ASIDE Gastroenterology
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description: ASIDE Gastroenterology Journal is a peer-reviewed, open-access journal published and owned by PubPorta Publishing LLC, 16192 Coastal Highway, Lewes, Delaware 19958, USA. Academic oversight and scholarly guidance are provided by the American Society for Inclusion, Diversity, and Equity in Healthcare (ASIDE). The journal is dedicated to advancing gastroenterology and hepatology through the publication of high-quality scholarly work across digestive and liver diseases. It promotes diversity, equity, inclusion, and accessibility in healthcare by highlighting health disparities, inclusive clinical approaches, the role of social determinants of health, and strategies to improve outcomes for underserved and marginalized populations. It serves as an international platform for clinicians, researchers, educators, and public health professionals to share knowledge that strengthens patient care, supports education, and advances more equitable healthcare practice and policy.
publisher: PubPorta Publishing LLC
language: en
publication name: ASIDE Gastroenterology
issn: 3066-4004
copyright: Copyright and Licensing All articles published in ASIDE Gastroenterology are open access and are made freely available online immediately upon publication, without embargo. Creative Commons License This journal applies the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license, anyone may copy, redistribute, remix, transform, and build upon the material for any purpose (including commercial use), provided that appropriate credit is given to the original author(s), a link to the license is provided, and any changes are indicated. Machine-readable license metadata is embedded in each article and its DOI record. Copyright Holder Copyright in all articles remains with the author(s). By submitting a manuscript, authors grant the publisher (American Society for Inclusion, Diversity, and Equity in Healthcare – ASIDE) a non-exclusive license to publish, distribute, and archive the work under CC BY 4.0. Third-party Material Any material (e.g., images, figures, or tables) that is not covered by CC BY 4.0 will be clearly indicated within the article. Users must obtain permission directly from the relevant copyright holder for reuse of such third-party material. Author Rights and Self-Archiving Authors may deposit all versions of their work (preprint, author’s accepted manuscript, and the version of record) in institutional or subject repositories of their choice immediately upon publication, without embargo, provided that the DOI and license information (CC BY 4.0) are included.
items: Racial and Ethnic Disparities Across the MASLD/MASH Care Continuum in the United States: A Narrative Review
items: Comparative Outcomes of Glucagon-Like Peptide-1 Receptor Agonists versus Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Cirrhosis
items: Temporal Trends and Disparities in Liver Cell Carcinoma and Hepatic Failure Mortality in the United States: A 24-Year Analysis from CDC WONDER, 1999-2023
items: Association of Irritable Bowel Syndrome with Dementia: A GRADE-Assessed Systematic Review and Meta-Analysis
items: https://asidejournals.com/index.php/Gastroenterology/article/view/794
items: Inter-Hospital Transfer and Outcomes in Acute Cholangitis: A National Inpatient Analysis.
items: Endoscopy Timing in Older Adults (≥75 Years) with Upper Gastrointestinal Bleeding Undergoing Esophagogastroduodenoscopy: A Retrospective Cohort Study
items: Biopsy-Detected Microscopic Colitis and Nonspecific Chronic Inflammatory Change in Patients with Chronic Diarrhea and Normal Colonoscopy: A Two-Case Series
items: Gastrointestinal Non-Hodgkin Lymphoma: A Multifaceted Malady
items: The Impact of Vonoprazan on Tacrolimus Blood Levels in Transplant Recipients: A Systematic Review and Meta-Analysis
items: Annular Pancreas in Adults Presenting as Chronic Pancreatitis and Duodenal Obstruction: Literature Review and a Case Report
items: Emphysematous Gastritis in a Patient with Concomitant COVID-19 Infection and Celiac Trunk Stenosis: A Case Report
items: The Liver-Heart Axis: A Narrative Review of Clinical Implications of the MASLD Redefinition for Internists
items: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Multisystemic Narrative Review of Cardiovascular and Oncological Implications
items: Fish-Bone Migration to the Liver Causing Hepatic Abscess: A Scoping Review of Published Cases (2015–2025)
items: Alternative Gastrointestinal Conditions Identified in Patients Meeting Rome IV Criteria for Irritable Bowel Syndrome or Functional Diarrhea Referred to Secondary Care: A Prospective Study
items: ERCP Timing in Gallstone Disease: A Meta-Analysis of One-Stage versus Two-Stage Strategies
items: Endoscopic Sphincterotomy Increases the Risk of Pyogenic Liver Abscess: A Retrospective Study Using Real-World Data
items: Mycophenolate Mofetil Use for Inflammatory Bowel Disease
items: Efficacy and Safety of Tofacitinib in Pediatric Ulcerative Colitis Patients: A Systematic Review
items: Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis
items: Usage of Trapezoid RX Wire Guided Retrieval Basket with the Alliance™ II Inflation Handle for Treatment of Bouveret Syndrome: A Rare Clinical Entity
items: Potential Use of Icosapent Ethyl in the Management of Acute Pancreatitis
items: Early Palliative Care in Gastrointestinal Oncology: Evidence, Implementation Models, and Ethical Considerations
items: Safety and Efficacy of Na Alginate and Mesna in Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis
items: Comparative Outcomes of Esophageal Stent Placement in Esophageal Cancer Patients: A Prospective Study of 183 Cases
items: Evaluating Biliary Complications in Jaundiced Patients with Alcohol-Related Hepatitis: A Retrospective Study
items: https://asidejournals.com/index.php/Gastroenterology/article/view/77
items: An Unusual Case of Disseminated Hydatid Disease: A Laparoscopic Wonder
items: A Systematic Review and Meta-Analysis of Liver Transplant Outcomes in Lean Versus Non-Lean Metabolic Dysfunction-Associated Steatotic Liver Disease Patients

Racial and Ethnic Disparities Across the MASLD/MASH Care Continuum in the United States: A Narrative Review
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description: Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 25.6% of U.S. adults and is the fastest-growing indication for liver transplantation. The 2023 MASLD nomenclature change, 2024 FDA approval of resmetirom, and 2025 accelerated approval of semaglutide for metabolic dysfunction-associated steatohepatitis (MASH) reshaped the therapeutic landscape. Yet, racial and ethnic disparities persist across the U.S. care continuum. Methods: This narrative review searched PubMed, MEDLINE, Embase, and Cochrane CENTRAL from inception through 30 April 2026 for English-language studies on racial and ethnic disparities in MASLD epidemiology, screening, fibrosis progression, outcomes, trial representation, and pharmacotherapy access. Guidelines, systematic reviews, observational studies, and randomized trials were prioritized; no PRISMA methodology was used. Results: Hispanic/Latino adults bear the highest MASLD prevalence (pooled 41%; relative risk vs. non-Hispanic adults 1.50, 95% CI 1.32–1.69), with disproportionate biopsy-cohort MASH (61%), advanced fibrosis (27%), and lower transplant probability (sHR 0.793, 95% CI 0.747–0.842). Non-Hispanic Black adults exhibit lower MASLD prevalence on adjusted NHANES but higher mortality and lower transplant rates in cirrhosis. Noninvasive tools show reduced accuracy in Hispanics (false-negative rates 14%–21%). MAESTRO-NASH enrolled only 2% of Black participants. Resmetirom costs $47,000–$57,670 annually; GLP-1 prescribing disparities in obesity persist across all periods. Conclusions: Disparities accumulate across the continuum and reflect the interplay among genetic ancestry, social determinants of health, and structural barriers, rather than race or ethnicity as biological variables. An equity framework distinguishing clinical actions, implementation priorities, and research gaps is proposed. No intervention has been demonstrated in MASLD-specific studies to reduce inequities.
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creator: Rowan Bandaranaike
creator: Maria Kewish
creator: Samuel Tarwater
rights: Copyright (c) 2026 Rowan Bandaranaike, Maria Kewish, Samuel Tarwater https://creativecommons.org/licenses/by/4.0
date: 2026-07-11
publication date: 2026-07-11
starting page: 32
ending page: 43
doi: 10.71079/ASIDE.GI.071126795

