{ "slug": "why-does-my-bum-bleed-when-i-wipe", "question": "Why do I bleed bright red blood when I wipe my bum?", "shortTitle": "Bright Red Blood When Wiping", "clinicalQuestion": "In adults who notice bright red blood on toilet paper after wiping (with or without a palpable lump), what are the most common underlying anorectal causes and how often is each identified on evaluation?", "pico": { "population": "Adults presenting with bright red blood seen on toilet tissue after wiping, with or without an associated anal lump", "intervention": "Clinical evaluation including digital rectal exam and anoscopy/proctoscopy, with colonoscopy where indicated", "comparator": "No comparator; descriptive diagnostic yield across causes", "outcomes": [ "Proportion of cases due to hemorrhoids", "Proportion of cases due to anal fissure", "Proportion of cases due to other anorectal pathology (e.g., polyp, fistula)", "Proportion of cases due to colorectal neoplasia", "Resolution of bleeding after treatment of identified cause", "Rate of missed significant pathology on initial evaluation" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "anal-fissure", "rectal-bleeding", "colorectal-cancer" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Bright red blood on the toilet paper is usually from hemorrhoids or a small tear near the anus (a fissure) — but it can sometimes be an early sign of a growing polyp or bowel cancer, so it is worth getting checked, especially if you are under 50 or it keeps happening.", "detail": "A review of anorectal symptoms found that bright red blood just on the paper usually comes from hemorrhoids, while dark red blood, ongoing anal pain, or unexplained weight loss point more towards cancer [8]. Separately, large studies of people already having a colonoscopy for symptoms found that reporting rectal bleeding was linked to more than double the odds of finding an advanced pre-cancerous growth in adults under 50 [65], and to higher odds of being diagnosed with early-onset bowel cancer [88]. These studies describe people already being investigated for symptoms, not everyone who ever notices a spot of blood, so they cannot tell you the exact chance that your own bleeding is serious.", "studyIds": [ "pmid:42699804", "pmid:41752772", "pmid:41384824" ] }, "strength": { "level": "moderate", "why": "A systematic review addresses this question, but the underlying trials are limited.", "override": null }, "direction": { "level": "harm-signal", "why": "A well-conducted study in people reported harm.", "override": null }, "counts": { "recordsRetrieved": 7772, "recordsScreened": 199, "included": 95, "rcts": 0, "systematicReviews": 4, "observational": 26, "participants": 558514, "yearFrom": 2025, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Bleeding caused by hemorrhoids", "status": "insufficient", "note": "Hemorrhoids are repeatedly described as a common cause of bright red bleeding, but no study in this set gives a reliable percentage of how many people with this exact symptom turn out to have hemorrhoids.", "studyIds": [ "pmid:42699804", "pmid:41779539" ] }, { "name": "Bleeding caused by an anal fissure (small tear)", "status": "not-studied", "note": "No study here measured how often a fissure specifically explains bright red blood seen on wiping.", "studyIds": [] }, { "name": "Bleeding caused by other anorectal problems (polyps, fistulas, infections)", "status": "not-studied", "note": "Single case reports describe rectal polyps, fistulas, and infections causing bleeding, but one case cannot tell you how often these explain the symptom generally.", "studyIds": [ "pmid:42831609", "pmid:42282467", "pmid:42037797", "pmid:41662285", "pmid:41608549" ] }, { "name": "Bleeding caused by a polyp or bowel cancer (colorectal neoplasia)", "status": "possible-harm", "note": "In people already referred for colonoscopy because of symptoms, having rectal bleeding was linked to more than double the odds of an advanced pre-cancerous growth in adults under 50, and to higher odds of early-onset bowel cancer — though the absolute number of people found to have cancer stayed low.", "studyIds": [ "pmid:41752772", "pmid:41384824", "pmid:42287778" ] }, { "name": "Bleeding resolving after the cause is treated", "status": "insufficient", "note": "Case reports show bleeding stopped after a specific cause (a polyp, a hemorrhoid, a fistula) was treated, but no study tracked how often bleeding resolves across an unselected group of people with this symptom.", "studyIds": [ "pmid:42129663", "pmid:41662285", "pmid:41568119" ] }, { "name": "Missing a serious cause at the first check", "status": "possible-harm", "note": "Studies of people later diagnosed with bowel cancer found many had a delay of a month or more before seeing a doctor, and symptoms in younger adults were sometimes initially dismissed.", "studyIds": [ "pmid:42235251", "pmid:41832104", "pmid:42618835" ] } ], "benefits": [ { "text": "A systematic review identified features that help separate harmless bleeding from something more concerning: bright red blood just on the paper is usually from hemorrhoids, while dark red blood, ongoing anal pain, or unexplained weight loss point more towards cancer.", "studyIds": [ "pmid:42699804" ] }, { "text": "A large national registry found that a simple stool blood test (FIT) can help show who has a very low chance of cancer even when they report rectal bleeding, which may reduce the need for invasive tests in lower-risk