This editorial asks whether nutritional rehabilitation can bridge severely malnourished patients with achalasia cardia to definitive treatment.

It discusses a study of percutaneous endoscopic gastrostomy, or PEG, feeding before per-oral endoscopic myotomy, or POEM. Eligible patients had a body mass index, or BMI, less than 16 kilograms per square meter and had not improved with, or could not tolerate, nasogastric feeding.

Eight of the 45 enrolled patients had severe malnutrition. Two died before PEG placement, leaving six for analysis. All six achieved the primary outcome: BMI greater than 18.5 kilograms per square meter and serum albumin greater than 3.5 grams per deciliter. This occurred at a mean 11.33 plus or minus 0.94 weeks, with mean weight gain of 11.96 plus or minus 2.68 kilograms. All underwent uneventful POEM and subsequent PEG removal.

The editorial highlights the small sample and limited reporting of feeding composition, micronutrient assessment, dietetic planning, safety, costs, and longer-term outcomes. Muscle mass and quality of life were not assessed.

The clinical takeaway is that nutritional rehabilitation can enable definitive treatment in severely malnourished achalasia patients, but standardized protocols and broader outcome assessment are needed.

This editorial asks whether successful surgical repair of benign biliary stricture after bile duct injury during cholecystectomy restores long-term health and quality of life.

The authors discuss a study of 41 patients undergoing hepaticojejunostomy at a high-volume tertiary teaching hospital. At a median follow-up of five years, clinical outcomes were successful in greater than 95 percent, yet quality of life remained compromised in all domains compared with uncomplicated laparoscopic cholecystectomy. Interpretation is limited by substantial loss to follow-up: 93 of 156 patients.

Lifelong surveillance is needed because anastomotic strictures can develop decades after apparently successful repair. Delayed complications include recurrent cholangitis and secondary biliary cirrhosis. Follow-up combines clinical assessment, liver function tests and imaging, with magnetic resonance cholangiography recommended when obstruction is suspected.

Outcomes depend on injury severity, infection, timing and, particularly, surgical expertise. The authors favor delayed repair to allow optimization and control of sepsis and inflammation.

Repeated interventions, lost work and treatment costs can impair physical and mental well-being despite anatomical success. The clinical takeaway is that expert repair must be paired with lifelong follow-up and multidisciplinary support aimed at restoring quality of life.

This editorial examines whether semaglutide can address abdominal adiposity and liver fibrosis in Asian Indians with metabolic dysfunction–associated steatotic liver disease. The authors emphasize this population’s vulnerability to metabolic disease at lower body mass index and the limited availability of high-quality Indian trial data.

An Indian randomized trial enrolled 116 overweight or obese adults with liver fibrosis. At 28 weeks, weight change with oral semaglutide was minus 10.47 percent, compared with minus 2.4 percent in controls. Liver stiffness, a surrogate for fibrosis, declined from 7.61 to 5.70 kilopascals, while controls showed no meaningful change. Glycemic control, lipid profiles and blood pressure also improved.

However, the trial was open-label, single-centre and small, excluded people with type-2 diabetes, and lacked histological confirmation. Adverse events occurred in 67 percent of semaglutide recipients. Lean tissue loss also raises concern in a population with low baseline muscle reserves.

The clinical takeaway is that semaglutide offers promising weight and liver benefits, particularly for high-risk Indian patients, but oral treatment evidence remains limited. Lifestyle measures, adequate protein and resistance training remain essential, alongside attention to affordability and safety.

This editorial examines how high-resolution anorectal manometry can define dysfunction beyond symptom-based diagnosis in chronic constipation.

It discusses a retrospective comparative study of 120 patients with chronic constipation and 60 asymptomatic healthy volunteers. Functional defecation disorders were present in 57.5 percent of patients, predominantly as Type-1 dyssynergia. Compared with patients without these disorders, affected patients had higher anal residual pressures and lower recto-anal pressure gradients, anal relaxation percentages, and defecation indices, supporting outflow obstruction.