Comparative Outcomes of Glucagon-Like Peptide-1 Receptor Agonists versus Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Cirrhosis
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description: Background: Cirrhosis and metabolic comorbidities frequently coexist. Both glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown cardiometabolic and hepatic benefits, but their comparative effectiveness in established cirrhosis remains unclear. We compared 1-year clinical outcomes between adults with cirrhosis initiating either class. Methods: Using the TriNetX U.S. Collaborative Network, we identified adults with cirrhosis who initiated a GLP-1RA or SGLT2i after diagnosis and had no prior exposure to the comparator class. One-to-one propensity score matching balanced demographic, clinical, medication, and laboratory covariates. Primary outcomes at 1 year were all-cause mortality and inpatient hospitalization. Secondary outcomes included individual and composite cirrhosis decompensation events (ascites, paracentesis, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome) and adverse events (acute kidney injury, hypoglycemia, acute pancreatitis). Results: The matched cohorts comprised 8,016 patients per arm. GLP-1RA users had lower 1-year all-cause mortality (4.3% vs 5.3%; OR 0.80, 95% CI 0.69–0.93; p=0.003) and fewer composite decompensation events (5.3% vs 6.7%; OR 0.78, 95% CI 0.69–0.88; p<0.0001), driven by reductions in ascites and spontaneous bacterial peritonitis. Hospitalization did not differ (7.6% vs 8.2%; p=0.3). Variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome were comparable. AKI was less frequent with GLP-1RAs (4.8% vs 6.2%; p=0.001); rates of hypoglycemia and pancreatitis were similar. Conclusions: In this large real-world analysis of adults with cirrhosis, initiation of a GLP-1RA was associated with lower 1-year mortality and fewer ascites-related decompensation and AKI events compared with initiation of an SGLT2i.
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creator: Hatem Ahmed
creator: Imad Alabdul Razzak
creator: Eyad Abdulrazzak
creator: Sameh Gomaa
creator: Motaz Almahmood
creator: Khloud Abdelrazeq
creator: Joelle Lauchner
rights: Copyright (c) 2026 Hatem Ahmed, Imad Alabdul Razzak, Eyad Abdulrazzak, Sameh Gomaa, Motaz Almahmood, Khloud Abdelrazeq, Joelle Lauchner https://creativecommons.org/licenses/by/4.0
date: 2026-07-27
publication date: 2026-07-27
starting page: 1
ending page: 7
doi: 10.71079/ASIDE.GI.072726751

Temporal Trends and Disparities in Liver Cell Carcinoma and Hepatic Failure Mortality in the United States: A 24-Year Analysis from CDC WONDER, 1999-2023
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description: Background: Liver cell carcinoma (LCC) and hepatic failure (HF) are significant contributors to liver-related mortality in the United States. This study assessed LCC- and HF-related mortality trends (1999–2023) using CDC WONDER data, stratified by demographics and geography. Methods: Deaths among U.S. adults aged ≥25 years with LCC (ICD-10: C22.0) or HF (ICD-10: K72.9) as underlying or contributing causes were analyzed. AAMRs per 1,000,000 were calculated by direct standardization to the 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs) in AAMRs, stratified by sex (1999–2023) and race/ethnicity, urban-rural status, census region, and state (1999–2020). Results: From 1999–2023, 22,963 adult deaths were recorded (77.6% men). Overall AAMR declined from 1999–2007 (APC: −2.4), was stable through 2017 (APC: +0.2), then fell through 2023 (APC: −3.5). Male AAMR followed a non-linear trajectory (APC: −2.1, 1999–2010; +0.7, 2010–2017; −4.4, 2017–2023); female AAMR was stable post-2006 (APC: −0.1). NH Asian or Pacific Islanders showed the steepest decline (APC: −6.7); Hispanics increased post-2010 (APC: +0.6). Metropolitan AAMR declined overall; non-metropolitan AAMR increased (APC: +1.3). The West had the highest regional AAMR (5.6 per 1,000,000); Hawaii the highest state-level AAMR (10.3 per 1,000,000). Conclusion: LCC- and HF-related mortality declined overall, with descriptive subgroup variation by sex, race/ethnicity, urbanization, and geography. Targeted screening, hepatitis management, and equitable healthcare access are needed to address these patterns.
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creator: Sardar Muhammad Imran Khan
creator: Muneeb Khawar
creator: Muhammad Haris Khan
creator: Salman Ayub Jajja
creator: Ayesha Fatima
creator: Mohammad Azeem Malik
creator: Mirza Muhammad Hadeed Khawar
creator: Abdul Qadeer
rights: Copyright (c) 2026 Sardar Muhammad Imran Khan, Muneeb Khawar, Muhammad Haris Khan, Salman Ayub Jajja, Ayesha Fatima, M. Azeem Malik, Mirza M. Hadeed Khawar, Abdul Qadeer https://creativecommons.org/licenses/by/4.0
date: 2026-07-27
publication date: 2026-07-27
starting page: 8
ending page: 15
doi: 10.71079/ASIDE.GI.072726719

Association of Irritable Bowel Syndrome with Dementia: A GRADE-Assessed Systematic Review and Meta-Analysis
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description: Background: Numerous gastrointestinal (GI) diseases have been linked to an increased risk of dementia. Irritable bowel syndrome (IBS) is a prevalent GI disorder; however, existing studies investigating its association with dementia have reported mixed findings, and no prior meta-analysis has synthesized the available evidence. Methods: A comprehensive search of MEDLINE (via PubMed), Scopus, and Web of Science was conducted in August 2025, with no language restrictions, to identify observational studies comparing the risk of all-cause dementia and dementia subtypes (e.g., Alzheimer's disease (AD) in individuals with and without IBS. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the DerSimonian–Laird random-effects model. The certainty of evidence was assessed using the GRADE approach. Results: More than 750,000 participants were included from three cohort and two case-control studies. The pooled analysis showed that IBS was associated with significantly higher odds of all-cause dementia (OR = 1.22; 95% CI: 1.13–1.31; p < 0.00001; I² = 26%), with the overall certainty of evidence rated as high. The association remained robust across all sensitivity analyses. IBS was also significantly associated with higher odds of AD (OR = 1.27; 95% CI: 1.08–1.50; p = 0.005; I² = 64%), with the certainty of evidence rated as low. Conclusion: Our findings consistently suggest that IBS is associated with higher rates of dementia outcomes; however, this association is derived from observational data and does not establish causality. Further well-designed prospective studies are needed to clarify the nature of this relationship.
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creator: Nawris Alhassan
creator: Mohamed Mohsen Helal
creator: Jagdish Lal
creator: Stanley Jung
creator: Lisa Worsley
rights: Copyright (c) 2026 Nawris Alhassan, Mohamed Mohsen Helal, Jagdish Lal, Stanley Jung, Lisa Worsley https://creativecommons.org/licenses/by/4.0
date: 2026-08-02
publication date: 2026-08-02
starting page: 16
ending page: 28
doi: 10.71079/ASIDE.GI.080226620

https://asidejournals.com/index.php/Gastroenterology/article/view/794
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title: Endoscopic Vacuum Therapy Versus Self-Expanding Metal Stents for Upper Gastrointestinal Transmural Defects: A Narrative Review with Meta-Analytic Overlap Analysis, with Focus on Esophageal Anastomotic Leak and Perforation
description: Background: Upper gastrointestinal transmural defects carry mortality rates exceeding 20%. Endoscopic vacuum therapy (EVT) has emerged as a promising alternative to self-expanding metal stents (SEMS), yet optimal patient selection, timing, and technique remain uncertain. Methods: Relevant literature was identified through a narrative search of PubMed, Embase, and Cochrane Library through January 2026. Corrected covered area (CCA) analysis quantified primary study overlap across meta-analyses comparing EVT to SEMS. This review was reported in accordance with the SANRA checklist. Results: Five meta-analyses were identified, with all comparative evidence derived from esophageal anastomotic leak and iatrogenic perforation populations. CCA analysis demonstrated very high overlap (CCA = 95.0%), confirming convergent re-analyses of the same evidence base rather than independent replication. No randomized controlled trials have been completed. Within this low-certainty observational evidence, EVT was associated with higher defect closure rates (85% vs 64%), lower mortality (risk difference [RD] -0.12), shorter treatment duration (14-day reduction), and fewer adverse events (RD -0.24) compared with SEMS; all effect measures are EVT minus SEMS and should not be interpreted causally. Recent 2023-2025 data showed significantly fewer patient-level complications with EVT (8.3% vs 50%; P = .001). Critical predictors of failure include delayed initiation beyond 7 days, neoadjuvant chemoradiation, and intraluminal sponge placement. Conclusions: EVT was associated with favorable outcomes compared with SEMS across convergent analyses, primarily in esophageal leak and perforation populations; these hypothesis-generating findings should not be extrapolated to other indications without dedicated evidence. Prospective randomized trials, FDA device pathway development, and standardized protocols remain priorities.
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creator: Rowan Bandaranaike
creator: Benjamin Hewitt
creator: Tyler Black
creator: Paul Lamb
creator: Travis Rutland
rights: Copyright (c) 2026 Rowan Bandaranaike, Benjamin Hewitt, Tyler Black, Paul Lamb, Travis Rutland https://creativecommons.org/licenses/by/4.0
date: 2026-06-09
publication date: 2026-06-09
starting page: 13
ending page: 23
doi: 10.71079/ASIDE.GI.060926794