people.", "studyIds": [ "pmid:41601400" ] } ], "limitations": [ { "text": "The main systematic review addressing this question included only 46 people in total, and the authors note there are few randomised trials and limited data from primary care settings.", "studyIds": [ "pmid:42699804" ] }, { "text": "No randomised trial has tested how often each individual cause — hemorrhoids, fissure, polyp, or cancer — explains bright red bleeding in unselected people. Most of the supporting evidence here is single case reports of one rare patient, which cannot establish how common any cause is.", "studyIds": [ "pmid:42831609", "pmid:42282467", "pmid:42037797", "pmid:41662285", "pmid:41608549" ] }, { "text": "The studies linking bleeding to cancer risk were done in people already referred for colonoscopy because of symptoms, not in the general population of people who simply notice blood on the paper, so the real-world risk for someone with no other symptoms may be lower than these figures suggest.", "studyIds": [ "pmid:41752772", "pmid:41384824" ] } ], "risks": [ { "text": "In adults under 50, having rectal bleeding as a symptom was linked to more than double the odds of an advanced pre-cancerous growth being found on colonoscopy.", "studyIds": [ "pmid:41752772" ], "severity": "serious" }, { "text": "Rectal bleeding was one of several symptoms linked to significantly higher odds of early-onset bowel cancer in adults aged 20 to 49.", "studyIds": [ "pmid:41384824" ], "severity": "serious" }, { "text": "People later diagnosed with bowel cancer often waited a month or more before seeking care, and bleeding in younger adults was sometimes initially dismissed as minor.", "studyIds": [ "pmid:42235251", "pmid:41832104", "pmid:42618835" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "Hemorrhoids are extremely common and cause exactly this kind of bright red bleeding, so people assume that must be the cause without getting it checked." }, { "text": "The bleeding is usually painless and stops on its own after the toilet visit, which makes it easy to shrug off." }, { "text": "Embarrassment about anal symptoms stops many people from mentioning the bleeding to a doctor at all." } ], "keyStudies": [ "pmid:42699804", "pmid:41752772", "pmid:41384824", "pmid:41262021", "pmid:41601400", "pmid:42235251" ], "studies": [ { "id": "pmid:42831609", "pmid": "42831609", "doi": "10.14712/23362936.2026.29", "nctId": null, "pmcid": null, "title": "A Rare Mimicker of Malignancy: Inflammatory Cloacogenic Polyp Presenting as Obstruction in a Colon Cancer Survivor", "firstAuthor": "Bahari", "multipleAuthors": true, "journal": "Prague Med Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a colon cancer survivor presenting with symptoms suggesting cancer recurrence", "intervention": "not applicable (diagnostic case report)", "comparator": "not applicable", "primaryOutcome": "correct diagnosis of the cause of symptoms (obstruction/suspected recurrence)", "result": "the growth that looked like cancer recurrence turned out to be a benign inflammatory cloacogenic polyp, found through tissue biopsy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this is or what causes bleeding in general", "directness": "indirect", "limitations": "single case, no control group, findings may not generalize to other patients with rectal bleeding", "followUp": "", "plainFinding": "Rare benign polyp mimicked cancer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42831609/", "sourceText": "Inflammatory cloacogenic polyps are rare and often discovered either during routine colorectal cancer screenings or in symptomatic patients presenting with hematochezia. In unusual cases, they can present as an adhesive obstruction with radiological and clinical findings suggestive of a suspicious recurrent colorectal malignancy lesion. Because these polyps can mimic cancer during endoscopy, a detailed tissue examination is crucial for making the correct diagnosis and planning treatment. In this report, we share a challenging case where a patient with a history of cancer presented with signs that strongly suggested a malignant recurrence, but the final diagnosis was an inflammatory cloacogenic polyp. This case highlights the critical role of regular endoscopic monitoring in managing such complex conditions.", "provenance": [ { "field": "n", "quote": "a challenging case where a patient with a history of cancer presented" }, { "field": "population", "quote": "a patient with a history of cancer presented with signs that strongly suggested a malignant recurrence" }, { "field": "result", "quote": "the final diagnosis was an inflammatory cloacogenic polyp" }, { "field": "primaryOutcome", "quote": "the final diagnosis was an inflammatory cloacogenic polyp" }, { "field": "intervention", "quote": "a detailed tissue examination is crucial for making the correct diagnosis" }, { "field": "comparator", "quote": "Inflammatory cloacogenic polyps are rare and often discovered either during routine colorectal cancer screenings or in symptomatic patients presenting with hematochezia." } ] }, { "id": "pmid:42798120", "pmid": "42798120", "doi": "10.1097/MD.0000000000050820", "nctId": null, "pmcid": "PMC13619274", "title": "Mucinous adenocarcinoma presenting as adult colonic intussusception: A case report", "firstAuthor": "Han", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 75-year-old woman with multiple health problems and dementia", "intervention": "none (diagnostic workup and emergency