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Clinical insights, research updates, and conference highlights in gastroenterology — page 6.

(2026) Selective Decontamination of the Digestive Tract in Mechanically Ventilated Adults: What the Updated Bayesian Meta-Analysis Actually Tells You

(2026) Selective Decontamination of the Digestive Tract in Mechanically Ventilated Adults: What the Updated Bayesian Meta-Analysis Actually Tells You

A patient on day 3 of mechanical ventilation develops a fever, worsening oxygenation, and a tracheal aspirate growing Klebsiella pneumoniae. You prevented the last three VAPs on your unit with SDD. Your colleague stopped it last year citing antimicrobial resistance concerns. Both of you are reading the same literature - and reaching opposite conclusions. This post resolves that tension with the updated Bayesian evidence.

May 6, 2026•GastroAGI Team
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Hepatic Encephalopathy: West Haven Grading, Identifying the Precipitant, and Step-by-Step Management

Hepatic Encephalopathy: West Haven Grading, Identifying the Precipitant, and Step-by-Step Management

A 58-year-old man with known Child-Pugh B cirrhosis is brought in by his family - he has been sleeping through the day, missing meals, and said something bizarre at dinner last night. His ammonia is elevated, but so is everyone's with decompensated cirrhosis. The real question is not whether this is hepatic encephalopathy - it almost certainly is. The question is what triggered it, what grade it is, and what you do in what order. This post gives you a structured answer to all three.Hepatic encephalopathy management trips up even experienced clinicians not because the individual steps are difficult, but because the decisions happen in parallel - you are grading, hunting for precipitants, and initiating treatment simultaneously, often in a busy ward or emergency bay. The West Haven Criteria give you the language. The precipitant hunt gives you the lever. The management algorithm gives you the sequence. Miss any one of these, and you are treating a symptom rather than the episode. What makes this harder still is that ammonia levels correlate poorly with grade - a patient can have grade III HE with a modestly elevated ammonia, and a compensated cirrhotic can have a markedly elevated ammonia with minimal clinical findings. The clinical examination, not the lab value, grades the encephalopathy.

May 4, 2026•GastroAGI Team
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Aspirin After Colon Cancer Surgery: Who Actually Benefits in 2026?

Aspirin After Colon Cancer Surgery: Who Actually Benefits in 2026?

Your patient has just completed resection for stage III colon cancer. Chemotherapy is finished. The oncology team has signed off. And someone in the room asks: "Should we start aspirin?" It's a deceptively simple question with a nuanced, mutation-specific answer - and getting it wrong in either direction has real consequences. This post walks through exactly what the evidence says and the molecular subgroup where aspirin's postoperative benefit is now difficult to ignore.The challenge with aspirin in colorectal cancer is not a lack of data - it's a lack of precision. Decades of observational studies show population-level benefits. But routine use in all CRC patients post-surgery isn't supported, and for good reason: the benefit is not evenly distributed. What has crystallised from recent prospective data is that aspirin after colon cancer surgery in patients with PI3K/PTEN pathway mutations represents a pharmacologically coherent, increasingly evidence-backed adjuvant strategy. Approximately 37% of all CRC patients carry these alterations. That is not a niche subgroup. Understanding the mechanism - and the trials - is now part of the informed gastroenterologist's toolkit.

May 2, 2026•GastroAGI Team
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H. Pylori Treatment in 2026: Choosing the Right Regimen Based on Local Resistance Patterns

H. Pylori Treatment in 2026: Choosing the Right Regimen Based on Local Resistance Patterns

Your patient finishes a 14-day course of PPI-clarithromycin-amoxicillin. Breath test at 4 weeks: still positive. You prescribe again - bismuth quad this time - and they eradicate. That sequence was backwards. In India in 2026, empiric clarithromycin triple therapy should not be your opening move.The core problem governing H. pylori treatment guidelines in 2026 in India is not a lack of options - it is a mismatch between the regimen prescribed and the antibiotic resistance landscape the organism actually lives in. Clarithromycin triple therapy has underpinned first-line eradication for decades, yet the data are unambiguous: national resistance to clarithromycin in India now sits at 35.64% overall, with the picture substantially worse in South India, Gujarat, and Kashmir. A ten-year trend analysis across South Asian countries confirms clarithromycin resistance has climbed from 21% in 2003 to 30% by 2022 - and continues to rise. Prescribing clarithromycin empirically when local resistance exceeds 15–20% is what drives the treatment failures filling your endoscopy list.Yet no pan-India susceptibility atlas exists. Most Indian gastroenterologists are making regimen decisions blind to local culture data, relying on clinical intuition or outdated textbook algorithms. The decision framework below cuts through that ambiguity.

April 29, 2026•GastroAGI Team
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APASL 2026 Istanbul: Key Clinical Takeaways Every Hepatologist Needs to Know

APASL 2026 Istanbul: Key Clinical Takeaways Every Hepatologist Needs to Know

You walked out of Istanbul having sat through four days of world-class hepatology - or you didn't attend and you're now trying to piece together what shifted. Either way, APASL 2026 was not a conference of small refinements. Across 60-plus topics, several fault lines in clinical hepatology were exposed, debated, and - in some cases - resolved. This post gives you the high-yield clinical signal without the noise.The 35th Annual Meeting of the Asian Pacific Association for the Study of the Liver (APASL 2026) ran April 22–25, 2026 at the Istanbul Lütfi Kırdar International Convention and Exhibition Centre. The scientific program was dense - spanning viral hepatitis, metabolic liver disease, liver transplantation, portal hypertension, endohepatology, and the rapidly expanding territory of AI in hepatology. The challenge after any major conference is not finding information - it's filtering it. What follows are the APASL 2026 hepatology conference highlights that carry the most direct relevance to clinical decision-making.