Inter-Hospital Transfer and Outcomes in Acute Cholangitis: A National Inpatient Analysis.
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description: Background: Inter-hospital transfer is frequently used to facilitate access to advanced biliary intervention and higher-level care for patients with acute cholangitis. However, its association with inpatient outcomes remains incompletely defined. We evaluated the relationship between transfer-in status and clinical outcomes among adults hospitalized with acute cholangitis. Methods: We performed a retrospective hospitalization-level analysis using the National Inpatient Sample. Adult hospitalizations with acute cholangitis were identified using ICD-10-CM codes and stratified by interhospital transfer status. Survey-weighted analyses compared patient characteristics, outcomes, and resource utilization. Multivariable survey-weighted logistic regression assessed the adjusted association between transfer-in status and adverse outcomes. Results: An estimated 36,125 acute cholangitis hospitalizations were identified nationally; 16.8% involved inter-hospital transfer. Transferred hospitalizations were more often among White patients, patients from lower-income ZIP codes, and those treated at large urban teaching hospitals. Transferred patients had higher unadjusted rates of shock, acute respiratory failure, mechanical ventilation, dialysis, and in-hospital mortality (5.8% vs 4.5%; P = 0.047). After adjustment, transfer-in status was not significantly associated with in-hospital mortality (adjusted odds ratio [aOR], 1.26; 95% CI, 0.95–1.68; P = 0.106), but was associated with acute respiratory failure (aOR, 1.30; 95% CI, 1.06–1.58; P = 0.011), mechanical ventilation (aOR, 1.64; 95% CI, 1.28–2.10; P < 0.001), and dialysis (aOR, 1.39; 95% CI, 1.01–1.92; P = 0.045). Conclusions: Transfer-in status was not significantly associated with adjusted in-hospital mortality, but it was associated with markers of greater illness severity and resource utilization. Findings should be interpreted within the limitations of administrative hospitalization data.
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creator: Muhammad Haris Latif
creator: Imran Khokhar
creator: Ayesha Kang
creator: Eman Mazhar
creator: Kahee A. Mohammed
creator: Joel Riley
creator: Hani El Halawany
creator: Kamran Qureshi
rights: Copyright (c) 2026 Muhammad Haris Latif, Imran Khokhar, Ayesha Kang, Eman Mazhar, Kahee A. Mohammed, Joel Riley, Hani El Halawany , Kamran Qureshi https://creativecommons.org/licenses/by/4.0
date: 2026-06-10
publication date: 2026-06-10
starting page: 24
ending page: 31
doi: 10.71079/ASIDE.GI.061026639

Endoscopy Timing in Older Adults (≥75 Years) with Upper Gastrointestinal Bleeding Undergoing Esophagogastroduodenoscopy: A Retrospective Cohort Study
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description: Background: International guidelines recommend endoscopy within 24 hours for upper gastrointestinal bleeding (UGIB), yet real-world timing patterns in older adults remain uncertain. Methods: We conducted a retrospective single-center cohort study of 108 adults aged ≥75 years admitted with UGIB who underwent inpatient esophagogastroduodenoscopy (EGD) between 2023 and 2025. Early EGD was defined as ≤24 hours from presentation. Baseline characteristics, endoscopic findings, and clinical outcomes were compared between groups. Results: Among 108 patients, the mean age was 88.1 ± 6.1 years, the median age was 90 years (IQR 83–93), and 35 (32.4%) underwent early EGD, whereas 73 (67.6%) underwent delayed EGD. Baseline characteristics were broadly similar between groups; however, patients undergoing early EGD were more likely to present with shock, suggesting greater illness severity. The median time to EGD was 29.0 hours (IQR 23.0-45.3). Overall, 28-day all-cause mortality occurred in 5 (4.6%) of 108 patients, with no clear difference between early and delayed EGD groups (1 [2.9%] of 35 vs 4 [5.5%] of 73; absolute risk difference, −2.6%; 95% CI, −10.7% to 9.5%; p = 1.00). No statistically significant differences were observed in ICU admission, length of stay, transfusion requirement, readmission, or endoscopic therapy. Estimates were imprecise due to the small number of events. Conclusions: No clear difference in short-term outcomes was observed between early and delayed EGD in this cohort of older adults. These findings are descriptive and hypothesis-generating and should be interpreted cautiously given the small sample size, low event count, and potential bias.
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creator: Mustafa Sadek
creator: Alaa Almallouhi
rights: Copyright (c) 2026 Mustafa Sadek, Alaa Almallouhi https://creativecommons.org/licenses/by/4.0
date: 2026-06-01
publication date: 2026-06-01
starting page: 1
ending page: 4
doi: 10.71079/ASIDE.GI.060126701

Biopsy-Detected Microscopic Colitis and Nonspecific Chronic Inflammatory Change in Patients with Chronic Diarrhea and Normal Colonoscopy: A Two-Case Series
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description: Chronic diarrhea may occasionally persist despite macroscopically normal colonoscopy, and in selected patients, random colonic biopsy may reveal histologic abnormalities not apparent endoscopically. We report two illustrative cases of biopsy-detected microscopic or nonspecific inflammatory abnormalities in patients initially managed as having a functional bowel disorder. This retrospective descriptive case series included two adults identified during routine clinical practice over a recent two-year period (approximately 2024–2025) at a tertiary care hospital who underwent colonoscopy with random colonic biopsies despite macroscopically normal colonic mucosa, due to persistent diarrhea-predominant symptoms. Clinical follow-up was available for approximately six weeks in Case 1 and eight weeks in Case 2. In both patients, colonoscopy revealed macroscopically normal colonic mucosa, except for hemorrhoids. In Case 1, histopathology showed preserved crypt architecture, increased intraepithelial lymphocytes, and mild lamina propria inflammation, consistent with lymphocytic microscopic colitis. In Case 2, biopsy showed increased intraepithelial lymphocytes with chronic inflammatory infiltrates in the lamina propria, interpreted as nonspecific chronic inflammatory change. Both patients received colonic-release budesonide with short-term subjective symptomatic improvement on available follow-up. These cases illustrate that biopsy-detected microscopic or nonspecific inflammatory abnormalities may occasionally be identified in selected patients with persistent diarrhea and normal colonoscopy. They should not be interpreted as evidence of routine biopsy yield, but they support individualized biopsy decisions in carefully selected patients after exclusion of more common causes.
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creator: Jose Thomas
creator: Nihal Ali
creator: Aparna Gangoli
creator: Apoorva Srijayadeva
creator: Vijaya Kumar
creator: Salfi P K
rights: Copyright (c) 2026 Jose Thomas, Nihal Ali, Aparna Gangoli, Apoorva Srijayadeva, Vijaya Kumar, Salfi P K https://creativecommons.org/licenses/by/4.0
date: 2026-04-25
publication date: 2026-04-25
starting page: 43
ending page: 47
doi: 10.71079/ASIDE.GI.042526660

Gastrointestinal Non-Hodgkin Lymphoma: A Multifaceted Malady
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description: Lymphomas account for approximately 5% of human malignancies and are classified as Hodgkin or non-Hodgkin variants. Non-Hodgkin lymphomas (NHL) constitute nearly 90% of all lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent histological subtype. Although primarily nodal, extranodal involvement is common in NHL, with the gastrointestinal (GI) tract being the most frequently involved extranodal site. Lymphomas constitute only 1–4% of gastrointestinal malignancies, with appendix being an exceedingly rare site of involvement. Lymphomas are conventionally staged utilizing the Ann-Arbor system and risk categorized per the International Prognostic Index (IPI). The Dawson’s criteria differentiate primary versus secondary gastrointestinal lymphoma. Diagnosis of lymphoma relies heavily on conventional and immune stained histopathology. Surgery offers the best therapeutic option in localized disease, while chemotherapy is preferred in diffuse or non-resectable diseases. We present a unique and an exceedingly uncommon combination of recurrent DLBCL with appendicular involvement, gastrointestinal hemorrhage, hepatic metastases, and obstructive jaundice. This case highlights the diagnostic challenges posed by extranodal lymphoma, particularly in rare sites such as the appendix. It underscores the critical role of multimodal imaging, endoscopic intervention, and immunohistochemical profiling in diagnosing, staging, and managing intraabdominal lymphomas.
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creator: Mathew Vadukoot Lazar
creator: George Sarin Zacharia
creator: Mudhasir Ahmad
creator: Syed Mohamed Shimar
creator: Ipsita Panda
creator: Mohammad Ali
creator: Hardik Patel
rights: Copyright (c) 2025 Mathew Vadukoot Lazar, George Sarin Zacharia, Mudhasir Ahmad, Syed Mohamed Shimar, Ipsita Panda, Mohammad Ali, Hardik Patel https://creativecommons.org/licenses/by/4.0
date: 2025-09-11
publication date: 2025-09-11
starting page: 1
ending page: 6
doi: 10.71079/ASIDE.GI.091125122

