More than meets the eye: a strange cause of bowel obstruction and perforation
Case presentation A 55-year-old man presented with abdominal distension, vomiting, fever for 3 days and weight loss. He smoked 40 cigarettes and drank 100 g of alcohol per day. He had no documented medical or drug history and no history of receptive anal intercourse. Abdominal examination revealed diffuse tenderness. Laboratory values disclosed neutrophilia (13 720/µL), normocytic anaemia (7.4 g/dL), hypoalbuminaemia (25.2 g/L) and elevated inflammatory markers (C reactive protein of 70.27 mg/L, procalcitonin of 5.200 ng/mL), without eosinophilia (140/µL). HIV serology was negative. Stool was positive for occul...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Huang, W.-F., Ding, Y., Sun, J., Zhang, J.-Y. Tags: GUT Snapshot, Gut Editor ' s quiz: GI snapshot Source Type: research

Cost-effectiveness of endoscopic, surgical and pharmacological obesity therapies: a microsimulation and threshold analyses
Conclusions Cost-effective strategies were: ESG for class I obesity and SG for class II/III obesity. Semaglutide may be cost-effective with substantial cost reduction. Given potentially higher utilisation rates with pharmacotherapy, semaglutide may provide the largest reduction in obesity-related mortality. (Source: Gut)
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Saumoy, M., Gandhi, D., Buller, S., Patel, S., Schneider, Y., Cote, G., Kochman, M. L., Thiruvengadam, N. R., Sharaiha, R. Z. Tags: Gut Obesity Source Type: research

Optimal measurement of gastric emptying of solids in gastroparesis or functional dyspepsia: evidence to establish standard test
Conclusion The 320 kcal (30% fat) GES scintigraphic test provides consistent diagnosis in >85% and should be the standard test for suspected gastric emptying disorders. (Source: Gut)
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Camilleri, M., Zheng, T., Vosoughi, K., Lupianez-Merly, C., Eckert, D., Busciglio, I., Burton, D., Dilmaghani, S. Tags: Gut Neurogastroenterology & amp; motility Source Type: research

Eradicating Helicobacter pylori via 13C-urea breath screening to prevent gastric cancer in indigenous communities: a population-based study and development of a family index-case method
Conclusion A high participation rate, a high eradication rate of H. pylori and an efficient rollout method indicate that a primary prevention strategy is acceptable and feasible in indigenous communities. Trial registration number NCT03900910. (Source: Gut)
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Lei, W.-Y., Lee, J.-Y., Chuang, S.-L., Bair, M.-J., Chen, C.-L., Wu, J.-Y., Wu, D.-C., Tien ODonnell, F., Tien, H.-W., Chen, Y.-R., Chiang, T.-H., Hsu, Y.-H., Hsu, T.-H., Hsieh, P.-C., Lin, L.-J., Chia, S.-L., Wu, C.-C., Subeq, Y.-M., Wen, S.-H., Chang, H Tags: Open access, Gut Helicobacter pylori Source Type: research

Patient-reported experience of colonoscopy in Italy: a multicentre prospective observational study
We present the first clinical experience of assessing patient experience with the Newcastle ENDOPREM outside the UK, in a large, multicentre, prospective study. The questionnaire, designed for self-completion, is composed of seven sections largely structured to follow the temporal phases of the process: before, during and after the examination. After including 1625 patients, the established target level of 90% threshold of patients reporting positive experience for each item was only reached in 10/25 (40%) of the items before, 7/14 (50%) of the items during and 3/6 (50%) of the items after the... (Source: Gut)
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Fuccio, L., Rees, C. J., Frazzoni, L., Neilson, L., Radaelli, F., Sharp, L., Hassan, C., Spada, C., The ENDOPREM Study Group, the ENDOPREM Study Group, Barbera, Benini, Binda, Carloni, Giorgio, Fabbri, Fantin, Fusaroli, Gibino, Marca, Laterza, Lisotti, Mu Tags: Gut Endoscopy news Source Type: research

Potential of personalised approaches in gastric cancer prevention
An effective cancer screening programme should assure high participation of the target population, while also fulfilling a number of criteria set for an organised cancer screening programme, including governance, quality assurance and auditing. Such a programme is supposed to contain mechanisms for identification of the target population as well as for inviting eligible individuals for screening.1 Traditionally, letters of invitation have been used for this purpose, nevertheless new approaches and technologies are currently getting used more in reaching the target population; furthermore, in the future, cancer screening is...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Leja, M. Tags: Gut Commentary Source Type: research

Targeting myeloid signalling pathways to unleash T cells
Unlike in numerous other tumors, the efficacy of checkpoint inhibitor-based immunotherapies in colorectal cancer (CRC) is restricted to the small subgroup of patients with mismatch repair-deficiency or microsatellite instability accounting for only a small minority of cases.1 The vast majority of patients with advanced, microsatellite-stable CRC, however, is currently resistant to checkpoint inhibitors and thus are not candidates for regimens containing antibodies targeting inhibitory immune checkpoint receptors. Therefore, it is an urgent unmet clinical need to explore new avenues to render microsatellite-stable CRCs immu...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Michl, P., Krug, S. Tags: Open access, Gut Commentary Source Type: research

