Covert hepatic encephalopathy (CHE) is one of the important entities of hepatic encephalopathy (HE). In contrast to those with overt hepatic encephalopathy (OHE), patients with CHE have no readily identifiable clinical symptoms and signs, such as disorientation and asterixis, but present with neurocognitive abnormalities detected by neuropsychological and/or neurophysiological tests. Some patients may experience mild cognitive impairment, euphoria, or anxiety, and decreased attention and calculation abilities. CHE is not only prone to OHE development, but also has harmful impacts on fitness to drive and fine operation ability, impairs health-related quality of life, and increases the risk of accidental injury, thereby resulting in worse financial status and a heavy burden to both the family and society as well as reducing the survival of cirrhotic patients. To further improve the understanding of CHE and standardize its clinical diagnosis and management, the Chinese Society of Gastroenterology, Chinese Medical Association organized experts to establish a consensus based on the updated relevant guidelines, expert consensus, research advance in the diagnosis and management of the disease, and clinical practice in China. This consensus contains 19 statements on the definition, epidemiology, etiology, precipitating factors, pathogenesis, clinical manifestations, diagnosis, treatment, prognosis, and chronic disease management of CHE. This consensus may provide the best available evidence to guide clinical practice in the diagnosis and management of patients with CHE.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal (GI) tract and has been regarded as one of the most successful models of targeted therapy in solid tumors to date. In recent years, a deeper understanding of GIST biology, coupled with innovations in molecular pathology, imaging studies, endoscopic and minimally invasive techniques, as well as the development of targeted medications, has led to the evolution of the treatment paradigm into a multidisciplinary approach centered around surgery, which involves pathology, gastroenterology (including endoscopy), oncology, radiology, and interventional radiology, etc. Among all these modalities, surgical resection remains the primary and most effective treatment modality. Surgeons are expected to play a leading role in the comprehensive management of patients with GISTs. Recently, the Expert Working Group on Diagnosis and Treatment of Gastrointestinal Stromal Tumors under the Chinese College of Surgeons, Chinese Medical Doctor Association has released the Chinese Expert Consensus on Standardized Surgical Management of Gastrointestinal Stromal Tumors(2025 Edition), integrating the latest evidence and clinical insights to provide authoritative guidance for the surgical treatment of GISTs in clinical practice.

Objective: To evaluate the efficacy and safety of tegoprazan (TPZ) compared to conventional proton pump inhibitors (PPIs) for Helicobacter pylori eradication as first- and second-line therapies.

Methods: Four databases were searched for randomized controlled trials (RCTs) and retrospective studies comparing TPZ- and PPI-based regimens for H. pylori eradication published until October 15, 2024. A random-effects model was used to calculate pooled odds ratio (OR) and 95% confidence interval (CI) based on intention-to-treat and per-protocol analyses. The PROSPERO registration number of the study is CRD42024622705.

Results: Nine studies (three RCTs and six retrospective studies) involving 5228 treatment-naïve patients were included. TPZ was non-inferior to PPIs as a first-line therapy (intention-to-treat: odds ratio [OR] 1.066, 95% confidence interval [CI] 0.929–1.224; per-protocol: OR 1.142, 95% CI: 0.967–1.349). Subgroup analyses showed no significant differences based on study design, therapeutic regimen, or treatment duration. In patients with clarithromycin-resistant strains confirmed by 23S rRNA sequencing, TPZ achieved a higher eradication rate (OR 4.961, 95% CI 1.024–24.030). TPZ was associated with significantly lower odds of abdominal discomfort compared to PPIs (OR 0.490, 95% CI 0.268–0.897). Regarding treatment duration, a 14-day regimen was linked to a lower risk of diarrhea, while a 7-day regimen was associated with a higher risk of abdominal pain. No significant differences were observed in second-line therapeutic outcomes.

Conclusions: TPZ represents a non-inferior alternative to PPIs for H. pylori eradication, with potential benefits in clarithromycin-resistant infections and favorable safety profiles. Future studies are warranted to assess higher dosages and address pharmacokinetic limitations.

Objectives: Linaclotide, a guanylyl cyclase-C agonist, may enhance efficacy and tolerability when combined with polyethylene glycol (PEG) for bowel preparation. This meta-analysis evaluated linaclotide plus PEG versus PEG alone for bowel preparation prior to colonoscopy.

