Avoidant-restrictive food intake disorder (ARFID) is an eating disorder diagnosis implemented with DSM-5 in 2013. Elevated risk for ARFID in patients with gastrointestinal disorders is suggested. This systematic review explored (1) methods used to identify patients with gastrointestinal disorders and comorbid ARFID and (2) their clinical characteristics. Following the PRISMA guidelines, Medline/PubMed, Embase, PsycInfo and CINAHL were searched for studies from January 2000 to December 2025 and a narrative analysis of the systematically extracted data was performed. Twenty-three studies with a total of 6211 participants were included. Studies were primarily observational with retrospective chart reviews or self-reported surveys. Twenty studies were conducted in tertiary gastroenterology clinics, primarily covering disorders of gut-brain interaction. Four studies focused on paediatric populations, 18 on adults and one included both. Participants were predominantly female, aged 6-90 years. ARFID case identification was heterogeneous regarding both data collection method, application of diagnostic criteria and diagnostic tool. ARFID symptoms were most consistently reported, with fear of aversive consequences, such as fear of abdominal pain, nausea or vomiting, being the most dominant. The negative consequences of ARFID symptoms were less consistently described. Literature on ARFID in gastrointestinal populations has increased in recent years. However, inconsistent identification of ARFID cases may lead to an overestimation of ARFID prevalence among patients with gastrointestinal disorders. Longitudinal studies with full diagnostic criteria applied are needed to better understand the prevalence and presentation of ARFID in gastrointestinal populations.

Strategic management is a critical yet underutilized tool in clinical gastroenterology, enabling physician leaders to navigate the evolving healthcare landscape with clarity and purpose. By integrating structured frameworks and tools, gastroenterologists can address challenges such as rising clinical complexity, workforce constraints, and value-based care demands. This approach translates mission-driven goals into actionable strategies, enhancing operational efficiency, quality, and patient outcomes. Through environmental analysis, strategy formulation, implementation, and evaluation, gastroenterology leaders can build resilient systems, scale innovations, and foster sustainable programs. Strategic thinking bridges clinical expertise with transformative leadership, positioning GI care for long-term success in delivering value-driven healthcare.

Completion of follow-up colonoscopy after a positive stool-based test varies across health settings. Colonoscopy performed > 6months following a positive stool test is associated with adverse colorectal cancer outcomes. This retrospective study included 701 patients aged 45-75 in an urban, integrated health system with a positive stool test between February 1, 2022, and January 31, 2023. We examined rates of timely (i.e., within 180days) follow-up colonoscopy and at varying time points (90days, 365days, and any time during our follow-up period). Multivariable Cox proportional hazard models examined factors associated with timely colonoscopy, and a Pareto analysis identified barriers to timely completion. The median age of this cohort was 64years (IQR 56-70); 52.1% were female, 48.2% were non-Hispanic White, and 52.4% had a Charlson Comorbidity Index score ≥ 3. The rate of timely follow-up colonoscopy was 59.6%, with rates of 44.5% and 68.5% at 90days and 365days, respectively. In Cox models, patient outreach increased timely colonoscopy by 52% (HR 1.52, 95% CI 1.21-1.91), while Direct Access patients were less likely to complete timely colonoscopy (HR 0.59, 95% CI 0.41-0.86); no associations were observed with sociodemographic factors. The most common barriers to timely colonoscopy were (1) lack of gastroenterology clinic visit, (2) patient refusal, and (3) colonoscopy no-show or cancellation. The rate of timely, follow-up colonoscopy in this older, sicker population is suboptimal. System-level factors impact timely completion. A Pareto analysis reveals multiple elements that contribute to delays in colonoscopy and can inform interventions.