The Impact of Vonoprazan on Tacrolimus Blood Levels in Transplant Recipients: A Systematic Review and Meta-Analysis
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description: Background: Tacrolimus is essential for immunosuppression in transplant recipients but presents risks of toxicity and rejection due to its narrow therapeutic window. Vonoprazan, increasingly replacing proton pump inhibitors (PPIs) in these patients, may alter tacrolimus blood levels, but its impact remains unclear. Objective: To assess how switching from PPIs to vonoprazan affects tacrolimus through concentration and concentration-to-dose ratio, and to summarize related liver and kidney safety markers in transplant recipients. Methods: A systematic review was conducted of four Japanese studies (140 kidney or liver transplant recipients) evaluating tacrolimus-based immunosuppression before and after conversion to vonoprazan. The synthesis used exploratory meta-analyses and narrative interpretation, with clinically meaningful changes prespecified, while emphasizing study limitations. Results: Across studies, a trend toward higher tacrolimus levels was seen after switching to vonoprazan. However, the magnitude and consistency of these changes varied substantially between studies, and most results did not surpass thresholds for clinical concern. Liver and kidney safety signals were generally small and inconsistent. High risk of bias, considerable heterogeneity, and absence of pooled clinical endpoints prevent drawing firm conclusions from quantitative data. Pooled estimates are reported as exploratory only. Conclusions: There is low-certainty evidence that vonoprazan may increase tacrolimus exposure in transplant recipients, but the clinical significance is unclear due to small, regionally focused studies with major methodological limitations. Therapeutic drug monitoring during and after conversion is prudent, and well-controlled trials in diverse populations are needed before definitive recommendations can be made.
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creator: Islam Rajab
creator: Mohamed R. Ezz
creator: Mohamed S. Elgendy
creator: Omar K. Elsawy
creator: Mohamed Wagdy
creator: Mohamed A. Elshewikh
creator: Abdallah Hussein
creator: Patrick Tempera
creator: Walid Baddoura
rights: Copyright (c) 2025 Islam Rajab, Mohamed R. Ezz, Mohamed S. Elgendy, Omar K. Elsawy, Mohamed Wagdy, Mohamed A. Elshewikh, Abdallah Hussein, Patrick Tempera, Walid Baddoura https://creativecommons.org/licenses/by/4.0
date: 2025-12-17
publication date: 2025-12-17
starting page: 19
ending page: 26
doi: 10.71079/ASIDE.GI.121725125

Annular Pancreas in Adults Presenting as Chronic Pancreatitis and Duodenal Obstruction: Literature Review and a Case Report
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description: Background: Annular pancreas is a rare congenital anomaly with an estimated incidence of 3.4 per 1,00,000 live births. It is more commonly diagnosed in infants. Its occurrence in adults is exceptionally rare but clinically significant, as seen in our case, where it presented as a duodenal obstruction. Case presentation: We present a case of an adult male who presented with a 3-week history of projectile bilious vomiting associated with postprandial abdominal pain and early satiety. Imaging studies revealed a segment of the pancreas encircling the second part of the duodenum, along with pancreatolithiasis. Based on the diagnosis of annular pancreas with chronic calcific pancreatitis, the patient underwent pylorus-preserving pancreatoduodenectomy. Materials and Methods: A structured literature review was performed using PubMed and Scopus databases, covering the period from 2018 to 2024. A total of 24 case reports were analyzed. Results: The review confirms that annular pancreas remains a rare condition, often undiagnosed in asymptomatic individuals with abdominal pain (83.3%) and vomiting (41.6%) as the most common symptoms. The most common diagnostic modality is the CT scan (computed tomography), at 64.1%, and surgical procedures, such as gastrojejunostomy, are the most common treatment modality, at 46.5%. Conclusions: It is a rare congenital condition that usually remains undiagnosed in asymptomatic individuals but typically presents with abdominal pain and vomiting when symptomatic. Diagnosis relies primarily on CT imaging. Conservative management is preferred for asymptomatic cases, and surgery is for symptomatic patients. Further research is needed to develop standardized management protocols.
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creator: Gajendra Bhati
creator: Shruti Pandey
creator: Ripanbir Singh Kahlon
creator: Raghav Bansal
rights: Copyright (c) 2025 Gajendra Bhati, Shruti Pandey, Ripanbir Singh Kahlon , Raghav Bansal https://creativecommons.org/licenses/by/4.0
date: 2025-07-22
publication date: 2025-07-22
starting page: 27
ending page: 32
doi: 10.71079/ASIDE.GI.072225154

Emphysematous Gastritis in a Patient with Concomitant COVID-19 Infection and Celiac Trunk Stenosis: A Case Report
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description: This case report reviews a 75-year-old male with several comorbidities who presented with acute encephalopathy and sepsis in the setting of COVID-19 pneumonia, who was noted to have significant gaseous distention of the stomach, emphysematous gastritis (EG), and severe stenosis of the celiac trunk on initial CT imaging. He was treated with empiric IV antibiotics, including ceftriaxone and metronidazole, which were changed to intravenous piperacillin-tazobactam after 24 hours. After being evaluated by surgery and gastroenterology, it was determined that risks outweighed the benefits of EGD and surgical intervention as the patient had a labile hemodynamic status. After extensive goals of care discussions with the patient’s family, he was transitioned to comfort measures only on day 4 of admission and ultimately passed the same day due to cardiopulmonary arrest. EG is often diagnosed late in its course and is associated with extremely high mortality, even with surgical intervention. Evidence from recent case series suggests increasing success with conservative management in selected patients; there are no formal guidelines.
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creator: Hira Khan
creator: Anjali Rajagopal
creator: Karim Al Annan
creator: Murali Dharan
rights: Copyright (c) 2025 Hira Khan, Anjali Rajagopal, Murali Dharan https://creativecommons.org/licenses/by/4.0
date: 2025-12-03
publication date: 2025-12-03
starting page: 14
ending page: 18
doi: 10.71079/ASIDE.GI.120325228

The Liver-Heart Axis: A Narrative Review of Clinical Implications of the MASLD Redefinition for Internists
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description: Introduction: Metabolically-dysfunction-associated steatotic liver disease (MASLD) represents a paradigm shift emphasizing the metabolic underpinnings of hepatic steatosis and its systemic consequences. MASLD carries a substantial cardiovascular burden. This review examines the clinical implications of the MASLD redefinition for internists, with particular focus on the liver-heart axis. Methods: We conducted a narrative review synthesizing evidence through December 2024. Literature searches were performed in PubMed, EMBASE, and Cochrane Library using terms including "MASLD," "nonalcoholic fatty liver disease," "metabolic dysfunction-associated steatohepatitis, "cardiovascular disease," and "cardiometabolic risk." Priority was given to systematic reviews, meta-analyses, and large prospective cohort studies. Results: MASLD is associated with increased risks of coronary artery disease, myocardial infarction, heart failure with preserved ejection fraction, atrial fibrillation, and cardiovascular mortality. These associations are mediated through insulin resistance, chronic inflammation, oxidative stress, atherogenic dyslipidemia, hepatokine dysregulation, gut-derived metabolites, and genetic determinants — though substantial residual confounding by shared cardiometabolic risk factors remains. Hepatic fibrosis stage emerges as a critical amplifier of cardiovascular risk. Integrated management requires systematic case-finding, fibrosis risk stratification using validated noninvasive tools, comprehensive cardiovascular assessment, intensive lifestyle intervention, and pharmacotherapy including incretin-based therapies, sodium-glucose cotransporter-2 inhibitors, and statins. Conclusions: Internists must adopt integrated approaches addressing both hepatic and cardiovascular manifestations of MASLD. The liver-heart axis requires recognition as an interconnected system, with cardiovascular risk management prioritized alongside hepatic care. While the MASLD nomenclature is inte…
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creator: Hassan A. Abdou
creator: Saied A. Omar
rights: Copyright (c) 2026 Hassan A. Abdou, Saied A. Omar https://creativecommons.org/licenses/by/4.0
date: 2026-03-18
publication date: 2026-03-18
starting page: 26
ending page: 42
doi: 10.71079/ASIDE.GI.031826446

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Multisystemic Narrative Review of Cardiovascular and Oncological Implications
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description: Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has surpassed viral hepatitis as the primary driver of chronic liver disease globally. While traditionally viewed through the lens of hepatic progression, its clinical trajectory is increasingly defined by extrahepatic complications. Objective: This narrative review evaluates MASLD as a manifestation of systemic metabolic failure, specifically analyzing its role in accelerating cardiovascular dysfunction and extrahepatic carcinogenesis—the two principal causes of mortality in this population. Methods: A comprehensive literature synthesis was conducted from 2020 to December 2025, using databases including PubMed, Scopus, and the Egyptian Knowledge Bank (EKB) to identify high-impact studies and international guidelines. Results: The pathophysiology involves a metabolic cascade whereby hepatic lipid accumulation and insulin resistance trigger systemic inflammatory signaling. Disrupted lipid handling and genetic determinants promote pro-atherogenic and pro-oncogenic environments. The review advocates a transition to risk-stratified approaches using noninvasive biomarkers, such as the FIB-4 index. Conclusion: Addressing the bidirectional relationship between hepatic steatosis and systemic comorbidities requires a multidisciplinary therapeutic strategy. This framework provides a basis for early intervention to reduce the burden of cardiovascular events and malignancy among patients with MASLD.
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creator: Menatalla M. A. Mohamed
creator: Maha M. M. I. Taha
creator: Mohnd M. M. R. Ibrahim
rights: Copyright (c) 2026 Menatalla M. A. Mohamed, Maha M. M. I. Taha, Mohnd M. M. R. Ibrahim https://creativecommons.org/licenses/by/4.0
date: 2026-02-26
publication date: 2026-02-26
starting page: 15
ending page: 25
doi: 10.71079/ASIDE.GI.022626448