surgery)", "comparator": "none", "primaryOutcome": "cause of bleeding and bowel obstruction symptoms", "result": "bright red blood was caused by a rare colon cancer (mucinous adenocarcinoma) causing bowel telescoping (intussusception)", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot tell you how likely this cause is for anyone else.", "directness": "indirect", "limitations": "single case report with no comparison group; findings may not generalize to other patients with rectal bleeding", "followUp": "", "plainFinding": "Rare colon cancer found in one case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42798120/", "sourceText": "RATIONALE: Colonic intussusception is a rare cause of intestinal obstruction in adults, and is frequently associated with an underlying malignancy. Mucinous adenocarcinoma (MAC) is an uncommon histological subtype of colorectal cancer, characterized by abundant extracellular mucin and unfavorable biological behaviors. However, its presentation as a lead point for an intussusception is rare. Here we describe a rare case of MAC causing colonic intussusception. PATIENT CONCERNS: We describe the case of a 75-year-old woman with multiple comorbidities who presented with hematochezia, abdominal distension, intermittent colicky pain, and progressive weight loss. DIAGNOSES: Colonoscopy revealed a large intraluminal mass in the ascending colon, while contrast-enhanced computed tomography revealed ileocecal intussusception with ischemic features. INTERVENTIONS: Emergency right hemicolectomy was performed. Histopathology confirmed a moderately differentiated MAC without lymph node metastasis. Molecular analysis revealed a p.Gly13Asp KRAS (KRAS proto-oncogene, GTPase; protein change: glycine to aspartate substitution at codon 13) mutation with microsatellite stability. OUTCOMES: The patient's prolonged immobility due to dementia and prior hip fracture surgery likely contributed to chronic bowel hypomotility, potentially exacerbating symptoms. LESSONS: This case presents an unusual occurrence of MAC causing adult colonic intussusception, highlighting how tumor biology may synergize with host-related factors such as immobility to accelerate clinical deterioration. Early recognition using endoscopy and computed tomography and timely surgical resection is essential to optimize outcomes.", "provenance": [ { "field": "population", "quote": "a 75-year-old woman with multiple comorbidities who presented with hematochezia, abdominal distension, intermittent colicky pain, and progressive weight loss" }, { "field": "primaryOutcome", "quote": "Colonoscopy revealed a large intraluminal mass in the ascending colon, while contrast-enhanced computed tomography revealed ileocecal intussusception with ischemic features" }, { "field": "result", "quote": "Histopathology confirmed a moderately differentiated MAC without lymph node metastasis" }, { "field": "n", "quote": "a 75-year-old woman" }, { "field": "intervention", "quote": "Emergency right hemicolectomy was performed." }, { "field": "comparator", "quote": "Here we describe a rare case of MAC causing colonic intussusception." } ] }, { "id": "pmid:42793706", "pmid": "42793706", "doi": "10.3390/diagnostics16182921", "nctId": null, "pmcid": "PMC13605256", "title": "Diagnostic Indications and Endoscopic Correlates of Fecal Occult Blood Testing in Hospitalized Patients", "firstAuthor": "Contento-Anaya", "multipleAuthors": true, "journal": "Diagnostics (Basel)", "year": 2026, "design": "retrospective", "n": 160, "nField": "reported", "population": "hospitalized adults who had a fecal occult blood test (FOBT) done, mostly for anemia or suspected GI bleeding", "intervention": "fecal occult blood test (FOBT) result (positive or negative)", "comparator": "endoscopic findings (EGD or colonoscopy results)", "primaryOutcome": "whether a positive FOBT was linked to abnormal findings on endoscopy", "result": "after adjusting for the fact that positive tests were checked with endoscopy far more often than negative tests, there was no significant link between a positive FOBT and abnormal endoscopy findings", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "it is a retrospective study with only 160 patients and acknowledged bias because positive and negative tests were not checked equally with endoscopy.", "directness": "indirect", "limitations": "retrospective design, differential (unequal) endoscopic verification between positive and negative test results, wide confidence intervals", "followUp": "", "plainFinding": "No link between stool blood test and bleeding source.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42793706/", "sourceText": "Background: FOBT is widely used for colorectal cancer screening in asymptomatic populations but is frequently applied in hospitalized patients with anemia or suspected gastrointestinal bleeding despite limited supporting evidence. Objectives: To evaluate the clinical utility of fecal occult blood testing (FOBT) in hospitalized patients, focusing on its indications and its association with endoscopic findings while accounting for differential endoscopic verification. Methods: We conducted a retrospective study of 160 hospitalized adults who underwent FOBT at a medium-complexity referral center. Demographic, clinical, and endoscopic data were extracted from electronic medical records. Group comparisons used Wilcoxon rank-sum, chi-square, or Fisher's exact tests; multivariable logistic regression, verification-bias-corrected