Gastroenterology

Updated AGA MASLD pathway embeds new nomenclature, drugs, and implementation across care settings

This AGA pathway updates MASLD definitions and terminology while incorporating new FDA-approved medications into structured management algorithms. It emphasizes risk-based screening and stratification to identify which patients need gastroenterology or hepatology referral from primary or metabolic clinics. The pathway addresses liver manifestations alongside metabolic traits and elevated cardiovascular risk common in MASLD. An explicit implementation framework grounded in established models is provided for primary care, endocrinology, cardiology, obesity medicine, and GI practices. 1

Crohn’s remission shows persistent diet–microbiome–epithelial derangements despite deep immune suppression

Among 191 subjects, patients with Crohn’s disease in remission had global differences from non-IBD controls across diet, microbiome, metabolome, and ileal transcriptome. Remission featured marked downregulation of adaptive T-cell and innate granulocyte genes, indicating strong mucosal immune suppression. Despite this, epithelial antimicrobial pathways, DUOX2, and goblet cell and mucin glycosylation genes were upregulated, suggesting ongoing epithelial stress and barrier remodeling. Remission diets were higher in ultraprocessed foods and lower in fiber, folate, vitamin C, and vegetables than in controls. Greater ultraprocessed food intake associated with more dysbiotic microbial signals and lower mucin glycosylation gene expression. These persistent perturbations during remission suggest adjunctive interventions targeting diet, epithelium, microbiota, and metabolism to deepen and prolong remission. 2

AI-assisted EGD improves inspection completeness but not confirmed gastric neoplasm detection

In a 24-center RCT including 29,514 patients, AI-assisted EGD did not increase pathologically confirmed gastric neoplasm detection versus standard EGD. The relative risk for confirmed neoplasm detection with AI was 1.13, with confidence intervals crossing one and non-significant P value. AI modestly improved neoplasm detection based on original pathology but not after central pathologic review. AI significantly reduced blind spots per procedure yet lengthened procedure and inspection times. Exploratory analyses suggested possible benefit for less experienced endoscopists and during fatigue, but these findings were not definitive. 3

Cold snare and cold EMR are non-inferior to hot EMR for 10–20 mm sessile serrated lesions

In a multicenter non-inferiority RCT of 159 intermediate-size sessile serrated lesions, CSP and cold EMR matched hot EMR for complete histologic resection. Complete resection rates were around 90% for CSP and cold EMR and similar for hot EMR, meeting non-inferiority thresholds. CSP had shallower vertical resection depth but this improved with submucosal injection and was accompanied by shorter polypectomy and total procedure times. En bloc resection rates were highest with hot EMR, but CSP en bloc rates improved with submucosal injection. These data support cold techniques as effective, efficient alternatives to hot EMR for 10–20 mm sessile serrated lesions, with potential safety advantages. 4