Fish-Bone Migration to the Liver Causing Hepatic Abscess: A Scoping Review of Published Cases (2015–2025)
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description: Background: Foreign body ingestion is common; however, migration of an ingested fish bone into the liver with subsequent abscess formation is rare, frequently presents with nonspecific abdominal symptoms, and poses a diagnostic challenge in routine clinical practice, often leading to delayed diagnosis. Methods: A scoping review of PubMed, Google Scholar, SciELO, and ScienceDirect identified human case reports and case series (2015–2025) describing confirmed intrahepatic fish-bone migration or penetration causing hepatic abscess. Reports without radiologic or intraoperative confirmation and those involving non–fish-bone foreign bodies were excluded. Extracted data included demographics, migration routes, imaging findings, management, and outcomes. Results: Twenty-seven publications reporting 29 patients met the inclusion criteria, including 25 individual case reports and 2 case series. Presumed transgastric migration was reported in 22 patients (75.9%), and the left hepatic lobe was involved in 20 cases (69.0%). Computed tomography identified a linear radiodense foreign body in 24 patients (82.8%). Surgical or minimally invasive foreign-body removal was performed in 21 patients (72.4%), with generally favorable outcomes, although follow-up reporting was variable. Conclusion: Intrahepatic fish-bone migration is a rare but clinically important cause of hepatic abscess and should be considered in patients with unexplained, particularly left-lobe, hepatic abscesses when CT demonstrates a linear foreign body or when response to standard therapy is atypical; timely source control is usually effective.
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creator: Zaid Alezzi
creator: Tarek Aboubakr
creator: Ashraf Yahia Hegab
creator: ‪Abdulkarim Hasan‬‏
rights: Copyright (c) 2026 Zaid Alezzi, Tarek Aboubakr, Ashraf Yahia Hegab, ‪Abdulkarim Hasan‬‏ https://creativecommons.org/licenses/by/4.0
date: 2026-02-21
publication date: 2026-02-21
starting page: 8
ending page: 14
doi: 10.71079/ASIDE.GI.022126507

Alternative Gastrointestinal Conditions Identified in Patients Meeting Rome IV Criteria for Irritable Bowel Syndrome or Functional Diarrhea Referred to Secondary Care: A Prospective Study
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description: Introduction: Organic gastrointestinal (GI) disorders can be missed in individuals with irritable bowel syndrome (IBS). This study investigated the frequency of organic disorders in patients with diarrhea-predominant IBS or functional diarrhea and the impact of treatment for any identified alternative diagnoses. Methods: Between April 2019 and March 2020, the results of comprehensive investigations, including blood and fecal tests, a 75selenium homophobic acid taurine scan, a breath test, and endoscopies performed on consecutive eligible patients, were recorded. Symptom burden was reassessed after treatment for any GI conditions identified. Results: 66 (15 males) consecutive patients were included. Two patients (3%) were diagnosed with colonic malignancy; 21 (38%) had bile acid diarrhea; one (1%) had pancreatic exocrine insufficiency; and 31 (54%) had small intestinal bacterial overgrowth. 21 patients (32%) had at least two GI diagnoses. Significant improvement in symptoms occurred following treatment (p<0.0001). Conclusions: Multiple co-existing conditions were detected in many of these patients, with one-third of the cohort having more than one abnormal test. When these alternative diagnoses were treated, patients reported significant symptomatic improvement. Larger studies are required to validate our findings, and these patients' investigative and management pathways should be amended accordingly.
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creator: Dennis Poon
creator: Giles Major
creator: Jervoise Andreyev
rights: Copyright (c) 2025 Dennis Poon, Giles Major, Jervoise Andreyev https://creativecommons.org/licenses/by/4.0
date: 2025-06-20
publication date: 2025-06-20
starting page: 5
ending page: 12
doi: 10.71079/ASIDE.GI.06112565

ERCP Timing in Gallstone Disease: A Meta-Analysis of One-Stage versus Two-Stage Strategies
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description: Background: Cholecystocholedocholithiasis involves gallbladder and bile duct stones. Standard two-stage care involves ERCP followed by cholecystectomy, whereas single-stage intraoperative ERCP may streamline treatment. We performed a meta-analysis comparing stone clearance, complications, and hospital stay between single-stage and two-stage strategies. Method: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library up to April 2025 for clinical studies comparing one-stage laparo-endoscopic rendezvous with two-stage ERCP + LC. RCTs and observational studies reporting stone clearance, complications, conversion, bile leaks, hospital stay, repeat ERCP, or cannulation failure were included. Data extraction and ROB2/NOS assessments were done independently. Result: Twenty-four studies met the inclusion criteria. The one-stage approach demonstrated significantly higher CBD clearance (96.5% vs. 91.8%; RR = 1.03) and a notably lower overall complication rate (11.55% vs. 19.56%; RR = 0.51). Postoperative pancreatitis (RR = 0.50), cholangitis (RR = 0.33), and bleeding (RR = 0.47) were also significantly reduced. Although conversion to open surgery and bile leak rates were lower in the one-stage group, these differences were not statistically significant. Importantly, single-stage management resulted in shorter hospital stays (mean difference = −3.23 days), fewer postoperative repeat ERCPs (RR = 0.21), and markedly reduced cannulation failure (RR = 0.26). Conclusion: The one-stage approach for managing bile duct stones offers higher clearance rates, fewer complications, and shorter hospital stays compared to the two-stage approach. These results support adopting one-stage treatment as a more effective and efficient clinical strategy.
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creator: Mohamed Gamal
creator: Mohamed Wagdy
creator: Mahmoud Abd El-Nasser
creator: Abdalla Ahmed Mohamed
creator: Abdelrhman Waleed
creator: Abdulrahman Ziada
creator: Abdelrahman Abdalla Mohamed
rights: Copyright (c) 2025 Mohamed Gamal, Mohamed Wagdy, Mahmoud Abd El-Nasser, Abdalla Ahmed Mohamed, Abdelrhman Waleed Kotb, Abdulrahman Ziada, Abdelrahman Abdalla Mohamed https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
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doi: 10.71079/ASIDE.GI.123125198

Endoscopic Sphincterotomy Increases the Risk of Pyogenic Liver Abscess: A Retrospective Study Using Real-World Data
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description: Introduction: Pyogenic liver abscess (PLA) after Endoscopic Retrograde Cholangiopancreatography (ERCP) is a rare infectious adverse event. The association between post-ERCP PLA and endoscopic sphincterotomy has not been extensively studied. Methods: We conducted a retrospective study using the TriNetX platform by including patients without history of PLA who received ERCP between October 2015 and December 2020. Two groups were made: the endoscopic sphincterotomy (ES) group (patients who received ES during ERCP) and the control group (patients who did not receive ES). The primary outcome was the risk of developing PLA within 1 year of the index ERCP. The secondary outcomes included sepsis, broad-spectrum antibiotics use, need for PLA drainage, and post-ERCP mortality within one year of the index ERCP. Results: There were 169 patients (1.43%) in the ES group who developed PLA compared to 123 patients (1.04%) in the control group, Relative Risk (RR): 1.37, P-value = 0.007. A total of 241 patients (2.05%) in the ES group developed sepsis compared to 176 patients (1.49%) in the control group, RR: 1.37, P-value = 0.001. A total of 2,954 patients (25.1%) in the ES group received treatment with broad-spectrum antibiotics compared to 2,132 patients (18.1%) in the control group, RR: 1.5, P-value < 0.0001. There was no statistically significant difference in the need for PLA drainage (RR: 1.19, P-value = 0.34) or mortality (RR: 0.969, P-value = 0.49). Conclusion: ES during ERCP was associated with an increased risk for PLA, sepsis, and broad-spectrum antibiotics use. No mortality difference was found.
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creator: Abdellatif Ismail
creator: Bisher Sawaf
creator: Pinghsin Hsieh
creator: Khalid Aloum
creator: Shahem Abbarh
creator: Mhd Kutaiba Albuni
creator: Mohammed Al-Aquily
creator: Mostafa Suhail Najim
creator: Amir Humza Sohail
creator: Saurabh Chandan
rights: Copyright (c) 2025 Abdellatif Ismail, Bisher Sawaf, Pinghsin Hsieh, Khalid Aloum, Shahem Abbarh, Mhd Kutaiba Albuni, Mohammed Al-Aquily, Mostafa Suhail Najim, Amir Humza Sohail, Saurabh Chandan https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: 27
ending page: 32
doi: 10.71079/ASIDE.GI.123125111

