Chronic diarrhea is a common symptom of the digestive system and also a frequent reason for consultation among patients in gastroenterology outpatient clinics. As one of the common etiologies of chronic diarrhea, bile acid diarrhea (BAD) has a relatively high incidence rate. However, due to the current limitations in physicians' awareness, medical standards, and diagnostic methods, BAD is often underdiagnosed or misdiagnosed; therefore, patients often fail to receive timely and appropriate treatment. To further improve clinicians' understanding and management of BAD, the Chinese Society of Gastroenterology, Chinese Medical Association, on the basis of drawing on domestic and international diagnostic and therapeutic experiences as well as guidelines and consensuses, has organized domestic experts to formulate this expert consensus focusing on the pathogenesis, clinical classification, diagnosis, and management of BAD.

Slow transit constipation (STC) is a chronic colonic motility disorder characterized by markedly delayed transit, leading to reduced bowel movements, abdominal discomfort, and significant quality-of-life impairment. It predominantly affects women and is associated with abnormalities in enteric neuronal signaling, smooth muscle contractility, interstitial cells of Cajal, gut peptides, bile acid homeostasis, and autonomic regulation. Secondary causes of constipation and structural lesions must be excluded before the diagnosis of STC, with colonic transit studies serving as the gold standard. Complementary investigations such as anorectal manometry and defecography help detect coexisting outlet obstruction, which can alter management. The treatment of STC should follow a stepwise approach, beginning with dietary and lifestyle modification, osmotic and stimulant laxatives, and prokinetics such as prucalopride. Secretagogues and bile acid modulators may offer additional benefit. Biofeedback therapy is primarily indicated for overlapping dyssynergic defecation. For refractory STC, interventional therapies, such as fecal microbiota transplantation, acupuncture, sacral nerve stimulation, and transanal irrigation, are found to have equivocal outcomes. Antegrade continence enema procedures can be an alternative for patients unsuitable for colectomy. Surgical options, including subtotal colectomy with ileosigmoid or cecorectal anastomosis, and total colectomy with ileorectal anastomosis, are reserved for carefully selected patients with medically intractable symptoms, following thorough physiological evaluation. Although advances in understanding STC pathophysiology are guiding novel therapeutic development, robust randomized controlled trials remain scarce. Optimal care requires multidisciplinary collaboration between gastroenterologists, colorectal surgeons, and pelvic floor specialists to ensure accurate diagnosis, tailored treatment, and improved long-term outcomes.

Objectives: Appendiceal orifice lesions are occasionally detected during colonoscopy in patients with recurrent appendicitis. Conventional surgery with partial cecal resection may cause unnecessary trauma. Transcolonic endoscopic appendectomy (TEA) has been proposed as a minimally invasive alternative. We aimed to evaluate the feasibility, safety, and efficacy of transcolonic endoscopic appendectomy and to compare through-the-scope twin clips (TTS-TC) combined with metal clips versus metal clips alone for defect closure.

Methods: Twenty patients with recurrent appendicitis and no prior abdominal surgery who underwent transcolonic endoscopic appendectomy between December 2020 and December 2024 were included. Clinical and pathological variables, procedural parameters, and follow-up outcomes were analyzed. TTS-TC plus metal clips and metal clips alone for defect closure were compared.

Results: All procedures were technically and clinically successful. Postoperative time to resume diet and length of hospital stay were 4.05 and 6.40 days, respectively. TTS-TC combined with metal clips reduced suture time (18 min [interquartile range {IQR} 15.5–20 min] vs. 25 min [IQR 20–30 min]), procedure time (85 min [IQR 72.5–92 min] vs. 115 min [IQR 110–124 min]), and number of clips used (7 [IQR 6.5–8] vs. 8 [IQR 7–9]) compared with metal clips alone. No adverse events were reported. Colonoscopy performed at 3 months post-procedure showed no residual lesions or recurrence.

Conclusions: TEA is a feasible, safe, and effective approach for recurrent appendicitis with orifice lesions. It provides a minimally invasive dual-benefit strategy and can be facilitated by a novel closure method to streamline the procedure.

