Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, accounting for approximately 10% of all cases, and is the second leading cause of cancer-related deaths in the United States. In patients with Familial Adenomatous Polyposis (FAP), APC mutations drive c-MYC overexpression, promoting metabolic and immune dysregulation that contributes to CRC development, making c-MYC a potential target for FAP-associated chemoprevention. Although no c-MYC inhibitors are currently available, recent evidence indicates that a uropathogenic E. coli protease can degrade c-MYC protein. This study evaluated recombinant LON protease (rLONP) for chemopreventive efficacy in PIRC rats, a model of FAP. Rat pups were genotyped, baseline polyp burden was established by colonoscopy, and animals were randomized to receive saline or rLONP twice daily (2.5 mg/kg, p.o.) for 2 or 4 weeks. Serum analyses showed no significant changes in liver or kidney function markers in rLONP-treated rats compared with controls. rLONP-treated male rats exhibited a ∼40% reduction in colonic polyps at both time points, and small intestinal polyp counts were also lower in treated males and females. Combined analysis demonstrated a ≥60% reduction in total intestinal polyp multiplicity after 2-4 weeks of treatment (p<0.001). Protein expression analyses of colonic polyps revealed decreased c-MYC protein levels following rLONP treatment. Immunohistochemistry further showed reduced Ki-67, Cyclin D1, and c-MYC expression in treated polyps compared with controls. Overall, rLONP was well tolerated and significantly reduced intestinal polyp burden in PIRC rats in this short-term study, supporting further long-term efficacy evaluation.

Juvenile polyposis syndrome (JPS) is an inherited autosomal dominant disease that is distinguished by the emergence of numerous juvenile polyps within the gastrointestinal (GI) tract and has an increased risk of cancer. JPS is associated with germline mutations of the BMPR1A or SMAD4 genes. We aim to describe a case of familial occurrence of the SMAD4 germline pathogenic variant c.403C>T in a Brazilian family. We present a case of an 18-year-old female with rectal bleeding and chronic anemia who had a family history of colorectal issues-her mother had a total colectomy due to multiple polyps, and her maternal grandfather died from colorectal cancer (CRC). Despite a negative physical examination for attenuated familial adenomatous polyposis (AFAP) signs, a colonoscopy revealed around 30 proximal colon polyps of juvenile nature. These were systematically removed through multiple sessions, and an upper digestive endoscopy uncovered a few sessile inflammatory polyps. Notably, no polyps were found in the small intestine via double-balloon enteroscopy. After polyp removal, her bleeding episodes ceased, and her anemia resolved. She now maintains her health through biennial colonoscopies, upper digestive endoscopies, and endoscopic capsule procedures. Genetic testing identified a pathogenic mutation in exon 3 of the SMAD4 gene (c.403C>T), resulting in a truncated SMAD4 protein (p.Arg135 [∗]). While previously documented in international databases, this represents the first report of a Brazilian family carrying this variant. Additionally, no mutations were found in the BMPR1A gene during genetic testing. In conclusion, molecular analysis confirmed the familial occurrence of the SMAD4 germline pathogenic variant c.403C>T within this Brazilian family.