April 28, 2026•GastroAGI Team
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Rome V in 2026: What Changed in the Diagnosis and Management of Disorders of Gut–Brain Interaction

Rome V in 2026: What Changed in the Diagnosis and Management of Disorders of Gut–Brain Interaction

A 34-year-old woman presents to your clinic with recurring epigastric fullness after meals, loose stools three to four times a week, and intermittent cramping that partially resolves with defecation. She meets Rome IV criteria for both functional dyspepsia - postprandial distress subtype - and IBS with predominant diarrhea. Prior workup is unremarkable. She's been dismissed twice with "irritable bowel" and sent home without a clear plan. Rome V, published in May 2026, gives you the language, the framework, and the therapeutic roadmap to do better.The release of Rome V represents the most substantive revision to the disorders of gut–brain interaction (DGBI) classification since Rome III introduced postprandial distress syndrome and epigastric pain syndrome as distinct entities. The update spans a decade of evidence - from the microbiome-gut-brain axis to pharmacogenomics to cross-cultural epidemiology - and restructures both nomenclature and diagnostic thresholds to close the gap between what the research criteria define and what clinicians actually encounter. For gastroenterologists managing patients daily, this is not an academic update. It changes how you diagnose, how you explain, and increasingly, how you treat.

April 27, 2026•GastroAGI Team
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Rockall vs AIMS65 vs Glasgow-Blatchford: Which Score to Use for Upper GI Bleeding Risk Stratification in 2026

Rockall vs AIMS65 vs Glasgow-Blatchford: Which Score to Use for Upper GI Bleeding Risk Stratification in 2026

A 58-year-old man walks into the ED at 11 PM with two episodes of hematemesis, a heart rate of 104, and a haemoglobin of 9.2. He's on low-dose aspirin. His BP is 98/64. The emergency physician wants to know: can he go to the ward, or does he need scoping tonight? You reach for a scoring system - and then pause, because you have three to choose from. This post tells you exactly which one to use, and when.The problem with upper GI bleeding risk stratification scoring is not a lack of tools - it is too many tools, with overlapping purposes that guidelines fail to clearly delineate. The Glasgow-Blatchford Score (GBS), Rockall Score, and AIMS65 are all validated, all widely used, and all different enough that deploying the wrong one at the wrong decision point can lead to either over-admission or undertriage. A 2020 Lancet study showed that GBS identified low-risk patients eligible for outpatient management with significantly higher sensitivity than Rockall in pre-endoscopy assessment, a distinction that still gets collapsed in everyday practice. Understanding what each score was built for - and where its discriminatory power actually sits - is the clinical skill this post addresses.

April 24, 2026•GastroAGI Team
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Spontaneous Bacterial Peritonitis in Cirrhosis: PMN Threshold, Antibiotic Selection, and Prophylaxis Protocol

Spontaneous Bacterial Peritonitis in Cirrhosis: PMN Threshold, Antibiotic Selection, and Prophylaxis Protocol

A 58-year-old man with Child-Pugh C alcoholic cirrhosis presents with low-grade fever, mild abdominal tenderness, and worsening encephalopathy. His ascites is long-standing, his last tap was six weeks ago, and his creatinine has crept up over 48 hours. Every finding points somewhere - and one of those somewhere-s is SBP. The clinical decision at this moment is not whether he has it. It's whether you are treating it fast enough.Spontaneous bacterial peritonitis diagnosis treatment decisions in cirrhosis carry a weight that the textbook PMN count does not fully convey. A 10–30% in-hospital mortality, a 70% one-year mortality without prophylaxis, and a risk of hepatorenal syndrome that rises sharply with delayed albumin - these are the stakes. Guidelines from EASL (2018) and AASLD are reasonably aligned on the core protocol, but the places clinicians go wrong are rarely the big decisions. They are the threshold edges, the albumin indications, and the distinction between primary and secondary prophylaxis.

April 23, 2026•GastroAGI Team
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Top Platforms for Publishing Gastroenterology Research in India: A Practical Guide for Clinicians and Researchers (2026)

Top Platforms for Publishing Gastroenterology Research in India: A Practical Guide for Clinicians and Researchers (2026)

You've completed a prospective study on H. pylori eradication failure rates in a tertiary care centre in India. The data is clean, the conclusions are solid, and now you face the question most clinicians skip thinking about until it's too late: where do I publish this? The wrong choice can cost your paper a year in review limbo, bury it behind a paywall your colleagues can't access, or worse - land it in a journal no one reads. This guide cuts through that confusion.

April 22, 2026•GastroAGI Team
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Gut Microbiome Research in India: What the Evidence Shows, What It Doesn't, and What to Do With It Clinically

Gut Microbiome Research in India: What the Evidence Shows, What It Doesn't, and What to Do With It Clinically

A 34-year-old vegetarian woman from Chennai presents with bloating, loose stools, and abdominal cramps for two years. Her colonoscopy is normal. Her H. pylori test is negative. You diagnose IBS-D - but you're treating her with protocols built almost entirely on Western microbiome data, in a patient whose gut flora has almost nothing in common with the cohorts those studies used. That gap is no longer just academic. This post maps what gut microbiome research in India has actually shown, where the critical unknowns remain, and how to use the emerging data in clinical practice today.

April 21, 2026•GastroAGI Team
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