diagnostic accuracy (Begg-Greenes method), and multiple imputation assessed the association between FOBT and endoscopic findings. Results: FOBT was positive in 61.3% of patients. Anemia was the main indication (51%), followed by melena (26%) and hematochezia (6.9%). FOBT positivity was significantly associated with anemia at admission (82% vs. 68%, p = 0.044) and hematochezia (10% vs. 0%, p = 0.007). Endoscopic verification differed markedly by the FOBT result (71% vs. 29%), and no significant association between FOBT positivity and abnormal endoscopic findings persisted after multivariable adjustment or bias correction, for either EGD (OR 2.01, 95%CI 0.66-6.10) or colonoscopy (OR 4.58, 95%CI 0.39-54.3). Conclusions: FOBT shows no robust diagnostic association with endoscopic pathology, upper or lower, once differential verification is accounted for. Its main actionable finding was frequent guideline-discordant use in patients with overt bleeding, identifying institutional stewardship as the primary target for improving diagnostic efficiency in inpatient care.", "provenance": [ { "field": "n", "quote": "We conducted a retrospective study of 160 hospitalized adults who underwent FOBT at a medium-complexity referral center." }, { "field": "population", "quote": "FOBT is widely used for colorectal cancer screening in asymptomatic populations but is frequently applied in hospitalized patients with anemia or suspected gastrointestinal bleeding" }, { "field": "intervention", "quote": "fecal occult blood testing (FOBT)" }, { "field": "comparator", "quote": "its association with endoscopic findings while accounting for differential endoscopic verification" }, { "field": "primaryOutcome", "quote": "To evaluate the clinical utility of fecal occult blood testing (FOBT) in hospitalized patients, focusing on its indications and its association with endoscopic findings" }, { "field": "result", "quote": "no significant association between FOBT positivity and abnormal endoscopic findings persisted after multivariable adjustment or bias correction, for either EGD (OR 2.01, 95%CI 0.66-6.10) or colonoscopy (OR 4.58, 95%CI 0.39-54.3)." } ] }, { "id": "pmid:42763603", "pmid": "42763603", "doi": "10.7759/cureus.114856", "nctId": null, "pmcid": "PMC13589451", "title": "Splenic Artery Pseudoaneurysm With Fistulization to the Transverse Colon: A Case Report", "firstAuthor": "Mitchell", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "Woman in her 80s with rectal bleeding", "intervention": "Endovascular embolization followed by splenectomy and colon resection", "comparator": "None", "primaryOutcome": "Resolution of bleeding and symptoms", "result": "Bleeding stopped and symptoms resolved after treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show whether this treatment works in general.", "directness": "indirect", "limitations": "Single case report; cause of bleeding (splenic artery pseudoaneurysm with fistula to colon) is a rare condition, not representative of typical causes of bright red rectal bleeding.", "followUp": "", "plainFinding": "Rare cause, successfully treated with surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42763603/", "sourceText": "Splenic artery pseudoaneurysms (SAPs) are rare occurrences, most commonly secondary to pancreatitis, abdominal trauma, or postoperative/iatrogenic causes. The most common presenting symptom is abdominal pain, but it may also be hematochezia, melena, or hematemesis. SAP rupture or fistulation causes massive hemorrhage leading to hemorrhagic shock and possible death if left untreated. The timely diagnosis and treatment of SAPs are therefore crucial in managing these patients. Here, we present a case of a female in her 80s presenting with rectal bleeding, diagnosed with SAP with fistulization to the transverse colon as seen on contrasted abdominopelvic CT. She was treated with endovascular embolization, which successfully resolved the bleeding, and subsequent splenectomy and splenic flexure colectomy. The patient's postoperative course was complicated by urinary retention due to presumed UTI, left-sided pleural effusion, mitral regurgitation, and tricuspid regurgitation. Once the complications resolved, the patient did well with symptom resolution. Early diagnosis is crucial for the management of these patients. Due to the nonspecific presentation, a high level of suspicion should prompt further evaluation to prevent adverse outcomes. Fistulization of SAPs to surrounding structures could lead to complications, as was seen with this patient. However, endovascular embolization of the SAP with subsequent segmental resection of the involved colon proved to be a successful treatment.", "provenance": [ { "field": "population", "quote": "a female in her 80s presenting with rectal bleeding, diagnosed with SAP with fistulization to the transverse colon" }, { "field": "intervention", "quote": "She was treated with endovascular embolization, which successfully resolved the bleeding, and subsequent splenectomy and splenic flexure colectomy." }, { "field": "comparator", "quote": "She was treated with endovascular embolization, which successfully resolved the bleeding, and subsequent splenectomy and splenic flexure colectomy." }, { "field": "primaryOutcome", "quote": "Once the complications resolved, the patient did well with symptom resolution." }, { "field": "result", "quote": "endovascular embolization of the SAP with subsequent segmental resection of the involved