Gastroenterology

Importance Globally, 968 350 new cases and 659 853 deaths from gastric cancer were reported in 2022. In the US, 30 300 new cases and 10 780 deaths were estimated in 2025.

Observations Gastric cancer is more common in men, and the median age at diagnosis is 68 years. Most gastric cancers (>90%) are adenocarcinomas. Worldwide, 85% of cases arise from the stomach body or antrum and 15% from the cardia. In the US, more than 90% of patients diagnosed with gastric cancer present with symptoms such as weight loss and abdominal pain. At presentation, approximately 13% have localized disease (limited to the stomach), 15% to 25% have locally advanced disease, defined as a tumor that has spread to regional lymph nodes, and 35% to 65% have metastatic disease. Helicobacter pylori infection is a treatable risk factor associated with 90% of gastric body and antrum cancers globally. Additional modifiable risk factors include smoking, alcohol, obesity, and salt intake. In countries with high incidence such as Japan and Korea, routine endoscopic screening beginning at age 40 years is associated with improved survival. Diagnosis is made by endoscopic biopsy. Patients with localized gastric cancer are treated with surgical resection and have a 5-year relative survival rate of 75% with treatment. Patients with more advanced-stage disease should receive gastrectomy, perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel and immunotherapy (durvalumab). Metastatic or unresectable disease may be treated with chemotherapy, immunotherapy, and/or targeted therapy depending on biomarkers, including programmed cell death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (ERBB2; formerly HER2 or HER2/neu), and claudin-18, isoform 2 (CLDN18.2). For PD-L1–expressing gastric cancer, adding immune checkpoint inhibitors, such as nivolumab and pembrolizumab, is associated with an additional 3 months of survival when compared with chemotherapy alone. For gastric cancers overexpressing the ERBB2 or CLDN18.2 proteins, the addition of trastuzumab or zolbetuximab, respectively, is associated with an additional 3 to 4 months’ survival. Early supportive care focusing on symptom management and on nutritional and psychosocial support is associated with 3 months of survival benefit. Less than 10% of patients with metastatic gastric cancer survive more than 5 years.

Conclusions and Relevance Approximately 30 300 new cases of gastric cancer are diagnosed annually in the US. Localized gastric cancer is treated with gastrectomy, and locally advanced disease is treated with surgery and chemoimmunotherapy. For patients with unresectable or metastatic gastric cancer, chemotherapy with immune checkpoint inhibitors and targeted therapies such as trastuzumab or zolbetuximab improves survival by several months.

Author/s:

Anuj Kishor Patel, Nilay S. Sethi

What Is Diverticulitis?

Megan George — Fri, 14 Nov 2025 19:07:17 +0000

Date Added:

November 14, 2025

Journal/Publication:

JAMA Patient Page

Publication Date:

November 13, 2025

URL:

What Is Diverticulitis?

Type:

Patient Education Materials

Format:

Poster

DOI (1):

10.1001/jama.2025.17403

Keywords

Gastroenterology

Diverticulitis

Diverticulum

PMID (1):

41231515

MeSH

diabetes mellitus, type 2

Analgesics

analgesics, opioid

Anti-Inflammatory Agents

Anti-Inflammatory Agents, Non-Steroidal

Diverticulitis

Diverticulitis, Colonic

risk factors

Diverticulum, colon

Inflammation

Ehlers-Danlos Syndrome

Information for patients about diverticulitis. James W. Mold, MD, MPH

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Diverticulitis involves inflammation of outpouchings of the intestinal wall, a condition known as diverticulosis.

Risk factors for diverticulosis include being older than 65 years, obesity (body mass index [BMI] of 30 or more), high blood pressure, type 2 diabetes, certain medications (such as opioids, steroids, and nonsteroidal anti-inflammatory drugs [NSAIDs]), connective tissue diseases (such as polycystic kidney disease, Marfan syndrome, and Ehlers-Danlos syndrome), and specific genetic variants.1

By age 60 years, nearly 60% of people have diverticulosis, most often on the left side of the colon. About 1% to 4% of people with diverticulosis develop diverticulitis in their lifetime. Acute diverticulitis affects about 180 per 100 000 people in the US each year, resulting in approximately 200 000 hospitalizations annually.