Rubinstein-Taybi syndrome is a rare genetic condition associated with a wide range of physical, cognitive, and developmental impairments, yet its gastrointestinal manifestations remain poorly characterized. Case reports and small series suggest a high prevalence of gastroesophageal reflux, constipation, dysphagia, and nutritional compromise, but no large cohort has examined these symptoms in detail. This study aimed to characterize gastrointestinal and nutritional comorbidities in children with Rubinstein-Taybi syndrome seen at a tertiary pediatric center between 2013 and 2023. Among 85 affected patients, 46 (54%) reported gastrointestinal symptoms, and 31 (66%) were evaluated in the Gastroenterology clinic. Symptoms frequently predated the genetic diagnosis. Constipation was most common, followed by reflux symptoms, dysphagia, vomiting, and feeding intolerance or poor weight gain. Most patients underwent at least one diagnostic evaluation, including upper gastrointestinal imaging, video swallow studies, or esophagogastroduodenoscopy. Nearly half required gastrostomy tube support, typically in later childhood, with subsequent improvements in weight and body mass index z-scores and successful transitions to partial or full oral intake in some cases. Oral-fed patients demonstrated modest growth improvement over shorter follow-up intervals. These findings highlight a substantial gastrointestinal disease burden in Rubinstein-Taybi syndrome and underscore the importance of early recognition and multidisciplinary management.

AGA Clinical Practice Update on Management of Gastric Polyps: Expert Review.

Limited data exist on the expression of immune checkpoint molecules (ICMs) in celiac disease (CD). This study aims to evaluate Tim-3 expression in duodenal biopsies from CD patients and those of non-CD patients, some of whom have increased intraepithelial lymphocytes (IELs). Duodenal tissues from 214 individuals who applied to the adult gastroenterology clinic were re-evaluated. The American College of Gastroenterology Guidelines were used to confirm the diagnosis of CD. Sections were prepared from formalin-fixed paraffin-embedded duodenal tissues for immunohistochemical analyses. The area with the highest Tim-3 expression in the lamina propria was counted at 40x (HPF) magnification. Receiver operating characteristic analysis offered a cut-off value predicting CD diagnosis as “>9 per HPF” (p<0.001, AUC: 0.744). High Tim-3 expression was associated with higher IEL numbers and a diagnosis of CD and correlated with endoscopic and serological findings of CD (p<0.001) in the whole cohort. In the CD group, a correlation was found between Tim-3 positive cell numbers and mean IEL counts (p=0.007, Spearman’s rho: 0.279). On the other hand, no difference was detected between Tim-3 expression and Marsh types (p=0.291), serum tTG (p=0.482), and EMA (p=0.765) titers in CD patients. In the non-CD group, Tim-3 expression was unaffected by either the increase in IEL or gastric Helicobacter pylori infection. In this study, we first demonstrated the expression profile of Tim-3 in the duodenal mucosa as an ICM. Confirmation of these findings with further analyses will provide a better understanding of the inflammatory cycle in the duodenal mucosa and new insights into diagnosing and understanding CD pathogenesis.

Helicobacter pylori is one of the most prevalent bacterial infections in humans, affecting more than half of the global population. It is a major contributor to gastric disorders among patients attending gastroenterology clinics. Therefore, this study aimed to evaluate the fecal prevalence and associated factors of Helicobacter pylori infection in adult patients with dyspepsia in Mogadishu, Somalia. A cross-sectional investigation was conducted at Shaafi Hospital between February and June 2025, encompassing 385 adult patients with dyspepsia. Researchers employed structured questionnaires to collect sociodemographic data and Helicobacter pylori infection-associated factors. Helicobacter pylori fecal antigen was detected in stool samples using lateral flow immunochromatographic assay. Binary and multiple logistic regression analyses were performed to identify the factors involved. A statistical association between variables was recognized when the p-value was below 0.05, ensuring a 95% confidence level. Out of 385 adult patients with dyspepsia examined, 40% (n = 154) tested positive for Helicobacter pylori infection. Bivariate analysis revealed several factors linked to the infection: residing with children or elderly individuals (OR = 0.447, p = 0.014), consuming unwashed fruits or vegetables (OR = 1.658, p = 0.017), and eating white meat (OR = 1.986, p = 0.001). However, in the multivariate analysis, only two factors remained significant: living with children or elderly people was associated with a reduced likelihood of infection (AOR = 0.471, p = 0.015), whereas consumption of white meat was associated with a higher risk of infection (AOR = 1.699, p = 0.019). Other factors, such as hygiene habits, income, education, and smoking, did not show statistically significant associations. This study found a notable prevalence of Helicobacter pylori infection among adults with dyspepsia. Consumption of white meat was associated with an increased risk of infection, whereas living with children or elderly individuals appeared to provide some protection. These findings highlight the need for targeted public health strategies and suggest the need for further investigation into dietary and household factors that may influence Helicobacter pylori transmission.