colon proved to be a successful treatment" }, { "field": "n", "quote": "a female in her 80s" } ] }, { "id": "pmid:42761181", "pmid": "42761181", "doi": "10.1002/ccr3.73555", "nctId": null, "pmcid": "PMC13586439", "title": "Gastrointestinal Histoplasmosis Mimicking Intestinal Tuberculosis and Crohn's Disease: Ileocecal Involvement in an Immunocompetent Host", "firstAuthor": "Sazal", "multipleAuthors": true, "journal": "Clin Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 26-year-old immunocompetent man with abdominal pain, rectal bleeding, and weight loss", "intervention": "antifungal treatment (itraconazole then liposomal amphotericin B) for gastrointestinal histoplasmosis", "comparator": "none", "primaryOutcome": "survival and resolution of gastrointestinal bleeding and disease", "result": "the patient developed severe lower gastrointestinal bleeding and died despite treatment", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single case report of a rare fungal infection, not a study of common causes of bleeding when wiping, so it cannot tell us much about the general question.", "directness": "indirect", "limitations": "single patient case report; rare opportunistic infection in a specific regional context, not representative of typical causes of bright red blood on wiping", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42761181/", "sourceText": "Gastrointestinal histoplasmosis is an under-recognized manifestation of disseminated Histoplasma capsulatum infection. Its ileocecal predilection closely mimics intestinal tuberculosis (TB) and Crohn's disease, posing serious diagnostic challenges, particularly in TB-endemic regions. A 26-year-old immunocompetent male presented with a 3-month history of diffuse abdominal pain, hematochezia, and 16 kg weight loss. He had received 60 days of empirical four-drug anti-tubercular therapy (ATT) without improvement. Examination revealed cachexia, pallor, digital clubbing, pedal oedema, a hard palate ulcer, and small cervical lymphadenopathy. Investigations showed microcytic anemia, C-reactive protein (CRP) 143.35 mg/L, hypoalbuminemia (2 g/dL), hyponatremia, and fecal calprotectin of 1849.47 μg/g. Magnetic resonance enterography (MRE) suggested multi-segmental small bowel disease consistent with Crohn's disease. Sequential colonoscopies revealed ulcero-nodular lesions involving the distal ileum, ileocecal valve, and caecum. Initial biopsies were inconclusive. Repeat deep tissue biopsy from the caecum and ileocecal valve identified intracellular narrow-based budding yeast forms with eccentric nuclei, consistent with H. capsulatum. GeneXpert and Quantiferon-TB gold plus were negative. Cervical lymph node fine-needle aspiration cytology (FNAC) confirmed disseminated disease. HIV testing was negative. Itraconazole was initiated, followed by liposomal amphotericin B. On day 15, the patient developed catastrophic lower gastrointestinal hemorrhage, resulting in refractory hemodynamic collapse and death. Disseminated histoplasmosis should be considered in the differential diagnosis of ileocecal disease even in immunocompetent patients from TB-endemic regions. Histopathological confirmation through deep tissue biopsy is critical prior to immunosuppressive therapy. Delayed diagnosis carries significant mortality risk.", "provenance": [ { "field": "n", "quote": "A 26-year-old immunocompetent male presented" }, { "field": "population", "quote": "A 26-year-old immunocompetent male presented with a 3-month history of diffuse abdominal pain, hematochezia, and 16 kg weight loss." }, { "field": "intervention", "quote": "Itraconazole was initiated, followed by liposomal amphotericin B." }, { "field": "comparator", "quote": "Initial biopsies were inconclusive." }, { "field": "primaryOutcome", "quote": "On day 15, the patient developed catastrophic lower gastrointestinal hemorrhage, resulting in refractory hemodynamic collapse and death." }, { "field": "result", "quote": "On day 15, the patient developed catastrophic lower gastrointestinal hemorrhage, resulting in refractory hemodynamic collapse and death." } ] }, { "id": "pmid:42737845", "pmid": "42737845", "doi": "10.3390/ijms27177946", "nctId": null, "pmcid": "PMC13566703", "title": "Conserved Epithelial Remodeling Programs Underlie Pediatric Juvenile Colorectal Polyps Associated with Allergic Sensitization", "firstAuthor": "Polo", "multipleAuthors": true, "journal": "Int J Mol Sci", "year": 2026, "design": "lab", "n": 8, "nField": "reported", "population": "children with colon polyps causing rectal bleeding and allergy-related (IgE) sensitization", "intervention": "Analyzing gene activity in cells from the polyp tissue", "comparator": "gene activity in nearby normal-looking tissue from the same children", "primaryOutcome": "differences in gene activity between polyp tissue and nearby tissue", "result": "Thousands of genes were turned up or down in polyp tissue, showing strong allergy-type inflammation and changes to the gut lining, with some overlap with genes seen in colon cancer", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small lab study looking at gene activity in tissue samples, not a treatment trial, so it can't tell us how to stop or explain bleeding in general.", "directness": "indirect", "limitations": "Very small number of children studied (8 polyp samples, 7 matched nearby-tissue samples), specific to allergy-associated juvenile polyps rather than bleeding causes in general, and no clinical outcome or treatment was tested.", "followUp": "", "plainFinding": "Allergy-driven inflammation found in polyp tissue.