As usual, in this editorial we would like to draw your attention to 10 key studies:

Links between Helicobacter pylori infection and the pathogenesis of gastric cancer are well established. However, a large unique population-based study in China has now shown for the first time that mass screening for H. pylori infection and subsequent eradication indeed reduces the risk of developing gastric cancer (Pan et al.). The diagnosis of celiac disease usually requires serology testing and duodenal biopsies. Recently, a subtype of celiac disease has been described in which inflammation is limited to the duodenal bulb (“ultra-short celiac disease”). In the first prospective and multicenter cohort of patients with “ultra-short celiac disease,” the disease presentation was comparable to that of individuals with “conventional” celiac disease. This underlines the need for biopsies to be taken from the duodenal bulb as part of the diagnostic workup as recommended by current guidelines (Raju et al.). The benefit of stress ulcer prophylaxis with proton pump inhibitors in ventilated patients has not been clearly demonstrated in prospective trials to date. In a large randomized trial with more than 4800 patients receiving invasive ventilatory support, significantly less gastrointestinal bleeding occurred in patients treated with pantoprazole as compared to placebo. However, mortality remained unchanged, as did the rates of ventilator-associated pneumonia or Clostridioides difficile infections (Cook et al.).

Immune checkpoint blockade can lead to an excellent response in colorectal cancer with mismatch repair deficiency. In the neoadjuvant setting, immunotherapy with nivolumab and ipilimumab achieved a remarkable pathologic response (remaining tumor tissue < 10%) in 95% of cases and complete pathologic response rates (no more detectable tumor) in 68% of cases in a phase 2 trial (Chalabi et al.). The pathogenesis of irritable bowel syndrome (IBS) is complex. In a large prospective and population-based British cohort study, a healthy lifestyle (characterized by non-smoking, optimal sleep habits, physical activity, high-quality diet, and moderate alcohol consumption) was associated with a significantly lower risk of developing IBS (Ho et al.). We would also like to point out the “Translational Science Corner.” A recent report based on mouse models demonstrates mechanisms of how primary sclerosing cholangitis may be associated with a more favorable course of chronic inflammatory bowel disease (Bedke et al.).

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are often incidental findings in older people that result in recurrent follow-up examinations. This raises the question of the optimal age to discontinue screening. Health economic modeling suggests that screening in men may be discontinued between the ages of 76 and 78, regardless of the type of IPMN. For women, this was dependent on the size and type of IPMN (Hamada et al.).

The field of metabolic dysfunction-associated steatotic liver disease and steatohepatitis (MASLD or MASH) is very dynamic. With regard to emerging drug therapies, GLP-1 receptor agonists, and more specifically agonists that also bind the GIP (glucose-dependent insulinotropic peptide) or glucagon receptors, appear to be promising novel therapeutic options. In two phase 2 trials, treatment with tirzepatide (Loomba et al.) and survodutide (Sanyal et al.) was superior to placebo therapy in terms of MASH resolution.

The efficacy of tranexamic acidfor gastrointestinal bleeding remains controversial. In a randomized trial from India in people with liver cirrhosis, the frequency of recurrent bleeding episodes (e.g. endoscopic variceal ligation-induced ulcer bleeding) was reduced by the use of tranexamic acid (Kumar et al.).

We very much hope that these new content-focused additions will appeal to you and make it easier to find the news most relevant to your daily practice. Please feel free to email us at peter.hasselblatt@uniklinik-freiburg.de or tobias.boettler@uniklinik-freiburg.de if you have any suggestions for further improvements!

Best regards,

Peter Hasselblatt and Tobias Böttler
Department of Internal Medicine II, University Medical Center Freiburg (Germany)