Gastroenterology

JAMA synopsis reinforces 2024 ACG H. pylori treatment guideline for routine practice

This synopsis distills the 2024 American College of Gastroenterology guideline on Helicobacter pylori treatment for clinicians. It summarizes recommended first-line and salvage regimens based on contemporary resistance patterns and eradication data. The article emphasizes systematic post-treatment testing to confirm eradication and prevent complications of persistent infection. It highlights implementation issues, including regimen selection, adherence, and coordination of testing in varied practice settings. 1

Reduced epithelial GPX4 predicts postoperative Crohn’s recurrence and is experimentally druggable

This multicohort study linked reduced intestinal epithelial GPX4 expression at ileocolonic resection with higher endoscopic postoperative Crohn’s recurrence. GPX4 added predictive value beyond standard clinical risk factors across three independent resection cohorts totaling 241 patients. Low GPX4 correlated with a mucosal ER-stress signature but not with CD genetics, histologic severity, or classic recurrence risk factors. In mouse enteritis models, selenium-mediated restoration of epithelial Gpx4 ameliorated inflammation, supporting GPX4 as a future preventive target. 2

Routine terminal ileal intubation adds little value in asymptomatic screening and surveillance colonoscopy

This systematic review and meta-analysis included 11 studies and 25,659 asymptomatic adults undergoing colorectal cancer screening or post-polypectomy surveillance. Among 13,672 procedures with terminal ileal intubation, any ileal abnormality was found in 1.74%, mostly nonspecific and clinically inconsequential. Clinically significant pathology yield was only 0.28%, and Crohn’s disease detection was about one case per 1,000 ileoscopies. The authors conclude routine terminal ileal intubation in this population offers negligible clinical benefit and should not be performed routinely. 3