Official journal of the American College of Gastroenterology

Current Issue Highlights

Differences in Outcomes After Ileocecal Resection in Older Adults With Crohn's Disease in the Biologic Era
August 2026: 121(8):2055-2058
INTRODUCTION:
Older adults represent a growing proportion of patients with Crohn's disease (CD). We compared outcomes after ileocecal resection between older and younger patients with CD.
METHODS:
We conducted a retrospective cohort study of patients who underwent ileocecal resection. Older adults were defined as those aged 60 years and older. Outcomes at one and five years were extracted from medical records.
RESULTS:
Among 86 older and 169 younger patients, older adults had lower odds of clinical recurrence at 1 year (OR 0.26) and 5 years (OR 0.40) but higher 5-year mortality (OR 20.55).
DISCUSSION:
Older adults had lower symptom-based clinical recurrence rates but higher mortality.
Evaluating the Use of Sex in Gastroenterology Algorithms: A Fairness Assessment in Representing Sex Framework Analysis
August 2026: 121(8):2052-2054
Introduction:
Clinical algorithms are integral to decision-making in gastroenterology, yet the inclusion of sex as a variable remains underexamined. We applied the Fairness Assessment in Representing Sex (FAIRS) framework to evaluate the medical, ethical, and equity implications of sex-based variables in adult gastroenterology algorithms.
Methods:
Of 184 algorithms reviewed, 11 met inclusion criteria by explicitly incorporating sex or gender. The FAIRS framework was applied to these algorithms.
Results:
Using FAIRS, 10 algorithms demonstrated appropriate and clinically justified inclusion of sex, typically reflecting biologically meaningful differences that improved prognostic accuracy without exacerbating disparities. Notably, Model for End-Stage Liver Disease 3.0 exemplified how sex inclusion can mitigate inequity in liver transplant allocation. By contrast, the Obesity Surgery Mortality Risk Score failed FAIRS criteria because evidence suggests sex-based risk differences are confounded by comorbidities and access to care.
Discussion:
Our findings highlight that sex inclusion in algorithms must be explicitly justified, continuously reevaluated, and contextualized to avoid perpetuating bias.
Efficacy and Safety of Gelatin Tannate and Tyndallized Acid Lactic Bacteria in Adults With Chronic Diarrhea and Altered Gut Microbiota: A Randomized, Double-Blind, Placebo-Controlled Study
August 2026: 121(8):2040-2051
INTRODUCTION:
Mucoprotectants, such as gelatin tannate, in combination with tyndallized acid lactic bacteria (GT), may offer advantages over live probiotics alone for the treatment of chronic diarrhea, a common presentation in primary care medicine and gastroenterology clinics. This study assessed the efficacy and safety of GT in adults with chronic diarrhea with an altered fecal microbiota and effects on intestinal bacterial composition.
METHODS:
In this prospective 4-week, randomized, double-blinded, placebo-controlled, multicenter postmarketing study of GT in adults with chronic diarrhea and an altered fecal microbiota, the primary US Food and Drug Administration-based composite outcome, abdominal relief efficacy, by the clinical outcomes of abdominal pain intensity, stool consistency and frequency, was based on patients' Likert scale assessments.
RESULTS:
Among 191 patients randomized to GT or placebo, over 4 weeks of treatment, GT was significantly more effective than placebo in improving abdominal pain intensity and stool consistency and frequency (P = 0.001 for all). By study end, the overall abdominal pain relief responder rate was greater with GT than placebo, 79.1% vs 43.0% (P < 0.001). Compared with baseline and placebo, the GT group showed statistically significant improvements in mean levels of most microbiota species assessed, including Faecalibacterium prausnitzii and Akkermansia muciniphila, suggesting an association between this correction and improvements in clinical outcomes. No adverse events or treatment discontinuation due to adverse events were reported.
DISCUSSION:
GT, a medical product that acts through a mechanical action on the gut wall, provides an effective and safe treatment option for adults with chronic diarrhea and an altered fecal microbiota composition.