Elevated rectal sensory thresholds in constipated patients also suggested rectal hyposensitivity, although sensation did not differ significantly between patients with and without functional defecation disorders.

An important caution was balloon expulsion test failure in 53 percent of patients versus 45 percent of controls, with p equals 0.37. The unusually high control failure rate raises concerns about test interpretation.

Limitations included retrospective design, water-perfused catheters, left lateral testing, and absent defecography or colonic transit testing, restricting full subtype characterization.

The clinical takeaway is that anorectal manometry helps characterize chronic constipation, but interpretation should incorporate clinical assessment, complementary testing, and locally relevant reference values rather than relying on manometry alone.

This systematic review with meta-analysis asked whether albumin-bilirubin, or ALBI, grade has prognostic value in patients with pancreatic cancer. With five-year survival near 10 percent, identifying prognostic factors may provide useful clinical insights for decision-making.

The investigators searched PubMed, Web of Science, Embase and Scopus through August 14, 2025, using pancreatic cancer and ALBI grade as keywords. They included studies evaluating the prognostic value of ALBI grade and assessed associations using hazard ratios with 95 percent confidence intervals.

For overall survival, the meta-analysis included six studies with 1665 patients. A higher ALBI grade was significantly associated with shorter overall survival. The hazard ratio was 2.14, with a 95 percent confidence interval from 1.53 to 3.00.

For recurrence-free survival or disease-free survival, the analysis included three studies with 936 patients. Higher ALBI grade was also significantly associated with worse outcomes for this combined endpoint. The hazard ratio was 2.39, with a 95 percent confidence interval from 1.02 to 5.58.

The researchers also examined whether the approach to comparing ALBI grades affected its prognostic value for overall survival. These comparisons included high versus low grade, grade 2 versus grade 1, and grade 3 versus grade 1. No significant differences between these grading approaches were observed in predicting overall survival.

The key clinical takeaway is that higher ALBI grade was associated with poorer overall survival and poorer recurrence-free or disease-free survival in pancreatic cancer. The authors conclude that ALBI grade could be considered a reliable prognostic marker for clinical use in this population.

This narrative review, “Nurturing gut health: A comprehensive framework,” asks whether daily, modifiable lifestyle behaviors can be organized into a bowel hygiene framework to support digestive health.

The authors describe gut health as a cornerstone of overall well-being, with connections to nervous, immune, metabolic, and hepatic pathways. Disruption of the gut ecosystem has been implicated in functional gastrointestinal disorders, metabolic diseases, and mental health disturbances.

Their proposed concept of bowel hygiene parallels oral hygiene and sleep hygiene. It brings together evidence from dietetics, behavioral science, exercise physiology, and traditional practices within a structured approach to everyday gastrointestinal care.

The framework has five core pillars: dietary regulation and hydration, adherence to routine timing, physical activity, mind–body practices, and behavioral toileting habits. Together, these practices aim to improve gut motility, stool consistency, microbial diversity, and resilience to stress. They may also help reduce the burden of chronic gastrointestinal and functional bowel disorders.

The authors note that traditional knowledge systems, community proverbs, and sayings align with this approach, giving it cultural relevance. They propose exploring bowel hygiene as a potentially low-cost, scalable intervention that can be adapted across cultures and introduced at individual, community, and school levels to promote lifelong digestive health.

Importantly, this is a conceptual framework supported by emerging evidence. The available abstract does not report quantitative estimates of benefit, and the authors acknowledge that clinical and mechanistic studies continue to evolve.

The key clinical takeaway is that bowel hygiene offers a promising framework for organizing lifestyle approaches to digestive health, while its potential role in preventive medicine and public health needs further exploration.

This narrative review examines how long-term use of non-steroidal anti-inflammatory drugs, or NSAIDs, can injure the small intestine, and considers the diagnosis, prevention, and treatment of NSAID enteropathy.

Harsh Srivastava, Tanisha Sehgal, Varun Mehta, and colleagues describe a frequently underdiagnosed consequence of drugs that remain essential for relieving pain, reducing inflammation, and controlling fever. With extended use, NSAIDs can cause mucosal damage, ulcerations, strictures, and increased intestinal permeability. Potential complications include bleeding, protein loss, and nutrient malabsorption.