Aim: Celiac disease (CD) is a chronic inflammatory enteropathy triggered by an autoimmune response to gluten. This study aimed to determine gastric pathologies accompanying CD, with a focus on the frequency of Helicobacter pylori (H. pylori) infection and atrophic gastritis. Material and Methods: Between January 2010 and March 2018, 47 patients diagnosed with CD at the Gastroenterology Clinic of Kayseri Training and Research Hospital, who underwent gastric biopsy during endoscopy, were enrolled as the study group. The control group consisted of 47 age- and gender-matched patients who underwent endoscopy for dyspeptic complaints. The groups were compared regarding the presence of atrophic gastritis, H. pylori, lymphocytic gastritis, and intestinal metaplasia. Data were analyzed using IBM SPSS V23. Results: A total of 94 patients (47 CD, 47 dyspepsia) were included. Both groups comprised 20 male and 27 female patients. Atrophy frequency was 27.7% in the CD group and 17.0% in the dyspepsia group (p = 0.322). H. pylori positivity was 61.7% in the CD group and 74.5% in the dyspepsia group (p = 0.269). Lymphocytic gastritis was present in 12.8% of the CD group but was not detected in the control group (p = 0.011). No statistical difference was found in metaplasia frequency (p = 0.307). Serum vitamin B12 levels were below 200 pg/mL in 80% of CD patients. Conclusion: Gastric biopsy during endoscopy is recommended for celiac patients, particularly those with persistent anemia, dyspepsia, or B12 deficiency despite a gluten-free diet. While the frequencies of H. pylori infection and atrophic gastritis were similar to those in the control group, lymphocytic gastritis was significantly more common in CD patients. This finding underscores the importance of evaluating gastric mucosal changes to manage refractory symptoms and nutritional deficiencies effectively.

This study aimed to evaluate the relationship between Helicobacter pylori infection and duodenal eosinophil-mast cell counts in dyspeptic patients with a history of drug allergy compared to those without such a history. A total of 88 dyspeptic patients with a history of drug allergy and 88 dyspeptic patients without a history of drug allergy (control group), who presented to our internal medicine and gastroenterology clinics, were included in the study. The demographic characteristics, laboratory findings, gastric-duodenal endoscopic findings and biopsy samples obtained via upper gastrointestinal endoscopy were retrospectively compared between the 2 groups. Statistical analysis was performed on the demographic, laboratory, endoscopic and histopathological data of both groups. There was no statistically significant difference between the groups in terms of age and gender parameters (P > .05). However, lymphocyte levels were found to be significantly higher in the group with a history of drug allergy compared to the control group (P = .035 and P = .018, respectively). The presence of H pylori infection, gastric atrophy, and duodenal eosinophil-mast cell counts were significantly higher in the drug allergy group compared to the control group (P < .05). No statistically significant differences were found between the groups in terms of intestinal metaplasia, gastric dysplasia, gastric edema/hyperemia, and duodenal edema/hyperemia (P > .05). The history of drug allergy should be considered in the management of dyspeptic patients. Further large-scale, multicenter, randomized controlled studies are warranted in this area.

Helicobacter pylori (H. pylori) infection remains a global public health burden, particularly in developing countries. While its eradication is a cornerstone for gastric cancer prevention, management is challenged by high infection rates, rising antibiotic resistance, and suboptimal treatment efficacy. Compounding these issues, patient loss to follow-up (LTFU) has emerged as a critical factor directly undermining the success of eradication therapy. This study aimed to investigate the risk factors associated with LTFU after H. pylori eradication, and to develop a predictive model for assessing the risk of LTFU. We conducted a prospective cohort study (April 2023-September 2024) enrolling treatment-naïve patients from a tertiary gastroenterology clinic. Following data collection via questionnaires and follow-ups, a nomogram for predicting loss to follow-up (LTFU) was developed by applying LASSO regression for variable selection and logistic regression for model building. The model was evaluated by its area under the ROC curve (AUC), calibration, and decision curve analysis (DCA), with internal validation performed via 500 bootstrap resamples to confirm reliability. A total of 145 (37.76%) patients failed to follow up. From 19 potential predictors, 6 variables were independent predictive factors. They were included in the risk score: BMI > 30 kg/m2 (OR = 3.81, 95% CI: 1.16-12.50), government employee (OR = 2.10, 95% CI: 1.21, 3.63), distance to hospital >10 km (OR = 11.27, 95%CI: 6.29-20.18), alcohol consumption (OR = 1.82, 95% CI: 1.19-2.79), outpatient waiting time (OR = 1.01, 95% CI: 1.00-1.02), and lack of awareness of follow-up (OR = 3.32, 95% CI: 1.93-5.69). In the training set, the model demonstrated an AUC of 0.885 (95% CI: 0.843-0.918), with a sensitivity of 93.58% and a specificity of 67.92%. Comparatively, in the test set, the model achieved an AUC of 0.862 (95% CI: 0.794-0.925), with a sensitivity of 83.33% and a specificity of 77.50%, effectively forecasting the risk of patient LTFU in H. pylori eradication. DCA demonstrated the favorable clinical utility of the nomogram, suggesting its potential as a valuable auxiliary tool for predicting the risk of LTFU. The nomogram effectively assessed the risk of LTFU after H. pylori eradication, thereby contributing to improved treatment management outcomes.