Methods: Randomized controlled trials (RCTs) including adults undergoing colonoscopy that compared linaclotide plus PEG with PEG alone for bowel preparation were identified via database search up to March 2024. Statistical analysis was performed in RevMan Web using random-effects models.

Results: Eleven RCTs were analyzed. Adequate bowel preparation rate was comparable (risk ratio [RR] 1.01, 95% confidence interval [CI] 0.98–1.04; I² = 23%), as was cecal intubation rate (RR 1.01, 95% CI 1.00–1.01). Subgroup analyses showed that compared with 3-L PEG alone, 2-L PEG plus linaclotide was non-inferior, while 3-L PEG plus linaclotide was superior regarding bowel preparation adequacy (RR 1.11, 95% CI 1.01–1.23) and total Boston Bowel Preparation Scale (BBPS) score (mean difference 0.44, 95% CI 0.04–0.85). Right and left colon BBPS scores were also higher with linaclotide. Polyp detection rate improved significantly in the 3-L PEG plus linaclotide subgroup (RR 1.78, 95% CI 1.32–2.40), whereas adenoma detection rate and withdrawal time were comparable. Linaclotide reduced abdominal pain, bloating, nausea, and sleep disturbance, and increased willingness to repeat colonoscopy.

Conclusions: Linaclotide with PEG provides comparable overall bowel cleansing to PEG alone while reducing adverse events and improving patient acceptance. Importantly, 2-L PEG plus linaclotide was non-inferior compared with 3-L PEG, whereas 3-L PEG plus linaclotide showed superiority over 3-L PEG alone, supporting its use in low-volume bowel preparation strategies.

Objectives: Immunotherapy yields limited results in patients with colorectal cancer (CRC), emphasizing the need for a deeper understanding of the immune landscape within the tumor microenvironment. Although the C-X-C motif chemokine ligand 13 (CXCL13) recruits B cells and promotes tertiary lymphoid structure (TLS) formation, its immune function and prognostic value in CRC remain unclear. This study investigated the impact of CXCL13 on patient outcomes and CRC immune landscape.

Methods: Four independent cohorts were recruited in this study. The Cancer Genome Atlas Program (TCGA) cohort evaluated survival differences as well as immune contexture associated with CXCL13 expression in CRC. Immunohistochemistry (IHC) in the Renji Hospital (RJ) cohort was used to validate CXCL13 and CD8 levels, while multiplex IHC assessed their spatial correlation. Two single-cell RNA sequencing (scRNA-seq) cohorts were used for evaluating the potential roles of CXCL13 and CXCL13⁺CD8⁺T cells in the immune context of CRC.

Results: Our study revealed a positive correlation between CXCL13 expression and improved survival among CRC patients. Elevated CXCL13 levels and CXCL13⁺CD8⁺T cells were linked to a favorable immune context that impeded tumor growth in CRC. Moreover, CXCL13 expression was more prevalent in microsatellite instability-high (MSI-H)/mismatch repair-deficient (MMRd) tumors, demonstrating its potential role in enhancing the response to anti-programmed death-1 ligand (PD-L1) treatment.

Conclusions: CXCL13 plays a critical role in shaping a favorable immune tumor microenvironment in CRC. Further research should elucidate how CXCL13 modulates CD8⁺T cell function to improve antitumor immunity.

Objective: To investigate the rate of Crohn's disease (CD)-related bowel surgery within an inception cohort in Eastern China in the era of evolving diagnostic and therapeutic expertise.

Methods: A single-center, prospective cohort study was conducted from July 2019 to June 2022 in China. Patients with newly diagnosed CD were followed annually. Risk factors of bowel surgery for complications such as obstruction, fistula, perforation, and bleeding were evaluated.