A central point is the gap between intestinal injury and symptoms. Modern diagnostic technologies, particularly capsule endoscopy, have revealed small-bowel injury in up to 70 percent of chronic NSAID users, although many patients remain asymptomatic. This figure refers to small-bowel injury, rather than to the proportion of patients experiencing the listed complications.

The authors emphasize the growing importance of clinical awareness and continued research into preventive and therapeutic interventions. They place this need in the context of increasingly prevalent long-term NSAID use in an aging global population.

The key clinical takeaway is that NSAID enteropathy can be common yet clinically silent: chronic exposure can produce small-intestinal injury with potentially important complications, making greater awareness essential.

This original article asks whether gastrostomy tube feeding can improve nutrition enough to allow definitive treatment in severely malnourished, surgically unfit patients with achalasia.

The prospective study evaluated percutaneous endoscopic gastrostomy, or PEG, feeding as a bridge to per-oral endoscopic myotomy, or POEM. It was conducted at a tertiary care centre from September 2023 to September 2024. Eligibility required a body mass index, or BMI, less than 16.0 kilograms per square metre, albumin less than 3.0 grams per decilitre, and a multidisciplinary assessment that the patient was surgically unfit.

Among 45 patients, eight, or 17.77 percent, qualified. Their median Eckardt score was 10, and median symptom duration was 3.5 years. Two patients died before PEG placement because of severe infections present at presentation.

The remaining six received PEG feeding and gained an average of 11.96 plus or minus 2.68 kilograms over 11.33 plus or minus 0.94 weeks. BMI increased from 13.9 to 19.15, with p less than 0.00001. Albumin increased from 2.8 to 4.2, with p less than 0.0001. Mid-arm circumference and biceps and triceps skin fold thickness also improved significantly.

All six subsequently underwent POEM, with 100 percent technical and clinical success.

The key clinical takeaway is that PEG feeding provided an effective nutritional bridge to successful POEM in these six severely malnourished patients initially considered unfit for definitive treatment.

This Original Article asks how patients fare over the long term after repair of benign biliary strictures caused by bile duct injury during cholecystectomy, and how their quality of life compares with patients after uncomplicated surgery.

Patients were assessed for inclusion if they had undergone stricture repair with at least three years of follow-up. Outcomes were evaluated using MacDonald grading, and quality of life using the Short Form 36, or SF-36, questionnaire. Controls had undergone uncomplicated laparoscopic cholecystectomy.

Of 156 patients screened, 41 were included. Median follow-up was five years, with an interquartile range of 4.8 years. Grade A outcomes were reported in 28 patients, or 68.3 percent; grade B in 12, or 29.2 percent; and grade D in one, or 2.4 percent.

Higher strictures, types IV and V, were associated with more grade B outcomes than types I through III: 53.8 percent versus 17.9 percent. Lower strictures were more likely to have grade A outcomes than higher strictures: 78.6 percent versus 46.2 percent, with p equals 0.044.

Despite these clinical outcomes, patients who underwent bile duct injury repair reported significantly lower scores across all eight SF-36 domains than controls, with p less than 0.05.

The key clinical takeaway is that delayed repair of benign biliary strictures can provide favorable long-term clinical outcomes in a high-volume center, but acceptable postoperative results do not eliminate the persistent compromise in quality of life.

This original article reports a randomized controlled trial asking whether oral semaglutide improves weight loss, non-invasive liver fibrosis markers, and cardiometabolic parameters in adults with overweight or obesity without diabetes mellitus.

The open-label trial was conducted at the Asian Institute of Gastroenterology in Hyderabad. Eligible adults had a body mass index greater than or equal to 30, or greater than or equal to 27 with comorbidities. Both groups received counselling on a reduced-calorie diet and increased physical activity. The treatment group also received oral semaglutide, starting at 3 milligrams per day and increasing to 14 milligrams per day over two to four weeks.