Accurate segmentation of colorectal polyps is crucial for the early prevention and diagnosis of colorectal cancer. However, due to the high heterogeneity of polyps in terms of shape, size, and texture, as well as the complexity of the intestinal environment (such as folds, specular reflections, and fecal residues), existing methods still face significant challenges in boundary localization and small-polyp detection. To address these issues, this paper proposes a Polyp Segmentation Network based on Pinwheel Convolution and Dual Attention (PWD-Net). The proposed network adopts a U-shaped encoder-decoder architecture, where a pretrained ResNet is employed as the encoder to extract multi-level local features. Specifically, a Pinwheel Convolution Module (PCM) is introduced at the bottleneck layer to capture the global geometric structure and multi-directional contextual information of polyps through multi-angle rotated convolution kernels. A Dual-Attention Mechanism (DAM) that integrates channel attention and spatial attention is designed to adaptively suppress background noise and enhance polyp-region features. In addition, a Multi-scale Feature Fusion (MSF) strategy is employed to combine deep semantic information with shallow boundary details, ensuring both completeness and precision of segmentation results. Experiments conducted on the Kvasir-SEG and CVC-ClinicDB datasets demonstrate that PWD-Net achieves average Dice coefficients of 0.865 and 0.944, and IoU scores of 0.765 and 0.892, respectively, significantly outperforming existing state-of-the-art methods. Ablation studies verify the effectiveness of each module, and cross-dataset evaluations confirm the strong generalization ability of the model. This study provides a high-precision and robust solution for clinical polyp segmentation, offering significant value for the early diagnosis of colorectal precancerous lesions and supporting computer-aided intervention.

Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal bleeding cases, with the small intestine being the most common source of origin. Primary small-bowel lymphoma is a rare malignancy that can present as intestinal bleeding in 2% to 22% of cases.  A 67-year-old male presented with a four-day history of diarrhea and melena, accompanied by severe anemia with a hemoglobin level of 5 g/dL. While a colonoscopy only revealed internal hemorrhoids and an ascending colon polyp, a subsequent non-contrast whole-abdomen CT scan demonstrated a 6-cm segmental small bowel wall thickening involving the proximal and distal ileum, accompanied by mesenteric fat stranding and aggressive aneurysmal dilatation. Further evaluation using antegrade enteroscopy identified a mass with central ulceration in the proximal ileum. Histopathological analysis of the ileal biopsy specimens revealed small intestinal mucosa heavily infiltrated by a diffuse, highly cellular tumor with small-to-medium neoplastic cells, confirming a malignant round cell neoplasm highly suspicious for non-Hodgkin lymphoma. This case highlights the critical clinical challenge of managing OGIB and underscores the importance of early diagnostic interventions. Utilizing CT imaging alongside device-assisted enteroscopy is vital for the prompt recognition of hidden small bowel disorders like lymphoma, enabling timely treatment, preventing life-threatening hemorrhagic complications, and improving the overall patient prognosis.

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant hamartomatous polyposis disorder characterised by mucocutaneous pigmentation and multiple gastrointestinal polyps, most commonly involving the small intestine. Paediatric patients frequently present with complications, such as abdominal pain, gastrointestinal bleeding, and recurrent intussusception. We report the case of a nine-year-old female with classical clinical and radiological features of PJS, including multisite gastrointestinal polyposis and a prior history of intussusception. Contrast-enhanced computed tomography revealed multiple heterogeneously enhancing sessile polyps involving the stomach, duodenum, colon, and rectum. Histopathological examination confirmed the diagnosis of PJS. In addition, imaging demonstrated incidental findings of femoral head epiphyseal flattening and sclerosis, consistent with avascular necrosis, suggestive of Legg-Calvé-Perthes disease (LCPD). A comprehensive review of the available literature revealed no previously reported cases describing a similar radiological association between PJS and LCPD. While both conditions are individually well documented, their coexistence appears to be extremely rare, thereby highlighting the novelty of the present case. The patient was managed conservatively and is currently under follow-up, with a stable clinical status. This case underscores the value of comprehensive cross-sectional imaging in pediatric patients with syndromic disorders, facilitating both diagnostic confirmation and the identification of unexpected but clinically significant incidental findings.