Pleiotropic role of NOTUM in colorectal cancer
Colorectal cancer (CRC) is one of the most common malignancies worldwide and a leading cause of cancer-related deaths. The vast majority of CRCs harbour a mutation in tumour suppressor gene adenomatous polyposis coli (APC), resulting in the continuous activation of the Wnt pathway.1 The subsequent translocation of β-catenin to the nucleus induces Wnt target gene expression that is regulating many key cellular processes including differentiation, stem cell self-renewal and proliferation. Given the importance of the Wnt pathway in homeostatic regulation, this pathway is tightly controlled to avoid excess signalling and ...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: van Driel, M. S., Linssen, J. D. G., van Neerven, S. M., Vermeulen, L. Tags: Open access, Gut Commentary Source Type: research

Gastroenterology climate action opportunities via education, empowerment of trainees and research
Climate change poses significant threats to our planet’s ecosystems, public health and current and future well-being.1 Several professional gastroenterology society guidelines and position statements highlight the importance of education and research in mitigating the detrimental consequences of the climate crisis on digestive health.2–4 In addition, trainees and early career gastroenterologists, being the future of our specialty, are in unique and important positions to make a positive and lasting impact on sustainability efforts related to climate change, and the health of our patients, communities and planet...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Shaukat, A., Shah, B., Fritz, C. D., Omary, M. B. Tags: Editor's choice, Gut Commentary Source Type: research

Climate change, paediatric health and ways that digestive health professionals can engage
Digestive health professionals can contribute to everyone’s future by addressing the existential threats posed by climate change (CC) in our practices, our professional societies and our communities. In this commentary, we introduce the implications of CC for children and adolescents, and provide ways that all physicians, nurses, trainees and managers, whether caring for children or adults, can add CC advocacy to their professional and personal lives. CC and paediatric health Without robust, urgent action to mitigate carbon emissions and adapt to the impacts of CC that are already occurring, CC will ‘define the...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Philipsborn, R., Manivannan, M., Sack, T. L. Tags: Editor's choice, Gut Commentary Source Type: research

NHS efforts in England to mitigate the climate crisis: uniting nurses and gastroenterologists
The National Health Service’s net-zero ambition For the majority of those working in the National Health Service (NHS—the UK’s publicly funded healthcare system), the passing of the Health and Care Act 2022 in the UK would have barely registered as a blip on their radar. But hidden amidst the usual proposals for reorganisation, this Act included a more far-reaching ambition: the NHS’s commitment to net zero. With this passing of the Act, the NHS became the first health service in the world to embed such a commitment into legislation.1 Every NHS institution is now required to have a strategy, with bo...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Baddeley, R., Watts, N., Donnelly, L. Tags: Editor's choice, Gut Commentary Source Type: research

Carbon footprint of gastroenterology practice
The healthcare sector is a major contributor to greenhouse gas (GHG) emissions,1 contributing to global warming and thereby to the harm of current and future generations. It is therefore a moral obligation for us as physicians to reduce the environmental impact of our practice. The GHG Protocol classifies emissions into three ‘scopes’ (figure 1). Scope 1 includes all direct emissions, for instance the burning of fuel, or release of anaesthetic gases within a hospital. Scope 2 (indirect) emissions are generated from producing electricity. Scope 3 emissions are mostly generated in the supply chain and represent t...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Pohl, H., Baddeley, R., Hayee, B. Tags: Editor's choice, Gut Commentary Source Type: research

Green gastroenterology adaptation, resilience and an industry perspective
We are living in unprecedented times—extreme weather conditions are becoming increasingly common, and greenhouse gas emissions have reached staggering levels. We are in a climate crisis, and it is up to every government, institution, industry and individual to act now. Climate change poses a serious threat to the healthcare industry, threatening facility closures, supply chain disruptions and the rapid spreading of diseases and traumatic events,1–3 as seen in 2012, when Atlantic Hurricane Sandy impacted eight countries including the eastern USA (particularly the states of New York and New Jersey). New York Univ...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Thiel, C., Pak, E., Burkard, R., Huber, H. Tags: Editor's choice, Gut Commentary Source Type: research

Approaches for greening endoscopy and reducing waste
Climate change represents a global crisis and a major menace to the future of the environment and humanity. Notably, the healthcare sector is responsible for 4.4% of the global carbon footprint.1 Nonetheless, direct and indirect emissions from healthcare facilities contribute far less compared with healthcare supply chains (71%).1 Gastrointestinal (GI) endoscopy is ranked third among the highest medical waste producers within a hospital.2 This is related to the fact that endoscopy is a resource-intensive activity that requires various single-use, plastic predominant consumables.3 However, the environmental impact of GI end...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Cunha Neves, J. A., Rodriguez de Santiago, E., Aabakken, L. Tags: Editor's choice, Gut Commentary Source Type: research

Impact of climate change on vulnerable populations
Vulnerability can be defined as a more significant potential exposure, or a greater susceptibility, to climate hazards. All of humanity is vulnerable to the effects of environmental change but some individuals and populations are more vulnerable to climate-induced adverse health effects than others by virtue of their personal or societal risk factors. How does climate change affect vulnerable populations? Greenhouse gas emissions and carbon sink destruction are altering the earth’s atmosphere. This is leading to the generation of climate hazards such as decreased air quality, reduced food and water quality and securi...
Source: Gut - November 24, 2023 Category: Gastroenterology Authors: Makharia, G. K., Sadeghi, A., Leddin, D., Costello, A. Tags: Editor's choice, Gut Commentary Source Type: research