Author/s:

Shreya Narayanan, Christopher D. Jackson, MD

Hemorrhoidal Disease: A Review

Megan George — Tue, 19 Aug 2025 16:12:53 +0000

Date Added:

August 19, 2025

Journal/Publication:

JAMA

Publication Date:

August 18, 2025

URL:

Hemorrhoidal Disease: A Review

Format:

Article

DOI (1):

10.1001/jama.2025.13083

Keywords

Gastroenterology

colorectal

hepatology

PMID (1):

40824576

MeSH

Pelvic Organ Prolapse* / surgery

A review of the diagnosis and management of patients with hemorrhoids. James W. Mold, MD, MPH

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Importance Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US. Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse.

Observations Hemorrhoids are classified as internal, external, or mixed (concurrent internal and external hemorrhoidal disease). Internal hemorrhoids originate above the dentate line, the boundary between the upper and lower anal canal, and may cause rectal bleeding, discomfort, and tissue prolapse from the anal canal. Internal hemorrhoid prolapse is classified as grade I (into anal canal), grade II (beyond the anus with spontaneous reduction), grade III (requiring manual reduction), and grade IV (irreducible). External hemorrhoids, arising below the dentate line, cause rectal pain when engorged or thrombosed. Initial treatment of all hemorrhoidal disease involves increasing intake of dietary fiber and water and avoiding straining during defecation. Phlebotonics (eg, flavonoids [thought to improve venous tone]) reduce bleeding, rectal pain, and swelling, although symptom recurrence reaches 80% within 3 to 6 months after treatment cessation. If dietary modification and phlebotonics are ineffective, grade I to grade III internal hemorrhoidal disease can be treated with office-based interventions. Rubber band ligation—placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow—resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%. Sclerotherapy, which induces fibrosis with a sclerosant injection, is efficacious in the short term (weeks to months) among 70% to 85% of patients, but long-term remission occurs in only one-third of patients. Infrared coagulation uses heat to coagulate hemorrhoidal tissue, yielding 70% to 80% success in reducing bleeding and prolapse. Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days). External hemorrhoidal disease rarely requires surgery unless acutely thrombosed. Outpatient clot evacuation within 72 hours of onset of a thrombosed external hemorrhoid is associated with decreased pain and reduced risk of repeat thrombosis. Patients presenting more than 72 hours after external hemorrhoid acute thrombosis should receive medical treatment (eg, stool softeners, oral and topical analgesics such as 5% lidocaine).

Conclusions and Relevance Hemorrhoidal disease affects 10 million people in the US. First-line treatment is increased fiber intake, avoidance of straining during defecation, and phlebotonics. In-office rubber band ligation for grade I to III internal hemorrhoid disease is first-line procedural treatment for persistent symptoms despite conservative therapies. Excisional hemorrhoidectomy is recommended for grade III to IV prolapse, thrombosis, or mixed hemorrhoidal disease that does not improve with less invasive approaches.

Author/s:

Jean H Ashburn

Diagnosis and Management of Celiac Disease

Alex Haga — Sun, 30 Jun 2024 18:10:50 +0000

Date Added:

June 30, 2024

Journal/Publication:

JAMA

Publication Date:

June 26, 2024

URL:

Diagnosis and Management of Celiac Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.5883

Keywords

Gastroenterology

celiac disease

PMID (1):

38922595

MeSH

Protein Glutamine gamma Glutamyltransferase 2

celiac disease

Gastroenterology

Hematologic Tests

American College of Gastroenterology Guideline for the diagnosis and management of celiac disease. James W. Mold, MD, MPH

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Guideline title American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease

Release date January 2023

Prior version May 2013

Developer and funding source American College of Gastroenterology

Target population Children and adults with celiac disease

Selected recommendations

Screening for celiac disease in asymptomatic people in the general population is not recommended (strong recommendation; low quality of evidence).

Upper endoscopy with multiple (≥4) duodenal biopsies is recommended for diagnostic confirmation in both children and adults who have characteristic signs and symptoms of celiac disease (strong recommendation; moderate quality of evidence).

In symptomatic children, a blood test with high-level tissue transglutaminase antibody (tTG) IgA (>10 times the upper limit of normal) and presence of endomysial antibody (EMA) in a second blood sample are suggested for diagnosis of celiac disease. In symptomatic adults who are unwilling or unable to undergo upper endoscopy, high-level tTG IgA and presence of EMA can be used to establish a diagnosis of likely celiac disease (conditional recommendation; moderate quality of evidence).

A gluten-free diet is required (strong recommendation; moderate quality of evidence) to achieve the treatment goal of resolution of histologic mucosal lesions in adults (conditional recommendation; low quality of evidence).