Abstract Objective This case series aims to describe whether transient elastography (TE) as a marker of liver stiffness is associated with clinically important liver disease in children and young adults with Shwachman‐Diamond Syndrome (SDS). Methods All patients ≤25 years of age with genetically confirmed SDS seen in the Pediatric Gastroenterology Clinic at Boston Children's Hospital from 07/2017 to 11/2019 were included. Data collected included TE, hepatic transaminases, fecal elastase, and anthropometry. The correlation of liver stiffness measurements with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was assessed by Spearman rank correlation accompanied by 95% confidence intervals based on Fisher's Z transformation. Results Eight patients (six female) were identified with genetically confirmed SDS for whom the median age on the day of TE was 6years. Median (range) AST and ALT were 31 U/L (17–61) and 30 U/L (12–87), respectively, obtained within a median of 18 days (range 0–168) from liver stiffness measurement (LSM). All patients had exocrine pancreatic insufficiency as defined by fecal elastase &lt;200 μg/g. Five patients had abdominal ultrasound within a median of 1.7 years (range 0.0–5.1), of whom four had normal results (one unknown). All eight patients underwent TE with median (range) LSM and controlled attenuation parameter (CAP) measurement ( n = 6) of 5.2 kPa (3.3–6.4) and 171 dB/m (113–250), respectively. LSM greater than METAVIR F0 was not associated with AST and ALT elevations. Conclusion In our case series of eight patients with SDS, LSM greater than METAVIR F0 was reported in three patients, two of whom had normal transaminases. This suggests that subclinical liver disease may exist in SDS patients with normal hepatic transaminases.

From Gut Feeling to Gray Matter: Mapping Defecation Urgency in Irritable Bowel Syndrome.

AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review.

Adults with inflammatory bowel disease (IBD) experience disproportionately high rates of comorbid mental health conditions, including depression and anxiety, which are associated with increased disease activity, reduced treatment adherence, higher healthcare utilization, and reduced quality of life. In this narrative review, we discuss ethical and practical considerations for mental health screening in adult patients with IBD and propose actionable strategies for implementation in gastroenterology practices. This narrative review applies the Four-Box Model of Clinical Medical Ethics to evaluate challenges and opportunities associated with anxiety and depression screening in IBD care. Practical considerations were developed based on existing literature on mental health screening in medical settings and expert opinion. Mental health screening in gastroenterology clinics is ethically justified and practically feasible when implemented with appropriate safeguards. Key challenges include limited visit time, clinician discomfort, symptom overlap between IBD and mental health comorbidities, and management of suicidal ideation. Opportunities include leveraging validated brief screening tools, normalizing mental health discussions, and establishing clear workflows for positive screens. The implementation of routine mental health screening for adults with IBD aligns with core ethical principles and supports comprehensive biopsychosocial care. With thoughtful implementation, gastroenterology practices can improve identification of depression and anxiety and facilitate timely access to appropriate mental health services.