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42737845/", "sourceText": "Juvenile colorectal polyps (JP) are the most common polypoid lesions of the colon in children and the leading cause of lower gastrointestinal bleeding in pediatric patients. Although histologically classified as benign hamartomatous lesions, they arise in a context of allergic sensitization and IgE-mediated inflammation, suggesting that the epithelial compartment may play an active role in their pathogenesis. To date, most studies have focused on the immune cell infiltrate, leaving the molecular programs operating within the epithelium largely unexplored. Whole-transcriptome RNA sequencing (RNA-seq) was performed on epithelial cells isolated from pediatric JP (n = 8) and paired tissue circumjacent to polyp (TCP) (n = 7) obtained from children with a history of rectal bleeding and IgE sensitization to food allergens. Differential expression, functional enrichment (GO, KEGG, GSEA), and cross-dataset comparison with TCGA colorectal adenocarcinoma (CRC) was conducted. Candidate genes were validated by RT-qPCR in independent samples, including colorectal cancer (CRC) and inflammatory bowel disease (IBD) tissue. Differential expression analysis identified 3273 differentially expressed genes (2342 upregulated, 931 downregulated in JP vs. TCP), with 220 genes exceeding 32-fold change, including SERPINB3 (log2FC = 12.16), MMP1 (log2FC = 10.19), NMUR2 (log2FC = 10.08) and CHI3L1 (log2FC = 8.87). JP epithelium displayed a coherent type 2 inflammatory signature, encompassing upregulation of the alarmin IL33, eosinophil-attracting chemokines (CCL11, CCL24), IgE receptor subunits (FCER1A, FCER1G), and a coordinately activated leukotriene and prostaglandin biosynthetic program (ALOX5, ALOX5AP, PTGS2). Concurrent alterations in epithelial identity were observed, including downregulation of absorptive enterocyte and intestinal stem cell markers (CDX2, LGR5, ASCL2) alongside upregulation of secretory and regenerative programs, including the ectopic gastric-type mucin MUC5AC. Tight junction dysregulation-notably upregulation of the pore-forming claudin CLDN2 and loss of barrier-sealing claudins (CLDN3, CLDN4, CLDN23)-was consistent with impaired epithelial permeability. Pathway analyses confirmed activation of type 2 immune and extracellular matrix remodeling programs, with concurrent suppression of mitochondrial oxidative phosphorylation. Cross-dataset comparison with TCGA CRC data identified 381 co-upregulated and 87 co-downregulated genes shared between JP and CRC, including SERPINE1, CXCL8, ICAM1, and MMP3, several of which were associated with poorer disease-specific survival in CRC patients. RT-qPCR validation confirmed elevation of CHI3L1 and SERPINE1 in both JP and CRC, while SERPINB4 appeared JP-specific. Epithelial cells from pediatric juvenile colorectal polyps associated with allergic sensitization display a comprehensive type 2 inflammatory transcriptome alongside profound alterations in lineage identity, barrier integrity, and metabolic programming. Partial convergence with CRC-associated gene expression programs-in the absence of histological dysplasia-suggests that chronic allergic inflammation activates conserved epithelial remodeling pathways shared across mucosal tissues. CHI3L1, SERPINE1, and SERPINB4 are candidate biomarkers warranting validation in larger cohorts.", "provenance": [ { "field": "n", "quote": "epithelial cells isolated from pediatric JP (n = 8) and paired tissue circumjacent to polyp (TCP) (n = 7)" }, { "field": "population", "quote": "obtained from children with a history of rectal bleeding and IgE sensitization to food allergens" }, { "field": "intervention", "quote": "Whole-transcriptome RNA sequencing (RNA-seq) was performed on epithelial cells isolated from pediatric JP" }, { "field": "comparator", "quote": "paired tissue circumjacent to polyp (TCP) (n = 7)" }, { "field": "primaryOutcome", "quote": "Differential expression, functional enrichment (GO, KEGG, GSEA), and cross-dataset comparison with TCGA colorectal adenocarcinoma (CRC) was conducted." }, { "field": "result", "quote": "Differential expression analysis identified 3273 differentially expressed genes (2342 upregulated, 931 downregulated in JP vs. TCP)" }, { "field": "result", "quote": "JP epithelium displayed a coherent type 2 inflammatory signature, encompassing upregulation of the alarmin IL33, eosinophil-attracting chemokines (CCL11, CCL24), IgE receptor subunits (FCER1A, FCER1G), and a coordinately activated leukotriene and prostaglandin biosynthetic program" } ] }, { "id": "pmid:42699967", "pmid": "42699967", "doi": "10.7759/cureus.114025", "nctId": null, "pmcid": "PMC13544949", "title": "Utility of the Inflammatory Bowel Disease Serology, Genetics, and Inflammation (IBD-SGI) Panel in the Evaluation of Atypical Ulcerative Colitis With Active Nonsteroidal Anti-Inflammatory Drug Use: A Case Report", "firstAuthor": "Guo", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 39-year-old man with rectal bleeding, diarrhea, and long-term high-dose NSAID use", "intervention": "a blood test panel (IBD-SGI) used alongside colonoscopy and biopsy to help diagnose the cause of bleeding", "comparator": "colonoscopy and biopsy findings alone, without the blood panel", "primaryOutcome": "whether the blood panel helped clarify the diagnosis when biopsy results were unclear between NSAID damage and inflammatory bowel disease", "result": "the blood panel supported a diagnosis of ulcerative colitis when combined with other test results, and the patient improved after starting targeted treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this approach works in general.", "directness": "indirect", "limitations": "single case report with no comparison group, so findings cannot be generalized", "followUp": "three-month follow-up", "plainFinding": "Blood test aided colitis diagnosis.