Colorectal serrated polyps are now recognized as an important pathway in colorectal carcinogenesis. An association between serrated polyposis syndrome (SPS) and duodenal serrated lesions sharing a similar immunophenotype in both the colon and duodenum has been reported in the literature. We present a case of a 38-year-old male who presented in June 2023 with abdominal pain and fever. Initial investigations, including multiple computed tomography scans of the abdomen and pelvis, revealed an appendiceal abscess and small bowel intussusception involving two segments of the jejunum without evidence of obstruction, along with multiple polyps throughout the small and large bowel suggestive of an intestinal polyposis syndrome. Further evaluation with colonoscopy, esophagogastroduodenoscopy, and magnetic resonance enterography confirmed the presence of numerous polyps of varying sizes involving the duodenum, jejunum, ileum, and all segments of the colon. The initial differential diagnosis included familial adenomatous polyposis, Peutz-Jeghers syndrome, and PTEN hamartoma tumor syndrome. The patient subsequently developed complicated small bowel obstruction due to intussusception and underwent open small bowel resection. Multiple intestinal polyps were identified, and histopathological examination confirmed the diagnosis of SPS. At a later stage, the patient was planned for subtotal colectomy, preceded by elective endoscopic polypectomy, which achieved clearance of the left colon up to 20 cm from the anal verge. Gross examination of the colectomy specimen revealed more than 20 large polyps measuring up to 4 cm. Histopathological analysis demonstrated colonic serrated polyposis without evidence of invasive malignancy, wall infiltration, or lymph node involvement, with clear surgical margins.

Objective: To summarize the clinical features, endoscopic characteristics, treatment and prognosis of cap polyposis (CP) in children. Methods: In this case series study, clinical data including clinical manifestations, laboratory tests, endoscopic examinations, pathological results, treatment plans and follow-up conditions of 6 CP children diagnosed at Xi'an Children's Hospital from January 2018 to August 2025 were summarized. Results: Among the 6 children, there were 5 males and 1 female, with the age range at diagnosis of 9.2 to 14.3 years. The symptoms included bloody stool in all 6 cases, diarrhea in 4 cases, prolapse of perianal masses in 2 cases, and malnutrition in 2 cases. Among the auxiliary examinations, 3 cases were positive for 13C-urea breath test, and 5 cases were positive for Helicobacter pylori (Hp) in gastric mucosa histopathology. Colonoscopy revealed irregular polyps covered with white mucus, with 3 cases involving the rectum and 3 cases involving both the rectum and sigmoid colon. Histopathology showed inflammatory polyps covered with fibrous purulent exudate. The treatment plan included Hp eradication, mesalazine, hormone enema, thalidomide, and endoscopic polypectomy. The symptoms of all 6 children improved. Five of the children underwent re-examination with colonoscopy. Among them, 3 cases showed small polyp-like protrusions, and 2 cases showed local intestinal mucosa with slight congestion. Conclusions: CP is rare in children, with hematochezia and diarrhea as the main clinical manifestations. Colonoscopy typically reveals polyps with mucus adhering to the surface. Diagnosis requires histopathological examination, and individualized treatment should be formulated based on the specific condition of the child.

Esophageal cancer is a highly aggressive malignancy of the digestive tract, with surgical resection remaining the cornerstone of curative treatment. For patients with an intact stomach, reconstruction using a gastric conduit via gastric pull-up is the preferred approach following esophagectomy. However, in cases where the stomach is unavailable—due to prior gastric surgery, polyps, or concurrent tumors—alternative conduits must be considered. By reviewing relevant domestic and international research literature, this review evaluates the indications, benefits, limitations, and common complications associated with jejunal, colonic, and ileocolonic interpositions. Additionally, strategies for the prevention and management of complications are discussed. By synthesizing the latest clinical evidence, we aim to provide practical recommendations to guide surgical decision-making and improve outcomes in the management of esophageal cancer. The jejunum, colon, and ileocolon represent the primary options for esophageal reconstruction, each offering unique anatomical and functional advantages as well as distinct technical challenges and complication profiles.