IntroductionChronic exogenous exposures related to perianal fistula care may lead to systemic effects in patients with Crohn’s disease and require a multisystemic evaluation. In this case, we aimed to raise awareness by presenting a rarely encountered treatment-related complication in a patient with Crohn’s diseaseClinical CaseA 22year-old female with history of ileocolonic, fistulizing Crohn’s disease had previously undergone right hemicolectomy and enterovesical fistula repair. The patient, who had prior exposure to adalimumab and ustekinumab, was most recently on upadacitinib, which had been discontinued 2 months earlier due to the development of a perianal fistula under treatment. Because of recurrent perianal fistulas, she had been under follow-up by general surgery. She was admitted to the gastroenterology clinic for further evaluation due to anal pain and elevated acute phase reactants.On admission, physical examination revealed complaints of hot flashes, sweating, and hand tremors. Tenderness in the perianal region and an active fistula tract were observed. Laboratory tests showed CRP 124 mg/L, TSH <0.01 mIU/L, fT3 >30.80 pmol/L, and fT4 >154.80 pmol/L. Thyroid ultrasonography(USG) was normal, while Tc-99m pertechnetate uptake was measured at 0.15% with a scintigraphic pattern reported as “compatible with exogenous iodine exposure/thyroiditis.” Thyroid antibody profile was negative. Spot urine iodine was 57 µg/L. Upon re-evaluating the history, it was learned that the fistula tract had been irrigated regularly with povidone-iodine for the past three months. With elevated urinary iodine levels and regular povidone-iodine exposure, the patient was diagnosed with iodine-induced thyrotoxicosis.Endocrinology consultation recommended initiation of methimazole 30 mg/day and propranolol 20 mg twice daily, with beta-blocker dose titrated according to symptoms. The patient was monitored daily for thyroid storm.Corticosteroid therapy was not initiated due to the presence of active perianal fistula and abscess. During this period, infection control was achieved with parenteral antibiotics, surgical drainage and seton placement, as well as initiation of infliximab therapy.The patient achieved control of the perianal infection, and Infliximab treatment was given for Crohn's. With antithyroid and symptomatic treatment, thyrotoxic manifestations were stabilized.ConclusionThis case demonstrates that chronic exogenous iodine exposure during perianal fistula care in Crohn’s disease may lead to systemic thyroid dysfunction. In the literature, iodine toxicity has been reported to cause various thyroid disorders. For the diagnosis; thyroid function tests, spot urinary iodine measurement, and thyroid scintigraphy are of particular importance. In conclusion, systemic effects of iodine-containing antiseptics used during perianal fistula care in Crohn’s patients should be carefully considered, and thyroid functions should be monitored regularlyTable 1:Follow-up of the patient's thyroid function test results

Background: Diabetes mellitus (DM) is a condition that may increase the severity of acute pancreatitis (AP) through chronic inflammation and disturbances in immune responses. However, the independent effect of DM on clinical outcomes in AP has not yet been fully elucidated. Methods: In this retrospective cohort study, 492 patients diagnosed with acute pancreatitis at the Gastroenterology Clinic of Ankara Bilkent City Hospital between January 2022 and March 2025 were included. Patients were divided into two groups based on the presence of diabetes, and outcomes were compared using statistical methods. Results: Of the total 492 patients (mean age 58.6 ± 17.2 years; 50.2% female) included, 98 (19.9%) had DM. Moderate-to-severe AP occurred in 67.3% of diabetic versus 37.8% of non-diabetic patients (p < 0.0001), and severe disease developed more frequently in the diabetic group (6.1% vs. 1.0%, p = 0.0057). Systemic complications were significantly more common in patients with diabetes (45.9% vs. 26.9%, p = 0.0004). Hospital mortality was higher among patients with diabetes (9.2% vs. 4.6%, p = 0.0344), and Kaplan–Meier analysis demonstrated numerically lower overall survival in patients with diabetes (log-rank p = 0.095), with early divergence in survival curves. Cox proportional hazards analysis confirmed diabetes as an independent predictor of in-hospital mortality (adjusted HR 2.64, 95% CI 1.17–5.97; p = 0.019). After adjustment for confounders, diabetes remained independently associated with the development of moderate/severe pancreatitis (adjusted OR 2.00, 95% CI 1.24–3.22; p = 0.004). Diabetes also independently predicted in-hospital mortality (adjusted OR 3.36, 95% CI 1.35–8.34; p = 0.009), along with APACHE II score. ROC analysis demonstrated that adding diabetes mellitus to the APACHE II score significantly improved mortality prediction compared with APACHE II alone (AUC 0.785 vs. 0.724). The retrospective and single-center design of this study may limit its generalizability and create potential selection bias. There were insufficient data on the type of diabetes, its duration, and glycemic control (e.g., HbA1c), and therefore, we could not assess these factors, all of which may influence risk estimates. Although the survival curves showed early divergence, the borderline log-rank significance (p = 0.095) highlights the limited statistical power to detect long-term survival differences in this cohort. Conclusions: DM is associated with substantially increased severity and in-hospital mortality in AP, primarily through an elevated risk of systemic organ failure. Incorporation of diabetes status into early severity stratification may improve prognostic accuracy and guide closer monitoring and timely interventions in this high-risk population.