Mycophenolate Mofetil Use for Inflammatory Bowel Disease
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description: Mycophenolate Mofetil (MMF) is a prodrug that gets converted to mycophenolic acid (MPA). MPA inhibits the Akt/mTOR and STAT5 pathways and has a reversible cytostatic effect on T and B lymphocytes [1]. MMF is FDA-approved for immunosuppressive therapy after solid organ transplantation. MMF has been used for multiple inflammatory/autoimmune conditions including psoriasis, dermatomyositis, autoimmune hepatitis, lupus erythematosus, myasthenia gravis, and Takayasu arteritis [2]. In this Editorial, we discuss the recently published systematic review and meta-analysis by Balassiano et al [3]. This systematic review and meta-analysis studied the use of MMF for the treatment of IBD patients. This review included both retrospective studies, case series, and clinical trials that evaluated the use of MMF in patients with IBD. Included patients were intolerant or unresponsive to Azathioprine. MMF was used in the included studies for induction and maintenance of remission, or as a steroid sparing agent/immunomodulator. This study demonstrated MMF’s efficacy in both induction and maintenance of remission in IBD patients. MMF was associated with added benefits for patients on steroids as well as those on anti-TNF therapy [3]. MMF has several boxed warnings in the United States, limiting its use outside FDA-approved indications. MMF should be prescribed only by healthcare providers experienced in immunosuppressive therapy and organ transplant management, with access to comprehensive laboratory and medical resources [4]. There is also a significant risk of infections associated with immunosuppression including but not limited to opportunistic infections, which may result in significant morbidity and mortality. MMF use is associated with an increased risk of malignancy including but not limited to lymphoma and skin cancers. There is also a boxed warning suggesting avoiding MMF use in pregnancy if alternative therapies are available as its use is associated with congenital malformatio…
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creator: Ahmed Abomhya
creator: Ahmed Elmoursi
rights: Copyright (c) 2025 Ahmed Abomhya, Ahmed Elmoursi https://creativecommons.org/licenses/by/4.0
date: 2025-04-14
publication date: 2025-04-14
starting page: 1
ending page: 2
doi: 10.71079/ASIDE.GI.04142552

Efficacy and Safety of Tofacitinib in Pediatric Ulcerative Colitis Patients: A Systematic Review
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description: Introduction: Ulcerative colitis (UC), an inflammatory Bowel Disease (IBD), is a chronic illness of unknown mechanism affecting the colonic mucosa, mainly causing diarrhea and bleeding. It can potentially disrupt the quality of life. Tofacitinib, a Janus Kinase inhibitor, showed a promising effect in inducing remission in IBD patients. In this study, we aim to assess the efficacy and safety of Tofacitinib in treating children with ulcerative colitis. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), we searched four electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies reported up to July 2024. We reported outcomes as frequencies and proportions in our study. Results: We identified five studies encompassing 83 children diagnosed with IBD, of which 57 children had ulcerative colitis. The proportion of patients achieving a clinical response across one included study was 66.67%. The proportion of patients achieving clinical remission was 38.46%. Also, the proportion of patients achieving steroid-free remission across the three studies was 48.57%. The rate for serious adverse events was 25.53% across the three included studies. Conclusion: Tofacitinib could be useful in achieving clinical remission in children with UC and reducing colectomy rates. Also, a low infection rate and the incidence of serious adverse events were observed. Future randomized controlled trials with larger samples and longer follow-up periods are needed to support these findings.
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creator: Abdelaziz A. Awad
creator: Mohamed A. Aldemerdash
creator: Ahmed Aldemerdash
creator: Esraa Awad
creator: Salma Allam
creator: Ahmed L. Youseif
creator: Alshimaa M. Abu alabbas
creator: Nermin Elhossiny
creator: Hazem Abosheaishaa
rights: Copyright (c) 2025 Abdelaziz A. Awad, Mohamed A. Aldemerdash, Ahmed Aldemerdash, Esraa Awad, Salma Allam, Ahmed L. Youseif, Alshimaa M. Abu alabbas, Nermin Elhossiny, Hazem Abosheaishaa https://creativecommons.org/licenses/by/4.0
date: 2025-04-21
publication date: 2025-04-21
starting page: 3
ending page: 8
doi: 10.71079/ASIDE.GI.04212519

Dexmedetomidine as an Adjunctive Sedative in Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis
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description: Introduction: Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract, but it carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assess its efficacy and safety. Methodology: We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model. Results: The initial search retrieved 216 studies, and eight studies were included in the final analysis after screening. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol and Dexmedetomidine plus Midazolam revealed the same findings regarding restlessness and bradycardia compared to controls, which confirmed the adjunctive effects of Dexmedetomidine. Conclusion: Dexmedetomidine appears safe and effective as an adjunctive sedative in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may reflect reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations.
subject: Original Article
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creator: Hazem Abosheaishaa
creator: Abdallfatah Abdallfatah
creator: Abdelmalek Abdelghany
creator: Arshia Sethi
creator: Abdellatif Ismail
creator: Doha Mohamed
creator: Moataz Aboeldahb
creator: Omar Abdelhalim
creator: Islam Mohamed
creator: Ahmed Y. Azzam
creator: Muhammed Amir Essibayi
creator: David J. Altschul
creator: Mahmoud Nassar
creator: Mohammad Bilal
rights: Copyright (c) 2025 Hazem Abosheaishaa , Abdallfatah Abdallfatah, Abdelmalek Abdelghany, Arshia Sethi, Abdellatif Ismail, Doha Mohamed, Moataz Aboeldahb, Omar Abdelhalim, Islam Mohamed, Ahmed Y. Azzam, Muhammed Amir Essibayi, David J. Altschul, Mahmoud Nassar, Mohammad Bilal https://creativecommons.org/licenses/by/4.0
date: 2025-03-11
publication date: 2025-03-11
starting page: 7
ending page: 14
doi: 10.71079/ASIDE.GI.0109257

Usage of Trapezoid RX Wire Guided Retrieval Basket with the Alliance™ II Inflation Handle for Treatment of Bouveret Syndrome: A Rare Clinical Entity
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description: Bouveret Syndrome is an infrequent manifestation of gallstone disease, causing gastric outlet obstruction. This syndrome has diagnostic and therapeutic challenges due to its rarity and non-specific clinical presentation. Here, we present a case report involving a 78-year-old female patient who experienced gastric outlet blockage due to the presence of a sizable gallstone. A novel technique was applied wherein a trapezoid RX wire-guided retrieval basket (Boston Scientific) was utilized with Esophagogastroduodenoscopy to remove the stone without the need for surgical intervention. Post-procedure monitoring demonstrated a smooth recovery with immediate relief of symptoms. Imaging confirmed the absence of residual gallstones or obstruction.
subject: Case Report
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creator: Mahmod Ghoname
creator: Hazem Abosheaishaa
creator: Arshia Sethi
creator: Sharif Abbas
creator: Sherif Hegab
creator: Moataz Yousry Soliman
rights: Copyright (c) 2025 Mahmod Ghoname, Hazem Abosheaishaa, Arshia Sethi, Sharif Abbas, Sherif Hegab, Moataz Yousry Soliman https://creativecommons.org/licenses/by/4.0
date: 2025-01-02
publication date: 2025-01-02
starting page: 1
ending page: 4
doi: 10.71079/ASIDE.GI.0102255

Potential Use of Icosapent Ethyl in the Management of Acute Pancreatitis
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description: Dear Editor, We are writing to highlight the potential use of Icosapent Ethyl (Vascepa) as a management option for acute pancreatitis. To the best of my knowledge, a limited number of studies have investigated this use, but it is not yet Food and Drug Administration (FDA) approved for this indication. Previous studies have suggested that omega-3 fatty acids, such as Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA), may have anti-inflammatory properties and could potentially be beneficial in reducing the inflammation and triglyceride levels associated with acute pancreatitis [1]. These mechanisms consist of systemic inflammation reduction by the inhibition of inflammatory mediators since omega-3 fatty acids inhibit the synthesis of pro-inflammatory cytokines such as IL-1β and IL-6 [2]. Moreover, they alter intracellular signaling pathways linked to transcription factors such as nuclear factor-κB, which impacts the expression of genes linked to inflammation [3]. Surprisingly, it helped with inflammation resolution by enhancing the removal of inflammatory cells and promoting the production of certain pro-resolving mediators in mice with pancreatitis [4]. EPA may serve as a valuable dietary supplement for individuals with risk factors for heart disease. It has potential benefits for conditions such as cardiovascular disease, diabetes, obesity, cancer, and stroke. EPA has been shown to lower inflammation, cholesterol, blood pressure, and blood clotting, and improve coronary artery function. Additionally, it can reduce inflammation and enhance body composition, supporting weight loss efforts [5]. A case study reported the use of Icosapent Ethyl as a treatment for severe acute pancreatitis in a 31-year-old male patient with abrupt acute alcoholic pancreatitis, requiring ICU admission, intubation, and mechanical ventilation, renal replacement therapy, and pressors; the patient showed remarkable improvement after initiation of icosapent Ethyl treatment via gastrost…
subject: Letter to the Editor
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creator: Hazem Abosheaishaa
creator: Mahmoud Nassar
rights: Copyright (c) 2025 Hazem Abosheaishaa, Mahmoud Nassar https://creativecommons.org/licenses/by/4.0
date: 2025-01-07
publication date: 2025-01-07
starting page: 5
ending page: 6
doi: 10.71079/ASIDE.GI.0107256