Results: The cohort consisted of 438 patients with newly diagnosed CD, with a male predominance (73.5%) and a median age of 28 years. Of these, 68 patients underwent bowel surgery, with the 1-, 2-, and 3-year cumulative surgery rates being 11.8%, 14.3%, and 15.4%. Multivariate analysis identified patient enrollment in the third year (adjusted hazard ratio [aHR] 0.45, 95% confidence interval [CI] 0.21–0.99), smoking (aHR 3.57, 95% CI 1.70–7.47), stricturing (aHR 31.38, 95% CI 10.93–90.07) or penetrating behavior (aHR 39.83, 95% CI 13.16–120.58), and hypoalbuminemia (aHR 1.95, 95% CI 1.12–3.38) as independent predictors. Patients enrolled in 2019–2020, 2020–2021, and 2021–2022 had 1-year surgery rates of 18.4%, 14.2%, and 5.3%, respectively. Significant differences were observed among the three cohorts in age at diagnosis, onset symptoms, disease location, and behavior.

Conclusions: Disease behavior, year of enrollment, smoking, and hypoalbuminemia were independent factors related to bowel surgery in CD. First-year bowel surgery rate and age at diagnosis decreased over the 3 years, while the proportions of patients with onset perianal symptoms, inflammatory behavior, and perianal disease increased.

Objectives: In this retrospective study we aimed to assess the diagnostic, monitoring, and prognostic utility of transabdominal ultrasound (TBUS) in patients with Crohn's disease in China and evaluate the utility of 16-week bowel wall thickness (BWT) reduction as a predictor of long-term outcomes.

Methods: Patients with CD, either newly or previously diagnosed, who received biologic therapy for the first time and underwent baseline TBUS and endoscopy between June 2022 and September 2023 were included, with follow-up TBUS performed at Weeks 16 and 52 after the initiation of biologic therapy; clinical, ultrasound, laboratory, and disease activity data were collected.

Results: Among the 60 patients, TBUS identified bowel wall thickening in 55 patients, with an average thickness of 7.36 ± 2.56 mm. The Limberg score of vascularization in the affected segments was ≥ 3 in 58.3% of the patients. Ascites, lymphadenopathy, and mesenteric fat hypertrophy were observed in 23.3%, 41.7%, and 41.7% of the patients, respectively. Significant correlations were found between baseline SES-CD or CDAI and BWT (r = 0.650 for SES-CD and 0.331 for CDAI) and the Limberg score (r = 0.538 for SES-CD and 0.387 for CDAI). The receiver operating characteristic (ROC) curve analysis revealed high diagnostic accuracy for BWT (area under the ROC curve [AUROC] 0.973) and the Limberg score (AUROC 0.927). Follow-up TBUS at Weeks 16 and 52 showed significant reductions in BWT and Limberg score. BWT reduction at Week 16 was significantly associated with CD clinical remission at Week 52 (p < 0.05).

Conclusion: TBUS, particularly BWT and Limberg score, may serve as a useful noninvasive tool for diagnosis, monitoring, and prognosis in CD.

Objectives: Patient prognosis for hepatocellular carcinoma (HCC) varies significantly even when they share the same clinical stage. We aimed to characterize the stage-specific transcriptomic landscape in super survivors with HCC and develop a prognostic gene signature for the prediction of patient survival.

Methods: Data from The Cancer Genome Atlas (TCGA) among 76 age- and sex-matched super (alive at 5 years) and poor survivors (deceased within 1 year) with HCC were analyzed. Gene set enrichment analysis stratified by tumor stage was conducted, and a key prognostic gene signature was developed. The gene signature was then validated by using the whole TCGA cohort and the independent International Cancer Genome Consortium (ICGC) cohort.

Results: Stage-specific transcriptomic profiling revealed that stages I and II HCC cases showed positive enrichment in immune response pathways, while stage III tumor exhibited enhanced catabolic activities but reduced glycolysis. Across all tumor stages, cell cycle biological processes were less active in super survivors. A 19-gene signature, incorporating immune-, metabolism-, and cell cycle-related genes, accurately distinguished super survivors from poor survivors with 90.8% accuracy. The gene signature reliably predicted overall survival in both the verification cohort (area under the receiver operating characteristic curve [AUROC] for 1-, 3-, and 5-year survival: 0.82, 0.80, and 0.78) and the independent validation cohort (AUROC for 1- and 3-year survival: 0.80 and 0.83). Consistent AUROC was observed across tumor stages.

Conclusion: The 19-gene signature, considering the dynamic shift during HCC progression, may accurately predict survival outcomes in HCC patients as a potential tool for personalized prognosis.