Objective: We aimed to investigate the relationship between fecal bile acid (BA) profile and intestinal microbiota in patients with chronic radiation enteritis (CRE).

Methods: Altogether 60 patients with cervical cancer (CC) who visited Xijing Hospital between December 2022 and September 2023 were enrolled, including 20 patients who did not undergo any treatment (the CC group), 20 patients who developed CRE after radical radiotherapy (the CRE group), and 20 patients who did not experience CRE after radical radiotherapy (the non-CRE [NRE] group). Patients’ characteristics and fecal samples were collected. Fecal BA profiles were quantified, and intestinal microbiota were analyzed by using the 16S rRNA gene sequencing. Differentially expressed BAs and microorganisms were identified across groups, and their correlations were assessed using Spearman's correlation analysis.

Results: In patients with CRE, BA metabolism was characterized by increased proportions of primary BAs and decreased proportions of secondary BAs, particularly lithocholic acid and its isomers. In addition, the abundance of beneficial bacterial genera, such as Bifidobacterium and Megasphaera, was reduced, whereas that of potentially pathogenic genera, including Megamonas and Dorea, was increased. Furthermore, a bidirectional relationship between BA metabolism and intestinal microbiota was observed.

Conclusions: Patients with CRE present notable alterations in BA metabolism and intestinal microbiota. CRE may trigger a harmful feedback mechanism driven by the interaction between these two factors. Targeted regulation of BA metabolism and intestinal microbiota may be a promising therapeutic approach for the management of CRE.Trial Registration:ClinicalTrials.gov identifier: NCT05728060.

Objective: To estimate the disability-adjusted life-years (DALYs) and incidence of vascular intestinal disease (VID) in individuals aged 65 years and above and identify its causal relationship with hypertension.

Methods: Analysis of VID burden focused on the incidence and DALYs in individuals aged 65 years and above. Socioeconomic inequalities were evaluated using the slope and concentration indices. Temporal trends of VID were evaluated with age-period-cohort (APC) modeling and Bayesian projections. Mendelian randomization (MR) analysis was employed to investigate the causal relationship between hypertension and VID.

Results: From 1990 to 2021, the global age-standardized DALYs rate (ASDR) and age-standardized incidence rate (ASIR) for VID declined, while the absolute number of incident cases increased. In 2021, the incident cases and DALYs reached 789 979 (95% uncertainty interval [UI] 615 343–978 593) and 1 116 683 (95% UI 996 036–1 210 921), with ASIR and ASDR of 105.59 per 100 000 (95% UI [82.43–130.50] per 100 000) and 151.66 per 100 000 (95% UI [134.58–164.67] per 100 000), respectively. Eastern Europe showed the highest DALYs rates. Bayesian APC projections indicated declining age-standardized rates but rising absolute numbers by 2040. MR analysis revealed hypertension as a significant causal risk factor for VID, with an odds ratio of 2.817 for inverse-variance-weighted and 3.618 for weighted median methods.

Conclusion: Although VID burden remains high in high-income regions, its overall ASDR and ASIR have been declining. Meanwhile, hypertension is a causal factor for VID.

Objectives: Discharged cirrhotic patients hospitalized for acute decompensation (AD) without acute-on-chronic liver failure (ACLF) have heterogeneous long-term prognosis; however, reliable prognostic tools are lacking. We aimed to identify the risk factors associated with 1-year adverse outcomes including mortality and liver transplantation (LT) after patient’s discharge and to develop an evidence-based prognostic model.

Methods: We enrolled 1212 and 621 cirrhotic patients who clinically improved after AD without ACLF before discharge from the Chinese AcuTe-on-CHronic LIver FailurE (CATCH-LIFE) derivation and validation cohorts, respectively. The primary outcome was 1-year adverse outcomes (all-cause mortality or LT) post-discharge. Independent risk factors for 1-year post-discharge adverse outcomes were identified using multivariable analysis, and a prognostic model was derived and validated.

