Comparative Efficacy of Advanced Therapies for Management of Moderate-to-Severe Crohn’s Disease: 2025 AGA Evidence Synthesis.

For Summary press comment 👇

AGA November 2025

Ascitic fluid analysis ( SAAG )

Adapting dose of DOACs in liver or kidney failure.

Safety of uninterrupted anticoagulation in the setting of routine colonoscopy

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GIE December 2025

HIV infection cycle within a host cell.

HIV first binds to CD4 and CCR5 receptors (1), followed by membrane fusion (2). Once inside, viral RNA is converted into DNA by reverse transcriptase (3), which integrates into the host genome (4). The proviral DNA is transcribed (5) and translated (6) into viral proteins. New viral components assemble near the cell membrane (7) and are released as mature infectious virions.

Each step is a therapeutic target, with antiretroviral drugs designed to block viral replication and prevent immune system destruction.

Chronic Non-bloody Diarrhea and abdominal pain in conjunction with normal appearing colonic mucosa on colonoscopy are hallmarks of microscopic colitis (MC). Although the exact etiology remains unknown, MC is associated with a number of risk factors, such as age > 50 years, female sex, certain medications, smoking, and a history of autoimmune conditions (e.g., celiac disease, rheumatoid arthritis, type 1 diabetes mellitus). The diagnosis is typically confirmed on biopsy, which shows intraepithelial lymphocytic infiltrates in lymphocytic MC or thick, subepithelial collagen bands in collagenous MC. About 50% of patients with MC also present with mild anemia and increased inflammatory markers. Treatment usually consists of management of risk factors (e.g., smoking cessation, discontinuation of any triggering medications) and symptomatic therapy (e.g., loperamide for diarrhea), followed by therapy escalation with corticosteroids.

Cholecystitis is usually caused by the passage of gallstones into the cystic duct. Cystic duct obstruction can lead to gallbladder inflammation with symptoms of right upper quadrant abdominal pain, nausea, and fever, as seen in this patient. Cholescintigraphy (HIDA scan) typically shows delayed or absent uptake of radioactive tracer in the gallbladder; a HIDA scan is primarily used to diagnose cystic duct obstruction if RUQ ultrasound fails to show gallstones. In uncomplicated cholecystitis, cholestasis parameters (i.e., ALP, GGT, and bilirubin) are typically normal or only mildly elevated because there is usually no obstruction of the hepatic ducts or common bile duct.

✳️ Clostridioides difficile is a Gram-positive bacillus causing pseudomembranous colitis, typically after recent broad-spectrum antibiotic use.

▶️ Transmission occurs via the faecal-oral route through ingestion of spores.

▶️ Toxins A and B produced by C. difficile cause intestinal epithelial damage and inflammation leading to colitis.

▶️ Clindamycin is historically associated with a high risk of causing C. difficile infection, though cephalosporins are now more common triggers.

▶️ Oral vancomycin is the first-line antibiotic treatment for initial episodes of C. difficile infection.

▶️ The severity of infection is assessed using criteria such as white cell count, creatinine rise, temperature, and clinical features, guiding management.

▶️ Recurrent infection occurs in approximately 20% after first episode; fidaxomicin or vancomycin are used depending on timing of recurrence.

▶️ Infection control measures: isolation until diarrhoea resolves for 48 hours, use of gloves and aprons, and hand washing (not alcohol gel) to prevent spread.

2026 ADA standard of care “ slide deck “

Primary Biliary Cholangitis in 2025: A New Frontier

AJG December 2025

SUMMARY: Post-banding ulcer bleeding (PBUB) is a significant but understudied complication of endoscopic band ligation (EBL), a primary treatment for esophageal variceal bleeding in cirrhosis. This study aimed to investigate the incidence, mortality, and risk factors for PBUB.

Study Design & Population
A retrospective cohort study was conducted at Bern University Hospital, Switzerland (Jan 2018–Dec 2022). It included 206 patients with cirrhosis who underwent a total of 630 EBL sessions (for primary/secondary prophylaxis or urgent treatment).

Key Findings
Incidence of PBUB:

17.5% of patients experienced PBUB.