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42699967/", "sourceText": "Hematochezia has a broad differential, including nonsteroidal anti-inflammatory drug (NSAID)-induced, infectious, and inflammatory colitis. Colonoscopy with biopsy is primarily used to evaluate suspected colitis or inflammatory bowel disease (IBD) in patients with hematochezia, rather than to diagnose all causes of hematochezia. While the inflammatory bowel disease serology, genetics, and inflammation (IBD-SGI) blood panel test has been studied and marketed by laboratories, it is not widely implemented in routine clinical practice due to the restriction of current clinical guidelines, lack of FDA clearance/approval, and limited medical insurance coverage. Thus, we report a case of the utility of the IBD-SGI panel in the evaluation of atypical ulcerative colitis (UC) with active NSAID use. A 39-year-old man with hematochezia, diarrhea, and chronic high-dose NSAID use developed anemia, elevated fecal calprotectin, and endoscopic evidence of inflammation. Biopsies by colonoscopy showed focal colitis with features suggestive of both NSAID injury and IBD. To provide additional diagnostic support in this challenging case, an IBD-SGI blood panel was used. When interpreted with the patient's clinical presentation, elevated fecal calprotectin level, colonoscopic findings, and histopathologic features, the panel results supported a diagnosis of UC. Based on the overall clinic-pathological assessment, including continuous circumferential inflammation on colonoscopy and histopathologic evidence of chronic IBD, the patient was diagnosed with UC and treatment with vedolizumab was initiated. Anemia attributed to hematochezia was also managed. At the three-month follow-up, the patient had resumed his daily activities and returned to work. In the setting of overlapping features of UC and possible NSAID-associated colitis, the IBD-SGI panel provided adjunctive diagnostic information. This case highlights the panel's potential value as a supportive tool when endoscopic biopsy findings are inconclusive and multiple possible etiologies coexist.", "provenance": [ { "field": "population", "quote": "A 39-year-old man with hematochezia, diarrhea, and chronic high-dose NSAID use developed anemia, elevated fecal calprotectin, and endoscopic evidence of inflammation." }, { "field": "intervention", "quote": "an IBD-SGI blood panel was used" }, { "field": "comparator", "quote": "Biopsies by colonoscopy showed focal colitis with features suggestive of both NSAID injury and IBD." }, { "field": "primaryOutcome", "quote": "To provide additional diagnostic support in this challenging case, an IBD-SGI blood panel was used." }, { "field": "result", "quote": "the panel results supported a diagnosis of UC" }, { "field": "n", "quote": "A 39-year-old man with hematochezia, diarrhea, and chronic high-dose NSAID use" }, { "field": "followUp", "quote": "At the three-month follow-up, the patient had resumed his daily activities and returned to work." } ] }, { "id": "pmid:42699804", "pmid": "42699804", "doi": "10.2147/JMDH.S638033", "nctId": null, "pmcid": "PMC13544518", "title": "Hemorrhoids and Rectal Cancer: A Systematic Review of Clinical Overlap, Diagnostic Misclassification, and Early Detection Strategies for Primary Care", "firstAuthor": "Tu", "multipleAuthors": true, "journal": "J Multidiscip Healthc", "year": 2026, "design": "systematic-review", "n": 46, "nField": "reported", "population": "people with anorectal symptoms like rectal bleeding, where hemorrhoids and rectal cancer can look similar", "intervention": "reviewing symptoms and diagnostic methods to tell hemorrhoids apart from rectal cancer", "comparator": "", "primaryOutcome": "how often hemorrhoids and rectal cancer symptoms overlap and cause misdiagnosis", "result": "bright red bleeding on wiping is usually from hemorrhoids, but dark red blood, ongoing anorectal pain, or unexplained weight loss can signal rectal cancer and warrant checking", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "this is a well-conducted review of existing studies, but it combines different types of research without new patient testing and notes a lack of strong trial evidence.", "directness": "direct", "limitations": "few randomized controlled trials on diagnosis, limited data from primary care settings, and early-stage evidence for newer screening technologies", "followUp": "", "plainFinding": "Bright red usually hemorrhoids, dark red needs checking.