With the approval of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for pediatric obesity, families are increasingly considering pharmaceutical treatment alongside lifestyle optimization for their children, although how caregivers will make these decisions remains unexplored. This is especially important in contexts where food insecurity may limit the feasibility of lifestyle change and adjunct therapy could improve outcomes. To explore how caregivers make decisions regarding the inclusion of GLP-1 RAs for pediatric obesity treatment in the context of food insecurity. In this qualitative study, eligible participants were caregivers (aged ≥18 years) of children (aged <18 years) with obesity and metabolic dysfunction-associated steatotic liver disease who screened positive for moderate-severe food insecurity between July 1, 2022, and October 31, 2023. Caregivers were recruited from pediatric gastroenterology clinics of a regional academic health care system. Semistructured interviews via telephone or video were offered in participants' preferred language between December 1, 2023, and April 30, 2024. The main outcome was factors influencing caregiver decisions regarding medication use for their child's metabolic disease. Interview transcripts were translated to English as needed, then thematically analyzed inductively by 2 research investigators to identify themes within an array of caregivers' decision-making processes. Of 37 eligible caregivers, 21 completed interviews, 20 of which were included in the analysis. Of the 20 caregiver participants (19 [95%] mothers; mean [SD] age, 40.5 [6.1] years), 18 (90%) were born outside the US, 13 (65%) had not completed high school, and 15 (75%) used a language other than English in clinical settings. Of the 20 child patients, 18 (90%) were male, and mean (SD) age at interview was 12.9 (2.9) years. All caregivers had received lifestyle-related recommendations from their child's physicians and had been referred to dietetics; 10 (50%) had met with a dietitian. Twelve (60%) desired adjunct pharmacotherapy for their child. Three common themes influenced caregiver decision-making about GLP-1 RA use: (1) prior experience with lifestyle change, (2) trust in the safety and efficacy of GLP-1 RAs, and (3) values regarding optimal care for children. An updated conceptual framework was applied to illustrate caregivers' decision-making. In this qualitative study, children's caregivers experiencing food insecurity expressed interest in both lifestyle-only and medication-inclusive approaches, with decisions shaped by lived experience, perceptions of safety, and values. Shared decision-making conversations in clinical settings that acknowledge these influences-and address barriers to both treatment options-could foster more family-centered, equitable, and effective pediatric obesity care.

Abstract Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD). The main goal of treatment is to induce and maintain remission. Therefore, determining disease activity plays a crucial role in treatment decisions. (1) EUS has been studied in the assessment of UC activity. A scoring system was developed by Tsuga et al., and later Yan et al. proposed a revised EUS-UC score to improve interrater reliability. (2,3) Despite previous studies, the necessity of EUS in assessing UC activity remains uncertain. In this study, we aimed to evaluate the efficacy of EUS in assessing UC activity, compare EUS findings with clinical, biochemical, endoscopic, and histological parameters, and investigate whether EUS is superior to the endoscopic Mayo score and the Mayo score in predicting histological activity. Methods The data of 39 patients aged 18 and older, diagnosed with UC, who underwent rectal radial EUS at Dokuz Eylül University Faculty of Medicine Hospital, Gastroenterology Clinic between 01.01.2024 and 01.10.2024, were retrospectively analyzed. Anamnesis information, Mayo score, Truelove-Witts classification, endoscopic Mayo score, laboratory values, and EUS findings were obtained from the hospital information system. Preparations retrieved from the pathology archive were reevaluated, and Geboes histological score(GHS), Nancy histological index (NHI), and Robart histopathology index (RHI) were calculated. EUS findings were compared with other parameters. Results A significant positive correlation was found between revised EUS UC score and Mayo score (r = 0,723; p &amp;lt; 0,001), endoscopic Mayo score (r = 0,710; p &amp;lt; 0,001), GHS (r = 0,506; p &amp;lt; 0,001), NHI (r = 0,576; p &amp;lt; 0,001), and RHI (r = 0,553; p &amp;lt; 0,001). Rectal wall thickness also correlated with fecal calprotectin (r = 0,348; p = 0,035). When revised EUS UC score analyzed in Mayo score subgroups, the difference between remission and mild activation groups (p = 0,007), and difference between remission and medium/severe activation groups (p = &amp;lt;0,001) were statistically significant. ROC analysis showed that, according to GHS/NHI, the AUC for the revised EUS UC score was 0,872 (95% CI: 0,750-0, 995; p = 0,001), while the AUC for the Mayo score was 0,959 (95% CI: 0,903-1, 000; p &amp;lt; 0,001). The DeLong test indicated no significant difference between the AUCs (p = 0,1646). Conclusion EUS was found to be effective in assessing UC activity but its superiority over the Mayo score in predicting histological activity could not be demonstrated. To investigate the superiority of EUS over traditional methods, larger sample-sized, prospectively designed cohort studies are needed, in which inter-observer reliability is assessed, patients are followed up after treatment, and long-term outcomes are evaluated.

