Gender differences were identified in the frequency and clinical presentations of inflammatory bowel disease (IBD) and depressive and anxiety disorders, which are more common in IBD patients than in the general population. The present manuscript provides a critical overview of gender differences in the frequency and clinical course of mood and anxiety disorders in IBD patients, with the aim of helping clinicians provide individualized management for patients. All of the included studies found that IBD patients reported a higher frequency of depressive and anxiety disorders than the general population. These findings should encourage healthcare providers to employ validated tools to monitor the mental health of their IBD patients, such as the Patient Health Questionnaire (PHQ-9). In addition, most studies confirm that women with IBD are more likely than men to develop affective disorders and show that up to 65% of women with IBD have depressive and anxiety disorders. Women with IBD require close mental health monitoring and ultimately a multidisciplinary approach involving mental health professionals. Drug treatment in women should be individualized and medications that may affect mental health (e.g., corticosteroids) should be thoroughly reconsidered. Further data are needed to ensure individualized treatment for IBD patients in a framework of precision medicine.

Background and aims: Hepatocellular carcinoma (HCC) patients frequently present with comorbidities that limit therapeutic options and increase mortality. This study evaluated the performance of the Charlson Comorbidity Index (CCI) and a modified CCI (mCCI) in stratifying patients with HCC to predict treatment allocation and survival. Methods: A retrospective single-center cohort study analyzed 401 patients with de novo HCC (74% male, median age 68 years, 80% Child–Pugh-Turcotte (CPT) A, 65% viral etiology, 70% Barcelona Clinic Liver Cancer stage (BCLC) 0/A). CCI and mCCI (with points related to HCC and chronic liver disease excluded), were calculated at diagnosis for each patient. The primary endpoint was overall survival (OS) estimated by Kaplan–Meier method and compared across mCCI classes; Cox uni/multivariable models were applied to identify predictors of mortality. The secondary aim was evaluating the association between mCCI and treatment allocation. Results: While CCI classified 94% of patients as “high-risk”, mCCI reclassified patients into “high-risk” (21%), “intermediate-risk” (48%), and “low-risk” (31%), demonstrating better stratification whilst maintaining a strong correlation with CCI (Kendall’s tau-b = 0.57, p < 0.001). BCLC B patients with “high-risk” mCCI exhibited significantly lower access to first-line curative treatment (14% vs. 47%, p = 0.03). Moreover, “high” or “intermediate-risk” patients according to mCCI experienced significantly shorter OS compared to “low-risk” (median OS 36 vs. 49 vs. 74 months, p < 0.001). “High-risk” and “intermediate-risk” mCCI classes were independent predictors of mortality, alongside alpha-fetoprotein, CPT and BCLC stage. Considering the items composing mCCI, age and cardiovascular diseases were independent predictors of mortality. Conclusions: mCCI provides a more accurate assessment of comorbidities than the standard CCI and is associated with survival, hence it can contribute to designing patient-tailored therapeutic strategies.

A 33-year-old patient presented to an outpatient clinic with a diagnosis of intestinal lymphangiectasia following the onset of dependent edema, hypoalbuminemia, and altered liver transaminases in January/2024. Further evaluation revealed hypogammaglobulinemia, IgA/IgG/IgM deficiency, negative anti-TTG antibodies, normal fecal calprotectin/elastase, and persistent hypoalbuminemia. The patient was on biweekly human albumin infusions, medium-chain triglyceride (MCT) oil, and vitamin D supplementation. To further investigate the suspected gastrointestinal pathology, the patient underwent the following diagnostic procedures: Esophagogastroduodenoscopy (EGD): Duodenal bulb/D2 with epithelial disruption. Histology showed normotrophic villi with lymphoplasmacytic/eosinophilic infiltration. Helicobacter pylori and Tropheryma whipplei were negative, and intraepithelial T-lymphocyte count (CD3+) was not increased. Video capsule endoscopy (VCE): Diffuse lymphangiectasia in the duodenum/proximal jejunum, pseudopolypoid appearance in some frames, and mild distal villous edema. Due to the persistence of lymphangiectasia with minimal improvement following albumin and MCT oil supplementation, further evaluation of the small intestine was pursued: Capsule endoscopy (PillCam SB3, Given Medtronic): demonstrated mild lymphangiectasia in the proximal and mid-small intestine with mild villous edema ([Fig. 1] and [Fig. 2]). Anterograde double-balloon enteroscopy (DBE) (Fujifilm EN-580T): Diffusely edematous mucosa with shortened, whitish villi, consistent with lymphangiectasia in the explored segments. Presence of two pseudopolyps in the proximal jejunum, which were biopsied, and a vermiform parasite, which was removed ([Video 1]). Histopathological analyses showed no dysplasia in the two pseudopolyps, which exhibited only mild inflammation of the lamina propria. Parasitological analysis identified the specimen as two hookworms of Ancylostoma spp. (male and female in reproductive phase) ([Fig. 3] and [Fig. 4]). Despite negative stool cultures for hookworm (repeated twice), only Blastocystis hominis was detected. Infectious disease specialists advised treating Ancylostoma with Albendazole (400 mg TID) with a rapid improvement of Immunoglobulin and albumin blood levels. Endoscopy_UCTN_Code_CCL_1AC_2AG Article published online: 10 November 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background: Machine learning (ML) is increasingly applied in medicine, underscoring the need for transparent and clinically relevant models. In gastrointestinal oncology, most ML studies rely on raw imaging data, which limits clinical adoption due to poor interpretability and the difficulty of collecting high-quality, large-scale video and image datasets in routine practice. Endoscopic ultrasound (EUS) plays a central role in the evaluation of pancreatic cancer; however, structured EUS features remain underused in predictive modeling. Objective: To assess the performance and interpretability of ML models for diagnosing pancreatic ductal adenocarcinoma (PDAC) using routinely collected EUS variables. Methods: We conducted a retrospective multicenter study using data from two Italian hospitals (n = 641) for model training and internal validation and from a third hospital (n = 120) for external validation, collected from 2015 to 2023. Decision trees, random forests, naïve Bayes and other classifiers were developed and evaluated. Model performance was assessed in terms of discriminative ability, calibration, and selective prediction. Results: All models demonstrated high discriminative performance (AUC ≥ 0.90). Decision trees provided the most favorable balance between interpretability and accuracy (balanced accuracy = 0.87; sensitivity = 0.89). Calibration and selective prediction analyses confirmed the robustness of the models. Conclusions: These findings demonstrate the feasibility of implementing interpretable yet high-performing ML models for PDAC diagnosis in real-life endoscopic settings.