Results: In the derivation cohort, 203 (16.7%) patients experienced 1-year adverse outcomes and 370 (30.5%) were readmitted within 90 days post-discharge. Age, prior decompensation, total bilirubin, international normalized ratio, albumin, and hemoglobin on discharge were independently associated with 1-year post-discharge adverse outcomes. The prognostic model achieved an area under the receiver operating characteristic curve (AUC) of 0.7767 (95% confidence interval [CI] 0.7408–0.8125) and 0.7274 (95% CI 0.6656–0.7892) in the derivation and validation cohorts. Using a risk threshold of ≥ 0.27, 17.70% of discharged non-ACLF cirrhotic patients with AD in the validation cohort were classified as high-risk, with 1-year adverse outcome rate being 43.96%.

Conclusion: A prognostic model for predicting 1-year adverse outcomes in discharged non-ACLF cirrhotic patients was developed and validated, with a high-risk cut-off ≥ 0.27, which may effectively stratify adverse outcome risks at 1-year post-discharge and guide intensive post-discharge management.

Objective: To examine whether baseline levels and short-term changes of asymmetric dimethylarginine (ADMA) are associated with subclinical carotid atherosclerosis (SCA) and its progression in adults with metabolic dysfunction–associated steatotic liver disease (MASLD).

Methods: A total of 600 adults with MASLD were prospectively recruited and followed annually for 2 years. Serum ADMA was measured at baseline and 1-year follow-up. SCA, defined as increased carotid intima-media thickness or carotid plaque, was assessed at baseline, 1- and 2-year follow-up. Multivariable regression and propensity score-based analyses were performed to assess the associations between baseline ADMA or change in ADMA and SCA risk.

Results: Increased baseline ADMA level was significantly associated with SCA. Each 1-standard deviation (SD) increase in baseline ADMA was associated with higher odds of SCA (odds ratio 2.24, 95% confidence interval [CI] 1.66–3.01), with a dose–response relationship across ADMA quartiles. Baseline ADMA was not associated with SCA progression; however, dynamic increase in ADMA over time was strongly associated with SCA progression at both 1 and 2 years. Each 1-SD increase in absolute and relative changes of ADMA was associated with higher risks of SCA progression at 1 year (relative risk [RR] 1.82, 95% CI 1.60–2.07; RR 1.44, 95% CI 1.29–1.61) and 2 years (RR 1.52, 95% CI 1.36–1.70; RR 1.31, 95% CI 1.20–1.42). Associations were more pronounced among participants with pre-existing SCA.

Conclusion: ADMA is associated with the prevalence of SCA, and short-term dynamic changes in ADMA may represent early indicators for SCA progression in adults with MASLD.

Objectives: Gallstone disease (GSD), a prevalent digestive disorder, remains mechanistically underexplored in relation to visceral adipose. The Metabolic Score for Visceral Fat (METS-VF), a novel metric for quantifying visceral adipose tissue, has not yet been evaluated for its association with GSD in cohort studies. We aimed to investigate the METS-VF–GSD association across multicenter cohorts.

Methods: Multicenter cohort analysis of 59 851 participants from two Chinese hospitals and 357 233 participants from the UK Biobank dataset was conducted using Cox models to investigate the association between METS-VF and GSD risk. Competing risk models were also applied to the UK Biobank cohort. Meta-analysis and mediation analysis were used to synthesize results from the cohort analysis and evaluate mediation effects of inflammatory biomarkers.

Results: Cox models revealed a significant positive association between METS-VF and GSD risk, with a “J-shaped” nonlinearity, as confirmed by restricted cubic spline analysis (p < 0.05). Meta-analysis revealed that for each 1-unit and 1-standard deviation increase in METS-VF, GSD risk increased by 84% and 57%, respectively. Compared with participants in quantile 1 (Q1) of METS-VF, those in Q2 (pooled hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.35–2.01), Q3 (pooled HR 2.16, 95% CI 1.83–2.54), and Q4 (pooled HR 3.00, 95% CI 2.82–3.19) were associated with progressively higher GSD risk. Mediation analysis revealed that certain inflammatory biomarkers partially mediated the effect of METS-VF on incident GSD.

Conclusions: Increased METS-VF is associated with a higher risk of GSD. It may serve as an important indicator for identifying high-risk populations for GSD.