remains the ‘gold-standard’ test with high sensitivity and specificity, and allows biopsy of lesions and removal of polyps. However, endoscopy

Once regarded as a rare disease, the incidence and prevalence of eosinophilic oesophagitis (EoE) have risen consistently over the past 25 years.1 It is now the second most common disease of the oesophagus after gastro-oesophageal reflux disease, and the most likely cause of thoracic dysphagia and of food bolus obstruction presenting to emergency departments.2 With the burden ever growing, it behoves

The role of viruses in the aetiopathogenesis of inflammatory bowel disease (IBD) has been a topic of conjecture for decades. Initial focus on specific viral agents in IBD like norovirus, rotaviruses and measles virus did not gain ground. The advent of metagenomics and detailed assessment of the ‘whole gut virome’ has now shown that the gastrointestinal tract harbours nearly 109 virus like particles

Microbiota are a source of low-grade inflammation during obesity and contribute to insulin resistance and poor blood glucose control among other mechanisms in the progression of type 2 diabetes.1 Nearly all bacteria that reside within the host are found in the intestine, but it is not yet clear how microbiota are a source of inflammation in the circulation or metabolic tissues during obesity. A key

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related deaths worldwide with few effective drug treatments. Recent combination therapies inhibiting immune checkpoints and angiogenesis showed better overall and progression-free survival outcomes than the protein kinase inhibitor sorafenib in patients with unresectable HCC,1 suggesting targeting tumour microenvironment (TME) is

Alcoholic liver disease (ALD) is the most prevalent cause of chronic liver disease in western countries with highly morbid complications, such as alcohol-associated hepatitis and limited therapeutic options.1 The pathogenesis of ALD is highly influenced by the gut-liver axis1 and some of the key features of ALD include dysbiosis (bacterial, fungal and viral), increased intestinal permeability and translocation

Resolving chronic hepatic infections caused by hepatitis B and C viruses (HBV and HCV) could be realised through two primary approaches: direct targeting of the virus or enhancement of the immune response, encompassing antiviral and immune-based therapies, respectively. Although direct-acting antiviral (DAA) medications exhibit remarkable efficacy in curing chronic HCV infection, the current approach

Despite ‘green endoscopy’ has meanwhile been regarded as a highly relevant topic, the scientific basis of ongoing discussions and various position statements is poor. We developed a tool for calculating the yearly emissions of a middle-sized gastrointestinal (GI) endoscopy unit in Germany (8000 procedures per year). Calculation was based on in-house energy consumption as well as emissions caused by

Objective Historically, psychological processes are associated with disorders at the functional end of the gastro-oesophageal reflux disease (GERD) spectrum. However, recent research suggests that psychological symptoms are relevant across the entire GERD spectrum. We aim to investigate whether psychological symptoms are associated with reflux phenotype (True GERD, Borderline GERD, reflux hypersensitivity

Objective We aimed to determine whether mepolizumab, an anti-IL-5 antibody, was more effective than placebo for improving dysphagia symptoms and decreasing oesophageal eosinophil counts in eosinophilic oesophagitis (EoE). Methods We conducted a multicentre, randomised, double-blind, placebo-controlled, trial. In the first part, patients aged 16–75 with EoE and dysphagia symptoms (per EoE Symptom Activity

Objectives Ulcerative colitis (UC) is a chronic inflammatory disorder of unknown aetiology. Gut virome dysbiosis is fundamental in UC progression, although its role in the early phases of the disease is far from fully understood. Therefore, we sought to investigate the role of a virome-associated protein encoded by the Orthohepadnavirus genus, the hepatitis B virus X protein (HBx), in UC aetiopathogenesis

Objective Ample evidence exists for the role of abnormal gut microbiota composition and increased gut permeability (‘leaky gut’) in chronic inflammation that commonly co-occurs in the gut in both obesity and diabetes, yet the detailed mechanisms involved in this process have remained elusive. Design In this study, we substantiate the causal role of the gut microbiota by use of faecal conditioned media

Objective Recent studies have shown that motorised spiral enteroscopy (MSE) enables deeper and total small bowel evaluation compared with single-balloon enteroscopy (SBE) in suspected Crohn’s disease (CD) when analysed per procedure. However, no randomised controlled study has compared bidirectional MSE with bidirectional SBE in suspected CD. Design Patients with suspected CD requiring small bowel

Objective Residual or recurrent adenoma (RRA) after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) of ≥20 mm is a major limitation. Data on outcomes of the endoscopic treatment of recurrence are scarce, and no evidence-based standard exists. We investigated the efficacy of endoscopic retreatment over time in a large prospective cohort. Design Over 139 months

Objective Colorectal tumours are often densely infiltrated by immune cells that have a role in surveillance and modulation of tumour progression but are burdened by immunosuppressive signals, which might vary from primary to metastatic stages. Here, we deployed a multidimensional approach to unravel the T-cell functional landscape in primary colorectal cancers (CRC) and liver metastases, and genome

Objective New screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. Design A formal consensus approach involving a multidisciplinary

Objective In up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through biliary disease and are amenable to treatment. Findings range from biliary sludge to microlithiasis but their definitions remain fluid and controversial. Design A systematic literature review (1682 reports, following