In total, 116 participants completed the study, with 58 per group. At 28 weeks, mean percentage weight reduction was minus 10.47 percent with semaglutide, with a standard deviation of 5.3, versus minus 2.4 percent with control, with a standard deviation of 4.5. The p-value was less than 0.001.

Semaglutide significantly improved alanine aminotransferase levels and reduced the aspartate aminotransferase to platelet ratio index, liver fat content, and liver stiffness. However, the non-alcoholic fatty liver disease fibrosis score and fibrosis-4 index did not show significant reductions.

Body mass index, waist circumference, glycated hemoglobin, fasting insulin, and C-reactive protein improved significantly more with semaglutide.

The key takeaway is that oral semaglutide added to lifestyle modification produced clinically meaningful weight loss and metabolic improvements, although improvements were not consistent across liver fibrosis markers.

This original article examines how endoscopic findings relate to gastric histopathology and Helicobacter pylori infection in adults with dyspepsia from the remote tribal region of Spiti Valley, Himachal Pradesh, India.

The cross-sectional observational study retrospectively analyzed data collected during a health camp. It included 106 patients aged 18 years and above who underwent endoscopy. Gastric biopsies from each patient underwent rapid urease testing and histopathological examination. The mean age was 46.9 plus or minus 13.4 years, and the male to female ratio was 1.4 to 1.

Erosive gastritis was the most common endoscopic abnormality, followed by peptic ulcer disease. On histopathology, chronic active gastritis with Helicobacter pylori was the most common finding, present in 83.0 percent. Gastric intestinal metaplasia was found in 48.1 percent.

For identifying histopathological abnormalities in gastric biopsies, endoscopy had a sensitivity of 76.5 percent and a specificity of 75.0 percent. Its positive predictive value was 98.7 percent, but its negative predictive value was only 11.1 percent. The correlation between rapid urease testing and histopathological examination for Helicobacter pylori was statistically significant.

The key clinical takeaway is that Helicobacter pylori-related chronic active gastritis and gastric intestinal metaplasia were common in this population. Although endoscopy showed high sensitivity, specificity, and positive predictive value for gastric histopathological abnormalities, its negative predictive value remained notably low. This contrast is central to interpreting the endoscopic findings alongside the biopsy results in these patients.

This original article reports a retrospective observational study from North India asking whether Child-Turcotte-Pugh, or CTP, score-based anti-tubercular treatment was tolerated and achieved tuberculosis resolution in patients with decompensated cirrhosis.

The clinical challenge is that treatment-related hepatotoxicity markedly increases the risk of severe liver failure in these patients.

Investigators reviewed electronic records from April 2022 to April 2024. Treatment was weight-based, with the number of hepatotoxic drugs determined by CTP score. Patients with scores less than or equal to 7 received two hepatotoxic drugs. Those with scores of 8 to 10 received one, preferably rifampicin. Those with scores greater than or equal to 11 received none; their intensive-phase regimen comprised Ethambutol, Levofloxacin and Amikacin, followed by Ethambutol and Levofloxacin. The continuation phase lasted 12 to 18 months.

Among 155 patients with decompensated cirrhosis, 21, or 13.5 percent, had tuberculosis. All 21 received modified treatment during the intensive phase. Drug-induced hepatotoxicity developed in four patients, or 19.1 percent, during that phase.

Two patients were subsequently lost to follow-up. Among the 19 patients reported to have completed the continuation phase, 15, or 78.9 percent, had tuberculosis resolution, and four, or 21.1 percent, died. All four deaths were related to cirrhosis.

The key clinical takeaway is that this retrospective cohort tolerated CTP-score-based modified treatment overall, with tuberculosis resolution in 78.9 percent of those completing the continuation phase, although hepatotoxicity still occurred during intensive treatment.

This original article examines how the burden of pancreatitis in India changed from 1990 to 2021, nationally and across states and union territories.

Using Global Burden of Disease 2021 data, the study assessed incidence, prevalence, deaths, disability-adjusted life years, years of life lost, and years lived with disability. Age-standardized rates per 100,000 population were analyzed across 31 states and union territories, with trends evaluated by age, sex, and region.