Abstract Background This study aimed to evaluate the effect of a structured patient education program based on the Health Belief Model (HBM) on treatment adherence and patient-nurse collaboration in individuals diagnosed with Inflammatory Bowel Disease (IBD) and receiving anti-TNF therapy. Methods A randomized controlled experimental design was employed. A total of 140 patients followed in gastroenterology clinics were assigned to intervention (n = 70) and control (n = 70) groups through stratified randomization. While both groups received an informational brochure, only the intervention group was provided with HBM-based structured patient education. Data were collected at three time points and analysed using SPSS 25.0. Data collection tools included a demographic information form, anti-TNF Adherence Scale, the Turkish version of the Partners in Health Scale (PIH-TR), and the Patient Education Satisfaction Scale. Results The intervention group showed a statistically significant improvement in treatment adherence, patient-nurse collaboration, and satisfaction levels ($p &amp;lt; 0.05$). Positive changes were particularly observed in the dimensions of personal factors, treatment discontinuation, and anxiety. The education program was found to be effective for both newly diagnosed patients and those with long-term disease duration. Conclusion The Health Belief Model (HBM)-based structured education has been shown to significantly improve treatment adherence, patient-nurse collaboration, and satisfaction levels. It increased participants’ awareness, reduced anxiety, enhanced treatment compliance, and encouraged more active involvement in disease management. The findings indicate that model-based patient education is an effective and transformative nursing intervention in chronic disease management.

The Constipation Scoring System (CSS) is a validated tool for assessing constipation severity and has been previously applied in Parkinson's disease (PD) populations. However, comparative data on post-treatment CSS outcomes between individuals with and without PD remain lacking. This study aimed to compare post-treatment constipation severity between PD and non-PD patients in real-world clinical settings, with particular focus on neurology and gastroenterology outpatient clinics. This retrospective chart review included 67 patients with PD from a neurology clinic and 50 non-PD patients with constipation from a gastroenterology clinic. Baseline characteristics were retrieved from electronic medical records. Follow-up assessments were conducted through direct or telephone interviews to evaluate constipation severity using the CSS. Additional data were collected on patients' self-reported intake of water, coffee, carbohydrates, and fiber, as well as exercise habits. Post-treatment CSS scores did not differ significantly between groups (PD: 6.07 ± 3.57 vs. non-PD: 5.24 ± 2.84; p = 0.172), with most participants classified as having mild constipation. No significant differences were observed in daily water, coffee, or fiber intake, or in exercise habits. However, non-PD patients reported significantly higher carbohydrate intake compared to PD patients (p = 0.003). PD patients more frequently reported long-standing constipation symptoms (≥ 6 years) than non-PD patients (p < 0.001). Patterns of laxative use also differed: while sennosides were most commonly used in both groups, non-PD patients more frequently used lactulose and mucilin, whereas PD patients more commonly used Unison enemas (p = 0.020) and milk of magnesia (p = 0.070). Although constipation severity and treatment outcomes were comparable between PD and non-PD patients, PD patients more often experienced long-standing symptoms and demonstrated distinct patterns of laxative use. Prospective studies are warranted to evaluate standardized treatment protocols to better clarify treatment outcomes and inform clinical practice.