Objective To better understand the immune microenvironment of pancreatic ductal adenocarcinomas (PDACs), here we explored the relevance of T and B cell compartmentalisation into tertiary lymphoid structures (TLSs) for the generation of local antitumour immunity. Design We characterised the functional states and spatial organisation of PDAC-infiltrating T and B cells using single-cell RNA sequencing

Objective The current treatment for hepatocellular carcinoma (HCC) to block angiogenesis and immunosuppression provides some benefits only for a subset of patients with HCC, thus optimised therapeutic regimens are unmet needs, which require a thorough understanding of the underlying mechanisms by which tumour cells orchestrate an inflamed tumour microenvironment with significant myeloid cell infiltration

Objective Alcohol-associated liver disease is accompanied by microbial dysbiosis, increased intestinal permeability and hepatic exposure to translocated microbial products that contribute to disease progression. A key strategy to generate immune protection against invading pathogens is the secretion of IgA in the gut. Intestinal IgA levels depend on the polymeric immunoglobulin receptor (pIgR), which

Objective Exhausted T cells with limited effector function are enriched in chronic hepatitis B and C virus (HBV and HCV) infection. Metabolic regulation contributes to exhaustion, but it remains unclear how metabolism relates to different exhaustion states, is impacted by antiviral therapy, and if metabolic checkpoints regulate dysfunction. Design Metabolic state, exhaustion and transcriptome of virus-specific

Drug rediscovery refers to the principle of using ‘old’ drugs outside the indications mentioned in the summary of product characteristics. In the past decades, several drugs were rediscovered in a wide variety of medical fields. One of the most recent examples is the unconditional registration of thioguanine (TG), a thiopurine derivative, in patients with inflammatory bowel disease in the Netherlands

Dufour et al highlighted that the effect of COVID-19 in patients with cirrhosis is derived from the prevaccination era and suggested that the impact of Omicron infection in patients with cirrhosis needs to be elucidated.1 We agree with the author that previous studies have reported significant morbidity and mortality in patients with cirrhosis infected with SARS CoV-2 in the prevaccination era.2–7

Recently, we read the article by Ng et al with great interest,1 which identified several gut microbiota harbour the potential to improve immune response and reduce adverse events following COVID-19 vaccines, and demonstrated that gut microbiota has the potential to complement the effectiveness of vaccines. Together with several recent studies, gut microbiota plays a key role in modulating immune responses

We read with interest the study by Kartal et al 1 showing that the gut-microbiota-derived biomarkers for disease stratification are often shared by subjects across disease cohorts. Here, we confirmed their observations with findings from a newly diagnosed natural killer/T-cell lymphoma (NKTCL) cohort, in which the gut biomarkers were significantly overlapped with those of multiple disease cohorts and

We kindly thank Larghi et al and Tiwari et al for their interest in our study.1–3 We acknowledge the limitations of our study. However, we would like to make some additional remarks. We agree with the authors that our approach inherits the risk of selection bias, given the non-randomised comparative design and baseline differences between groups. Being aware of this, we corrected for baseline imbalances

We were interested to read the letter by Mansoor et al , ‘epidemiology of inflammatory bowel disease (IBD) in men with high-risk homosexual activity’,1 which was in response to the two recently published studies by Agrawal et al 2 and Cha et al .3 However, we would like to point out significant methodological flaws in their design and analysis. The data used have the potential to misclassify both the

With great interest, we have read the article by Clooney et al , which highlighted the regional effects on the heterogeneity of the gut microbiota among populations with inflammatory bowel disease (IBD).1 As a result, regional effects would largely limit the microbial-based diagnosis of diseases across regions. Although current machine learning methods based on microbial features have been applied

A Southeast Asian man in his early 20s with no medical history presented with persistent abdominal pain and nausea for 3 weeks. He reported no recent sick contacts and no travel in the past 5 years since arrival to the USA. Physical examination was notable for right lower quadrant tenderness. CT of the abdomen and pelvis showed hyperaemia and fat stranding near the terminal ileum and cecum, concerning

Stone J, Funk C, Moin K, et al . P150 Adult menetrier’s …

Objective To evaluate the risk factors for lymph node metastasis (LNM) after a non-curative (NC) gastric endoscopic submucosal dissection (ESD) and to validate and eventually refine the eCura scoring system in the Western setting. Also, to assess the rate and risk factors for parietal residual disease. Design Retrospective multicentre multinational study of prospectively collected registries from 19

The objective of this article is to review the evidence of abnormal gastrointestinal (GI) tract motor functions in the context of disorders of gut–brain interaction (DGBI). These include abnormalities of oesophageal motility, gastric emptying, gastric accommodation, colonic transit, colonic motility, colonic volume and rectal evacuation. For each section regarding GI motor dysfunction, the article

Background Endoluminal radiofrequency ablation (RFA) has been promoted as palliative treatment for patients with cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC) in order to improve biliary drainage and eventually prolong survival. No high level evidence is, however, available on this technique. Design In this randomised controlled study, we compared endoluminal RFA plus stenting