New cases increased from 229,614 in 1990 to 523,074 in 2021. Prevalent cases rose from 249,067 to 547,618. Changes in age-standardized rates were more modest: incidence increased from 32.78 to 36.76 per 100,000, while prevalence increased from 37.83 to 39.70 per 100,000.

In contrast, the age-standardized death rate declined from 2.24 to 1.71 per 100,000. The disability-adjusted life year rate also fell, from 77.69 to 56.82 per 100,000. These findings show rising case numbers alongside declining age-standardized mortality and disability-adjusted life year rates.

Age-standardized rates remained consistently higher in males than in females. States with a higher Socio-Demographic Index showed increased years lived with disability and reduced premature mortality, highlighting regional differences in the pattern of burden.

The key clinical takeaway is that India’s increasing pancreatitis burden, with notable regional and sex-based differences, calls for early diagnosis, targeted interventions in high-burden states, and improved outpatient care to manage chronic morbidity.

This original article examined how high-resolution anorectal manometry profiles differ between patients with chronic constipation and healthy volunteers, and between constipated patients with and without functional defecation disorders.

The retrospective comparative study included 120 patients with chronic constipation and 60 healthy volunteers as historical controls. Patients underwent anorectal manometry and a balloon expulsion test. Functional defecation disorders were diagnosed using Rome IV criteria when both tests were abnormal.

Compared with controls, patients with constipation had significantly higher maximum anal squeeze pressure and higher volumes for first rectal sensation, desire to defecate, and maximum tolerance. Anal relaxation, defecation index, and recto-anal pressure gradient were significantly lower.

Balloon expulsion test results did not differ significantly between patients and controls: 53 percent versus 45 percent, with p equals 0.37.

Functional defecation disorders were identified in 57.5 percent of constipated patients. Compared with patients without these disorders, affected patients had higher anal residual pressure: 95 plus or minus 26 versus 45 plus or minus 21 millimeters of mercury, with p equals 0.001. Their recto-anal pressure gradients were lower: minus 4.5 versus 36 millimeters of mercury, with p equals 0.001. Rectal sensations were comparable between these subgroups.

The key clinical takeaway is that chronic constipation was associated with a distinct manometric profile, with functional defecation disorders and rectal hyposensitivity more common than in healthy volunteers. Type-1 recto-anal dyssynergia was the most common functional defecation disorder subtype.

This original article asks how well ChatGPT-4 and Gemini-1 answer patient questions about irritable bowel syndrome, or IBS, comparing comprehensiveness, accuracy, readability, and empathy.

Researchers collected 39 frequently asked questions from IBS organizations and hospital websites across six domains: general understanding, symptoms and diagnosis, causes, dietary considerations, treatment, and lifestyle factors. Two independent gastroenterologists assessed comprehensiveness and accuracy, with a third resolving disagreements. Readability was measured using five standardized indices, and three reviewers rated empathy on a 4-point Likert scale.

Gemini provided comprehensive and accurate answers to 94.9 percent of questions, or 37 out of 39. ChatGPT produced comprehensive responses to 89.7 percent, or 35 out of 39. Two Gemini responses and four ChatGPT responses were rated mixed. Comprehensiveness did not differ significantly, with p equal to 0.67. Both models performed best in symptoms and diagnosis and treatment; mixed responses were most frequent in general understanding and lifestyle.

Both models generated difficult-to-read, college-level content. Flesch Reading Ease scores were 35.83 plus or minus 3.31 for Gemini and 32.33 plus or minus 5.57 for ChatGPT, with p equal to 0.21.

ChatGPT was more empathetic: all responses were rated moderately empathetic, whereas 66.7 percent of Gemini responses were minimally empathetic.

The clinical takeaway is that both models provide extensive IBS information, but complex language and occasional inaccuracies limit patient education. Improvements should prioritize readability, contextual relevance, and accuracy to better meet patients’ and clinicians’ needs.