Validation of Dried Blood Spot Immunoreactive Trypsinogen as a Biomarker of Exocrine Pancreas Function in Children With Pancreas Disease
August 2026: 121(8):2032-2039
INTRODUCTION:
Radioimmunoassay (RIA)-serum trypsin serves as a pancreas function biomarker because its blood concentration correlates with duodenal trypsin output. With the unavailability of RIA tests and global availability of dried blood spot immunoreactive trypsin (DBS-IRT) testing as part of cystic fibrosis newborn-screening programs, IRT can be made accessible for routine clinical use. We aimed to validate DBS-IRT for its use as a biomarker of exocrine pancreas function in children older than the newborn age group.
METHODS:
Analytical accuracy of DBS-IRT was evaluated in 28 children (mean [SD] age: 13 [4.5] years) with known pancreas function status and simultaneous RIA-based serum trypsin testing. Reference ranges were established based on 134 metabolically stable children. Clinical validation was performed in 164 children with well-established pancreas phenotypes. Available cross-sectional imaging was reviewed to assess for pancreas atrophy to measure acinar cell loss.
RESULTS:
Total imprecision of DBS-IRT ranged from 7.1% to 16.4%; samples were stable samples at −20C for 28 days and showed excellent correlation to RIA-serum trypsin (r = 0.95, P < 0.001). A reference range of 6.9–21.2 ng/mL was newly established. DBS-IRT replicated serum trypsin in discriminating exocrine pancreatic insufficiency (EPI) in the cystic fibrosis group with high sensitivity (90.7%; 95% CI: 79.7%–96.9%) and specificity (94.7%; 95% CI: 73.9%–99.8%). Children with pancreatitis and EPI had significantly lower median DBS-IRT level compared with those without EPI (P = 0.01). Low DBS-IRT was associated with pancreas atrophy (P = 0.001).
DISCUSSION:
DBS-IRT was successfully validated as a biomarker of exocrine pancreas function which allows its use in clinical setting, in addition to fecal elastase to determine pancreas function.
Assessing the Reliability of 12- vs 24-Hour Esophageal pH-Impedance Monitoring for Gastroesophageal Reflux in Infants
August 2026: 121(8):2026-2031
INTRODUCTION:
The recommended duration of esophageal multichannel intraluminal impedance pH (MII-pH) monitoring to detect gastroesophageal reflux (GER) is currently 24 hours. This prolonged recording can be challenging in certain circumstances. We aimed to assess the diagnostic reliability of 12- vs 24-hour MII-pH in infants.
METHODS:
Retrospective multicenter study assessing MII-pH tracings from infants referred for suspect gastroesophageal reflux disease (GERD). Each MII-pH was analyzed twice as full-time recording and in the first 12 hours, and data were compared. GERD was diagnosed if one of the following occurred: number of GER episodes ≥100 in 24 hours, proximal GER episodes >44 (acid) or 57 (nonacid), reflux index (percent time with pH < 4) >7%, Bolus Exposure Index >2.4%, Bolus Clearance Time >18 seconds, Symptom index ≥50%, and Symptom Association Probability ≥95%. Univariate analysis was performed to compare MII-pH data.
RESULTS:
One hundred twenty-seven infants were studied. The median age at MII-pH was 61 days (interquartile range-IQR 27–116), and 49 were born preterm. There were no significant differences between the 12- and the 24-hour analysis regarding the number of total GER and proximal GER events/hr, reflux index, Bolus Exposure Index, Bolus Clearance Time, positive Symptom index/Symptom Association Probability. GER events lasting >5 min/hr were 1.97 ± 0.27 and 1.83 ± 0.44, respectively (P < 0.001). The 12-hour MII-pH recording showed 87.7% sensitivity, 75.6% specificity, 89.7% positive predictive value, and 71.7% negative predictive value for GERD compared with 24-hour MII-pH.
DISCUSSION:
Twelve-hour MII-pH had a good diagnostic performance compared with 24-hour recording. Only GER events lasting >5 minutes were significantly different between the 2, but the clinical significance of this observation is unclear.

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Official journal of the American College of Gastroenterology | ACG. August 17, 2026
Letter to the Editor
Official journal of the American College of Gastroenterology | ACG. August 17, 2026
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Official journal of the American College of Gastroenterology | ACG. August 12, 2026