Author/s:

Kerstin Austin, Nimrod Deiss-Yehiely, Jason T Alexander

Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss

Erin Blanchette — Mon, 12 Feb 2024 17:22:55 +0000

Date Added:

February 12, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 5, 2023

Issue:

Volume:

330

Pages:

1795-1797

URL:

Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2023.19574

Keywords

PMID (1):

37796527

MeSH

glucagon-like peptide 1

Estimated rates of various adverse GI events in patients taking GLP1 receptor agonists. James W. Mold, MD, MPH

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This database study examines the association between glucagon-like peptide 1 agonists (eg, semaglutide, liraglutide) used for weight loss and reports of gastrointestinal adverse events.

Author/s:

Mohit Sodhi, Ramin Rezaeianzadeh, Abbas Kezouh, Mahyar Etminan

What Is Ulcerative Colitis?

Erin Blanchette — Mon, 12 Feb 2024 16:55:58 +0000

Date Added:

February 12, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 2, 2024

Issue:

Volume:

330

Pages:

951-965

URL:

What Is Ulcerative Colitis?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.23814

Keywords

ulcerative colitis

Diarrhea

Gastroenterology

Inflammatory Bowel Disease

PMID (1):

38306113

MeSH

Information for patients about ulcerative colitis. James W. Mold, MD, MPH

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This JAMA Patient Page describes the condition of ulcerative colitis and its symptoms, diagnosis, and treatment options.

Author/s:

Rebecca Voelker

A “no-biopsy” approach to diagnosing celiac disease

Aubrey Delammermore — Tue, 25 Oct 2022 05:00:00 +0000

Date Added:

October 25, 2022

Journal/Publication:

Journal of Family Practice

Publisher:

Frontline Medical Communications

Publication Date:

October 1, 2022

Issue:

Volume:

Pages:

359-361

URL:

A “no-biopsy” approach to diagnosing celiac disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.12788/jfp.0485

Keywords

celiac disease

Gastroenterology

diagnosis

Predictive Value of Tests

MeSH

World Health Organization

This antibody test is almost as good as a biopsy for diagnosing celiac disease. James W. Mold, MD, MPH

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PRACTICE CHANGER
CONSIDER A “NO-BIOPSY” APPROACH BY EVALUATING SERUM IMMUNOGLOBULIN (IG) A ANTI-TISSUE TRANSGLUTAMINASE (TTG-IGA) ANTIBODY TITERS IN ADULT PATIENTS WHO PRESENT WITH SYMPTOMS CONCERNING FOR CELIAC DISEASE (CD). AN INCREASE OF ≥ 10 TIMES THE UPPER LIMIT OF NORMAL (ULN) FOR TTG-IGA HAS A POSITIVE PREDICTIVE VALUE (PPV) OF ≥ 95% FOR DIAGNOSING CD WHEN COMPARED WITH ESOPHAGOGASTRODUODENOSCOPY (EGD) WITH DUODENAL BIOPSY—THE CURRENT GOLD STANDARD.

Author/s:

Mott, T., Gray, C., Storey, J.

Development and Assessment of a Pictographic Pediatric Constipation Action Plan

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

The Journal of Pediatrics

Publication Date:

October 15, 2020

Volume:

229

Pages:

118-126

URL:

Development and Assessment of a Pictographic Pediatric Constipation Action Plan

Type:

Clinical Research Results, Clinical Decision Aids, Patient Education Materials

Format:

Article

DOI (1):

10.1016/j.jpeds.2020.10.001

Keywords

PMID (1):

33068567

MeSH

Patient Education as Topic

Perception

A pictographic action plan for children with functional constipation. James W. Mold, MD, MPH

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Objective: To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation.

Study design: The USCAP facilitates the management functional constipation by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included part 1 (pictogram validation) and part 2 (assessment). For part 1, pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n = 65) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical librarians (n = 3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n = 34) using Doak's Suitability Assessment of Materials (superior ≥70% rating).

Results: All 12 pictograms demonstrated appropriate transparency, translucency, and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability.

Conclusions: The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic functional constipation.

Author/s:

Reeves, Patrick T., Kolasinski, Nathan T., Shonna YIn, H., Alqurashi, Waleed, Echelmeyer, Sofia, Chumpitazi, Bruno P., Rogers, Philip L., Burklow, Carolyn S., Nylund, Cade M.