6.8% of all EBL procedures resulted in PBUB.

Incidence was higher after urgent EBL (13.1%) vs. prophylactic EBL (3.6%).

Independent Risk Factors (Multivariate Analysis):

Urgent EBL: SHR 2.78 (95% CI: 1.29–6.00, p=0.009).

Elevated Creatinine: SHR 1.04 per 10 µmol/L increase (95% CI: 1.01–1.07, p=0.024).

Clinical Outcomes & Management:

High Resource Use: PBUB required blood transfusions in 88.1% of cases and ICU admission in 74.4%.

High Mortality:

Short-term (in-hospital): 19% for patients with PBUB.

Long-term (52 weeks): 64% for patients with PBUB vs. 54% without.

Survival: Significantly lower in PBUB patients (HR=3.86, p<0.001), with a sharp decline within 4 months post-EBL.

Management: Involved a combination of endoscopic (repeat EBL, clips, spray, TIPS) and medical therapy (antibiotics, vasoactive drugs, PPIs).

Other Notable Results:

Post-banding ulcers (PBU) were common (37.9% per patient), but only a subset progressed to bleeding.

NSBB use was associated with a lower risk of PBUB in univariate analysis, but not in multivariate analysis.

PPI use, anticoagulant/antiplatelet therapy, and endoscopic factors (e.g., number of bands) were not independently associated with PBUB risk.

Patients who developed PBUB had more severe liver disease (higher MELD and Child-Pugh scores) and more frequent decompensation events.

Key Timing:
The median time between the EBL procedure and the occurrence of PBUB was 12 days.

The interquartile range (IQR) was 6–19 days, meaning most cases occurred within this window after the band ligation.

Clinical Context:
PBUB arises from ulcers that develop at the sites where the ligation bands were applied.

It was diagnosed when one or more ulcers at the ligation site were identified as the source of upper gastrointestinal bleeding, with no other bleeding source found.

Endoscopic Classification (Jamwal & Sarin):
The ulcers leading to PBUB were classified as:

Type A: Ulcer with active spurting (17% of PBUB cases)

Type B: Ulcer with oozing (2.4%)

Type C: Ulcer with a clot or pigmented base (56%)

Type D: Ulcer with a clean base (less commonly associated with bleeding)

Independent Risk Factors (Multivariate Analysis)
These factors remained statistically significant after adjusting for other variables:

Urgent EBL (performed for acute variceal bleeding within 24 hours of admission)

Sub-distribution Hazard Ratio (SHR): 2.78 (95% CI: 1.29–6.00, p=0.009)

Elevated Serum Creatinine (a marker of renal impairment)

SHR: 1.04 per 10 µmol/L increase (95% CI: 1.01–1.07, p=0.024)

Factors Associated in Univariate Analysis (but not independent)
These were significant in initial analysis but did not remain independent in the final multivariate model:

Higher MELD Score (SHR: 1.06, p=0.012)

Presence of Infection at the time of EBL (SHR: 4.42, p=0.003)

Elevated INR (SHR: 1.85, p=0.007)

Elevated Total Bilirubin (SHR: 1.03, p=0.018)

Lower Use of Non-Selective Beta Blockers (NSBB) was protective (SHR: 0.47, p=0.017)

Clinical & Demographic Factors Linked to Higher Risk (from cohort description)
More Severe Liver Disease: Patients who developed PBUB had significantly higher Child-Pugh scores and more frequent decompensation events (e.g., ascites, encephalopathy).

Indication for EBL: The incidence was over 3.5 times higher in urgent EBL (13.1%) compared to prophylactic EBL (3.6%).

Procedure Context: Urgent EBLs, often performed in actively bleeding or unstable patients, carried a higher inherent risk.

Factors NOT Associated with Increased PBUB Risk
The study found no significant association between PBUB and:

Proton Pump Inhibitor (PPI) use

Anticoagulant or antiplatelet therapy

Endoscopic technical factors (e.g., number of bands placed, variceal size, endoscopist experience)

Presence of hiatal hernia or gastroesophageal reflux disease (GERD)

Viral Hepatitis