Early Palliative Care in Gastrointestinal Oncology: Evidence, Implementation Models, and Ethical Considerations
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description: Background: Early palliative care is increasingly recognized as an important component of high-quality cancer care; however, the timing and extent of its integration vary across oncologic disciplines, including gastrointestinal (GI) oncology. Patients with GI malignancies frequently experience early symptom burden, complex treatment courses, and prognostic uncertainty, contributing to substantial supportive care needs over the disease trajectory. Methods: This narrative review synthesizes evidence on early palliative care in gastrointestinal oncology from randomized controlled trials, systematic reviews, GI oncology–specific clinical guidelines, and observational and health services research. The objective was to characterize patterns of evidence, implementation approaches, and ethical considerations relevant to early integration in gastrointestinal oncology. Results: Across heterogeneous study designs, early palliative care involvement is associated with improvements in quality of life, symptom control, and communication outcomes, without evidence of interference with disease-directed therapies. In GI oncology, particularly pancreatic cancer and hepatocellular carcinoma, unmet supportive care needs are consistently described. Diagnosis-anchored and needs-based referral approaches are discussed as alternatives to time-based models in settings of prognostic uncertainty. Evidence supporting home-based or hybrid palliative care models in GI oncology remains limited and context dependent. Conclusion: Overall, the literature suggests that earlier integration of palliative care may be appropriate for selected patients with gastrointestinal malignancies. Given variability in symptom burden and clinical trajectories, time-based referral models may be insufficient in some settings, whereas needs-based and diagnosis-anchored approaches may offer flexible frameworks. Ethical considerations should be interpreted in light of patient preferences, feasibility, and health system ca…
subject: Review Article
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creator: Abdullah Alabbasi
creator: Muhanad Alzahrani
rights: Copyright (c) 2026 Abdullah Alabbasi, Muhanad Alzahrani https://creativecommons.org/licenses/by/4.0
date: 2026-06-09
publication date: 2026-06-09
starting page: 5
ending page: 12
doi: 10.71079/ASIDE.GI.060926449

Safety and Efficacy of Na Alginate and Mesna in Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis
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description: Background: Sodium hyaluronate, commonly used in ESD, has drawbacks such as high cost and potential tumorigenesis. Sodium alginate (Na alginate) and Mesna offer promising alternative solutions with their viscoelastic and mucolytic properties. In this review we aimed to evaluate the safety and efficacy of Na alginate and Mesna solutions in ESD. Methods: A systematic search was conducted across multiple databases. Inclusion criteria were randomized controlled trials and observational studies assessing Na alginate and Mesna in ESD. Primary outcome included en-bloc resection rates. Secondary outcomes included adverse events such as perforation and delayed bleeding, and procedural time. Results: Eight studies involving 255 patients were included in this analysis. Overall en-bloc resection rate for sodium alginate was 97% [95% CI (93%-99%); I2:0%]. En-bloc resection subgroup analysis revealed 97% [95% CI (93%-99%); I2:0%] for 0.6% sodium alginate and 95% [95% CI (70%-99%); I2: 0%] for 0.4% sodium alginate. Moreover, En-bloc resection rate for Mesna was 98% [95%CI: 92%-100%); I2: 0%]. Delayed bleeding rates for sodium alginate were 5% [95% CI (1%-20%); I2: 65.2%]; however, after subgroup analysis delayed bleeding was 2% [95% CI (1%-6%); I2: 0%] for 0.6% sodium alginate and 22% [95% CI (8%-49%); I2:0%] for 0.4% sodium alginate. Perforation rate for 0.6% sodium alginate was 1% [95% CI (0%-5%); I2: 0%]. Conclusion: Na alginate (0.6%) and Mesna are effective and safe alternatives to sodium hyaluronate for submucosal injection in ESD. These solutions offer potential cost-effective and safer options for clinical practice, with Na alginate (0.6%) showing particularly low adverse event rates.
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creator: Hazem Abosheaishaa
creator: Abdallfatah Abdallfatah
creator: Imad Samman Tahhan
creator: Abdelmalek Abdelghany
creator: Iyiad Alabdul Razzak
creator: Mohamed Amer
creator: Ahmed Y. Azzam
creator: Muhammed Amir Essibayi
creator: Mahmoud Nassar
creator: Omar Abdelhalim
creator: Sherif Andrawes:
rights: Copyright (c) 2025 Hazem Abosheaishaa, Abdallfatah Abdallfatah , Imad Samman Tahhan, Abdelmalek Abdelghany , Iyiad Alabdul Razzak, Mohamed A. M. Amer , Ahmed Y. Azzam, Muhammed Amir Essibayi, Mahmoud Nassar, Omar Abdelhalim , Sherif Andrawes https://creativecommons.org/licenses/by/4.0
date: 2025-04-22
publication date: 2025-04-22
starting page: 9
ending page: 15
doi: 10.71079/ASIDE.GI.04222537

Comparative Outcomes of Esophageal Stent Placement in Esophageal Cancer Patients: A Prospective Study of 183 Cases
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description: Introduction: Esophageal stent placement is a vital, minimally invasive procedure for alleviating dysphagia and enabling smoother food passage. It offers immediate relief, reduces hospital stays, and enhances quality of life for high-risk patients. Effective for both malignant and benign conditions, stenting is cost-efficient and requires skilled professionals for optimal outcomes. This study examines outcomes of various stent types in esophageal cancer patients, evaluating efficacy, safety, and quality-of-life impacts. Methods: Between January and December 2022, 183 patients with esophageal cancer were enrolled from three tertiary healthcare facilities. Patients were divided into three groups based on the esophageal stent used: self-expanding metallic stents (SEMS, n = 84), self-expanding plastic stents (SEPS, n = 61), and fully covered self-expanding metallic stents (FCSEMS, n = 38). All stent placements were performed under endoscopic guidance, with follow-up assessments at 1 week, 1 month, 3 months, and 6 months to evaluate stent patency, dysphagia relief, and complications. Results: Technical success rates were high: SEMS 96.4%, SEPS 95.1%, and FCSEMS 97.4%. Immediate dysphagia relief occurred in 87.4% of patients. FCSEMS had a significantly longer median patency duration (8.0 months) compared to SEMS (6.3 months) and SEPS (5.6 months). Additionally, SEPS exhibited a higher migration rate (13.1%), while overall complications were noted in 18.0% of patients. Conclusions: Esophageal stent placement effectively palliates dysphagia in cancer patients. FCSEMS shows advantages with prolonged patency, yet careful stent selection is essential to optimize patient outcomes. These findings underscore the importance of individualized treatment planning and regular monitoring to achieve optimal outcomes.
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creator: Ahmed E. Salem
creator: Hazem Abosheaishaa
creator: Sarah Meribout
creator: Morad Zaaya
creator: Carla Barberan Parraga
creator: Kantash Kumar
creator: Aye Cherry
creator: Mohammed Abusuliman
creator: Mohamed Eldesouki
creator: Omar Abdelhalim
creator: Yuriy Tsirlin
creator: Aaron Z. Tokayer
rights: Copyright (c) 2025 Ahmed E. Salem, Hazem Abosheaishaa, Sarah Meribout, Morad Zaaya, Carla Barberan Parraga, Kantash Kumar, Aye Cherry, Mohammed Abusuliman, Mohamed Eldesouki, Omar Abdelhalim, Yuriy Tsirlin, Aaron Z. Tokayer https://creativecommons.org/licenses/by/4.0
date: 2025-09-24
publication date: 2025-09-24
starting page: 7
ending page: 13
doi: 10.71079/ASIDE.GI.09242544

