Gastroenterology

Unified reanalysis defines a shared microbiome signature at new-onset, treatment-naïve IBD

This systematic review and unified reanalysis pooled 36 studies, with 18 contributing 16S data from 1743 treatment-naïve, new-onset IBD patients and controls. Alpha diversity was reduced in several comparisons, including adult Crohn’s disease and ulcerative colitis versus healthy controls and pediatric ulcerative colitis versus symptomatic controls. Beta diversity showed distinct fecal versus mucosal communities and geographic clustering, with less community separation in ulcerative colitis. Multivariable models identified a core pattern across Crohn’s disease and ulcerative colitis: anaerobe depletion with enrichment of aerobic, facultative anaerobic, and oral-associated genera. 1

PEth adds short-term prognostic value beyond fibrosis NITs in alcohol-related liver disease risk

This prospective cohort followed 411 individuals at risk for alcohol-related liver disease, without known chronic liver disease, for up to five years for hepatic decompensation. Baseline PEth independently predicted decompensation (sHR per 100 ng/mL 1.04; 95% CI 1.01–1.06), after accounting for three fibrosis-based noninvasive tests. Fibrosis tests had the highest overall discrimination, but adding PEth improved six-month prognostic performance; PEth AUC declined from 0.77 at 6 months to 0.62 at 2 years. Among 162 patients with repeat PEth, an increase from baseline was associated with higher subsequent decompensation risk (sHR 4.92; 95% CI 1.09–22.34). 2

Cloud-based CADe improves detection of clinically significant colorectal neoplasia

In this multicenter RCT of 841 patients, colonoscopy with real-time cloud-based CADe was compared with standard colonoscopy across eight European centers. CADe increased adenomas per colonoscopy (0.82 vs 0.62; ratio 1.33, 95% CI 1.06–1.67) and adenoma detection rate (43.2% vs 35.9%). Detection of sessile serrated lesions (0.08 vs 0.03; ratio 3.30, 95% CI 1.41–7.57) and large polyps ≥10 mm (0.12 vs 0.05; ratio 2.36, 95% CI 1.33–4.17) also improved. Positive percent agreement for clinically relevant polyps was non-inferior, and network latency stayed within real-time thresholds using low-spec endoscopy hardware. 3

Parasutterella-driven NETosis links UC microbiota to colitis-associated colorectal cancer

This translational study found Parasutterella excrementihominis enriched in stool from ulcerative colitis patients compared with healthy controls. In dextran sulfate sodium colitis and azoxymethane/dextran sulfate sodium mouse models, P. excrementihominis colonization worsened colitis and increased colitis-associated colorectal tumor burden. Metabolomics showed increased succinic acid and 6-hydroxyhexanoic acid, which activated gasdermin D–dependent NETosis via succinate receptor 1 and G protein–coupled receptor 84 signaling. Neutrophil-specific gasdermin D deletion attenuated metabolite-driven tumorigenesis, implicating pathogenic NETosis as a key effector pathway. 4