Endoscopic procedures play a central role in the diagnosis and management of gastrointestinal (GI) diseases, yet the field lacks large-scale, clinically diverse benchmarks and unified datasets to evaluate vision foundation models. We introduce PanEndoSuite, the first unified ecosystem for endoscopic AI, developed through systematic collaboration between AI researchers and practicing gastroenterologists. PanEndoSuite consists of three complementary components: PanEndoAtlas, PanEndoX, and PanEndoFM. PanEndoAtlas is a harmonized dataset of over 420,000 labeled images from 30 public endoscopy datasets across 13 countries and 26 hospitals, creating a clinically-grounded hierarchical taxonomy that mirrors diagnostic reasoning patterns across 111 GI diseases. PanEndoX is a benchmark of 10 clinically grounded tasks, including hierarchical GI-tree classification, Barrett's esophagus grading, ulcerative colitis scoring, polyp subtyping, Boston Bowel Preparation Scale assessment, multi-organ disease classification, and anatomical landmark identification-designed to probe generalization across anatomical regions, disease presentations, and annotation granularities. PanEndoFM is a foundation model pretrained on a 10 million-image corpus curated from public data sources, spanning the entire GI tract. We benchmark PanEndoFM against two endoscopy-specific foundation models (EndoFM-LV, EndoSSL) and two general-purpose vision models (ViT-B/16, ResNet-50). PanEndoFM achieves the highest macro-AUC on 6 of 10 tasks, demonstrating broad clinical generalization; EndoFM-LV performs best on colon-focused tasks, EndoSSL excels in polyp subtyping, and ViT-B/16 shows strengths on small-intestine conditions. Together, PanEndoSuite establishes a foundation for building robust, generalist AI systems in gastrointestinal endoscopy that bridge current AI capabilities and clinical practice.

Cystic fibrosis (CF) alters gut physiology, yet its impact on microbial communities across colonic regions (ascending, transverse, descending colon) and microhabitats (lumen, mucosa) remains incompletely understood. Here, we applied culturomics to characterize gut microbiota in a small cohort of 32 individuals (22 non-CF, 10 CF). Persons with CF (pwCF) exhibited significantly higher viable bacterial loads than non-CF individuals, particularly in mucosal samples. Anaerobes predominated overall, with relative enrichment of aerobes in the mucosa of pwCF. Alpha diversity was reduced in mucosal samples and aerobic cultures for pwCF, whereas beta diversity was influenced by all the tested variables except the colonic region. Phylum-level analyses revealed enrichment of Proteobacteria and depletion of Actinobacteria, Bacteroidota, and Firmicutes in samples from pwCF, consistent with stool analysis. Random forest models identified selected oral-associated microbes as key predictive taxa and accurately classified polyp status within this cohort. Whole-genome sequencing of Bacteroides fragilis (n = 21) and Escherichia coli (n = 15) isolates, representing a subset of 109 gut bacterial genomes sequenced from this cohort, revealed minimal genomic variation across colonic regions and sample types, indicating intra-individual strain stability. The understandings from this pilot culturome study, after future validation, may help in developing targeted microbial therapeutic approaches to address the gut dysbiosis of CF.

Natural polyamines, such as spermidine and spermine, exert strong anti-inflammatory effects, but their therapeutic benefits are limited by rapid absorption in the small intestine, resulting in low colonic availability. In this study, engineered Citrobacter freundii overexpressing ppk1 (CPP) could significantly enhance both intracellular polyamine synthesis and polyphosphates (PolyP) accumulation. Under a two-step cultivation process, the engineered strain produced substantial amounts of polyamines, including spermidine (145.14 ± 5.11 mg/g) and spermine (175.31 ± 4.2 mg/g). CPP responds to environmental stress by importing large amounts of phosphate for PolyP synthesis. This process further promotes polyamine production, which binds to PolyP to neutralize intracellular charge. The resulting polyamine-polyphosphate granules (PPGs) enhance both binding stability and slow-release properties in vivo. Notably, the oral administration of PPGs increased colonic polyamine levels, alleviated DSS-induced colitis, reduced inflammatory cytokines, and restored gut microbiota balance. Overall, biosynthesized PPGs represent a highly promising material for mitigating colitis.