Evaluating Biliary Complications in Jaundiced Patients with Alcohol-Related Hepatitis: A Retrospective Study
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description: Introduction: This study aims to differentiate whether jaundice in patients with alcoholic hepatitis (AH) is due to alcohol-related liver disease or underlying biliary pathology, including choledocholithiasis, primary sclerosing cholangitis, primary biliary cholangitis, benign strictures, cholangiocarcinoma, or pancreatic cancer. Accurate differentiation is crucial for appropriate treatment decisions. Methods: A non-interventional retrospective study examined patients admitted to our institute for presumed alcohol-related hepatitis management from 2016 to 2023. The primary outcome was the occurrence of biliary processes, whether benign or malignant, in patients managed for alcohol-related hepatitis within 90 days. Secondary outcomes assessed bilirubin level trends over seven days to evaluate steroid effects on alcohol-related hepatitis and predict underlying biliary processes. Variables were analyzed using bivariate and multivariate logistic regression with biliary process as the dependent variable. Results: Our study revealed that patients with alcohol-related hepatitis and jaundice who had dilated common bile duct (CBD) or pancreatic duct (PD) on cross-sectional imaging were more likely to have biliary processes regardless of cholecystectomy history p-value 0.007 (CI 0.03-0.242) OR 7.5 and p-value 0.001 (CI 0.58-1.34), OR 1.2 respectively. However, there was no correlation between biliary process incidence and various demographic or clinical factors. Conclusion: Cross-sectional imaging should be routinely used to evaluate biliary tree conditions in alcohol-related hepatitis patients with jaundice who have dilated CBD, particularly those with previous cholecystectomy or gallstones on imaging studies. This systematic approach enables early identification of underlying biliary issues and facilitates prompt, appropriate management decisions.
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creator: Junaid Khan
creator: Qamar Iqbal
creator: Gajendra Acharya
creator: Mubasshar Shahid
creator: Safana Ismail
creator: Umme Ferdaush
creator: Christina Gomez
creator: Osama Kaddourah
rights: Copyright (c) 2025 Junaid Khan, Qamar Iqbal , Gajendra Acharya , Mubasshar Shahid , Safana Ismail , Umme Ferdaush , Christina Gomez , Osama Kaddourah https://creativecommons.org/licenses/by/4.0
date: 2025-06-24
publication date: 2025-06-24
starting page: 21
ending page: 25
doi: 10.71079/ASIDE.GI.06242551

https://asidejournals.com/index.php/Gastroenterology/article/view/77
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title: Efficacy and Safety of Tislelizumab in Combination with Chemotherapy versus Placebo Plus Chemotherapy in Patients with Advanced Gastric Cancer or Gastroesophageal Junction Cancer: A Systematic Review of Randomized Controlled Trials
description: Introduction: Advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC) is an aggressive malignancy often having a poor prognosis. Despite current systemic therapies, GC/GEJC remains the third most common cause of cancer-related deaths worldwide. Tislelizumab, an anti-PD1 antibody, has shown promising results in treating various cancers. Therefore, this systematic review investigated the efficacy and safety of tislelizumab plus chemotherapy for patients with GC/GEJC. Methods: Five databases were systematically searched until July 10, 2024. Articles identified in the screening process included two RCTs based on predefined inclusion criteria. We performed data extraction sheets and quality assessments using the Cochrane ROB2 tool. Results: Out of the two randomized controlled trials (RCTs), 1646 patients were included in our systematic review. In Rational-306, efficacy outcomes improved, overall survival (OS) significantly improved from 10.6 months (95\% CI 9.3–12.1) to 17.2 months (95\% CI 15.8–20.1), and progression-free survival (PFS) from 5.6 months (4.9–6.0) to 7.3 months (6.9–8.3). Rational-305 also notably significantly improved. Outcomes: Improved OS from 12.9 months (12.1-14.1) to 15 months (13.6-16.5), and PFS from 6.2 months (5.6 to 6.9) to 6.9 months (5.7 to 7.2). The proportion of patients with any grade 3 or worse treatment-related adverse events was similar between treatment groups. Conclusion: Compared with chemotherapy and placebo, Tislelizumab plus chemotherapy demonstrates superior efficacy with a similar safety profile in the two groups, encouraging the use of the tislelizumab group in patients with GC/GEJC.
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creator: Ahmed Reda Bahr
creator: Ahmed Magdy Hassan
creator: Mohamed Wagdy
creator: Mahmoud Abdelkader
creator: Ahmed Samy Elgammal
rights: Copyright (c) 2025 Ahmed Reda Bahr, Ahmed Magdy Hassan, Mohamed Wagdy, Mahmoud Abdelkader, Ahmed Samy Elgammal https://creativecommons.org/licenses/by/4.0
date: 2025-06-05
publication date: 2025-06-05
starting page: 16
ending page: 20
doi: 10.71079/ASIDE.GI.06052577

An Unusual Case of Disseminated Hydatid Disease: A Laparoscopic Wonder
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description: Human echinococcosis, caused by Echinococcus tapeworms, is a zoonotic disease in which ingested eggs of the tapeworm form cysts in the organs known as Hydatid cysts. These cysts are commonly found in the Liver and lungs, but in rare cases, they can also be found in the spleen, ovaries, round ligament, and peritoneal cavity. Treatment typically involves surgery. This is a case of a 32-year-old female who presented with chief complaints of pain in the abdomen for 2 months, which was associated with nausea, vomiting, reduced appetite, and increased size of mass per abdomen. Further investigations revealed the presence of multiple disseminated hydatid cysts in the upper abdomen and the peritoneal cavity. This was a rare & unusual entity that was meticulously managed by minimally invasive laparoscopic surgery. Echinococcosis can occur anywhere in the body, with concurrent localizations in the liver, spleen, round ligament, ovaries, and peritoneal cavity, which are rare and pose a diagnostic as well as a surgical management challenge. The inconvenience of multiple localization and the risk of contamination usually lead to open surgery in these cases. The presented case is unique due to the laparoscopic approach to the multiple localizations of hydatid disease, advocating for a minimally invasive first-line approach even in these particular localizations.
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creator: Gajendra Bhati
creator: Raghav Bansal
creator: Vanessa Pamela Salolin Vargas
creator: Ripanbir Singh Kahlon
rights: Copyright (c) 2025 Gajendra Bhati, Raghav Bansal, Vanessa Pamela Salolin Vargas , Ripanbir Singh Kahlon https://creativecommons.org/licenses/by/4.0
date: 2025-06-22
publication date: 2025-06-22
starting page: 13
ending page: 18
doi: 10.71079/ASIDE.GI.05242570

A Systematic Review and Meta-Analysis of Liver Transplant Outcomes in Lean Versus Non-Lean Metabolic Dysfunction-Associated Steatotic Liver Disease Patients
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description: Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent hepatic disease with metabolic dysfunction-associated steatohepatitis (MASH) as its severe necro-inflammatory subtype. At present, it is the second leading cause of liver transplant. A systematic literature review (SLR) was conducted to assess the effect of lean vs non-lean BMI on clinical outcomes after transplant in MASLD patients. Methods: A systematic search of PubMed, Cochrane Library, and Google Scholar databases was executed. Review Manager 5.4.1 was used for statistical analyses. A random-effect model was used with the results reported as Odds Ratio (OR) and 95% confidence interval (CI). A narrative approach was used where it was not feasible to conduct a meta-analysis. Results: Eleven observational studies were included in the SLR. Pooled results from three studies showed no significant difference in mortality between lean and non-lean patients at 1 year (OR= 0.78, p= 0.76), 2 years (OR= 0.83, p= 0.24), and 5 years (OR= 1.07, p= 0.51) post-transplant. There was also no significant relation of lean and non-lean BMI in graft survival, observed over 30 days (OR= 1.34, p= 0.27), 1 year (OR= 0.75, p= 0.25), 2 years (OR= 1.20, p= 0.45), and 5 years (OR= 1.07, p= 0.60) post-transplant. Qualitative analysis suggested morbid obesity is linked with higher waitlist dropout in MASH patients. Conclusion: The qualitative analysis of eight studies indicates a trend towards poorer outcomes in the non-lean group. There is a need for further investigations to comprehensively examine the factors influencing the relationship between BMI and post-transplant outcomes.
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creator: Manesh Kumar Gangwani
creator: Omar Irfan
creator: Muhammad Aziz
creator: Fnu Priyanka
creator: Dushyant Singh Dahiya
creator: Umar Hayat
creator: Fouad Jaber
creator: Hassam Ali
creator: Sumant Inamdar
creator: Mauricio Garcia Saenz de Sicilia
rights: Copyright (c) 2025 Manesh Kumar Gangwani, Omar Irfan, Muhammad Aziz, Fnu Priyanka, Dushyant Singh Dahiya , Umar Hayat , Fouad Jaber, Hassam Ali, Sumant Inamdar , Mauricio Garcia Saenz de Sicilia https://creativecommons.org/licenses/by/4.0
date: 2025-06-26
publication date: 2025-06-26
starting page: 19
ending page: 26
doi: 10.71079/ASIDE.GI.06262582