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42699804/", "sourceText": "Hemorrhoidal disease (HD) and rectal cancer (RC) are common anorectal disorders with overlapping clinical symptoms, including rectal bleeding, altered bowel habits, and anorectal discomfort. This similarity leads to frequent misdiagnosis of RC as HD, and early diagnosis is essential for improving survival and quality of life in patients with RC. This systematic review aimed to summarize overlapping features, analyze causes of misdiagnosis, and review advances in early detection to provide practical guidance for primary care. A literature search was performed in PubMed, Embase, and Web of Science, covering publications from January 2018 to February 2026. We included systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case-control studies, and clinical guidelines that addressed clinical association, differential diagnosis, or early detection of HD and RC, with case series requiring ≥10 participants; single case reports, conference abstracts, animal studies, and low-quality non-core journals were excluded. Two reviewers independently extracted data and assessed study quality using AMSTAR 2, Cochrane RoB, Newcastle-Ottawa Scale, and AGREE II, with disagreements resolved by consensus. Due to substantial heterogeneity across studies, a narrative qualitative synthesis was performed, grouping findings by the three review questions. Forty-six moderate- to high-quality studies were included in the analysis. Rectal bleeding was the most frequent overlapping symptom, followed by altered bowel habits and anorectal discomfort. Warning signs suggestive of RC included dark red blood per rectum, persistent anorectal pain, and unexplained weight loss. Major causes of misdiagnosis include clinical inertia, insufficient use of digital rectal examination, and limited access to endoscopy, especially in primary care settings. Limitations include scarcity of randomized controlled trials in diagnostic research, limited primary care data, and preliminary evidence for emerging technologies. Overlapping symptoms remain the main cause of misdiagnosis of RC. Increased clinical awareness, standardized diagnostic procedures, and proper screening tools can significantly reduce diagnostic errors. This review offers evidence-based support for differential diagnosis and early detection of RC in routine clinical practice.", "provenance": [ { "field": "population", "quote": "Hemorrhoidal disease (HD) and rectal cancer (RC) are common anorectal disorders with overlapping clinical symptoms, including rectal bleeding, altered bowel habits, and anorectal discomfort." }, { "field": "intervention", "quote": "This systematic review aimed to summarize overlapping features, analyze causes of misdiagnosis, and review advances in early detection to provide practical guidance for primary care." }, { "field": "primaryOutcome", "quote": "Rectal bleeding was the most frequent overlapping symptom, followed by altered bowel habits and anorectal discomfort." }, { "field": "result", "quote": "Warning signs suggestive of RC included dark red blood per rectum, persistent anorectal pain, and unexplained weight loss." }, { "field": "n", "quote": "Forty-six moderate- to high-quality studies were included in the analysis." }, { "field": "limitations", "quote": "Limitations include scarcity of randomized controlled trials in diagnostic research, limited primary care data, and preliminary evidence for emerging technologies." } ] }, { "id": "pmid:42682644", "pmid": "42682644", "doi": "10.3389/fped.2026.1885979", "nctId": null, "pmcid": "PMC13529935", "title": "Salmonella Typhimurium infection complicating very early-onset inflammatory bowel disease presenting with Pseudo-intussusception: a case report", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Front Pediatr", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 5-year-old boy with fever, abdominal pain, and bloody diarrhea", "intervention": "IV antibiotic (cefotaxime) combined with dexamethasone enemas and mesalazine suppositories", "comparator": "", "primaryOutcome": "resolution of symptoms", "result": "symptoms resolved within 10 days of combined treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether the treatment would work for others.", "directness": "indirect", "limitations": "Single case report in a young child with a rare combination of infection and very early-onset inflammatory bowel disease, not a general study of rectal bleeding.", "followUp": "", "plainFinding": "Bleeding resolved with antibiotics and anti-inflammatories.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42682644/", "sourceText": "The clinical manifestations of acute non-typhoidal Salmonella infection can overlap with underlying very early-onset inflammatory bowel disease (VEO-IBD), complicating early differential diagnosis. We report a 5-year-old boy who presented with fever, paroxysmal abdominal pain, and high-volume watery hematochezia. Initial abdominal ultrasonography revealed a \"concentric ring sign\" mimicking intussusception, while laboratory tests concurrently demonstrated elevated serum total immunoglobulin E (IgE) levels. Subsequent water-soluble gastrointestinal contrast studies and computed tomography ruled out mechanical intestinal obstruction. Early endoscopy and mucosal biopsy revealed cryptitis and chronic active inflammation from the rectum to the sigmoid colon, and stool cultures isolated Salmonella Typhimurium, with serum total IgE peaking at 2965 IU/mL. Based on these clinical findings, the patient was diagnosed with concurrent acute Salmonella Typhimurium infection and VEO-IBD. The patient received a combined regimen of systemic intravenous cefotaxime sodium and localized therapy comprising dexamethasone retention enemas and mesalazine suppositories, with symptom resolution within 10 days. This case illustrates the value of multimodal imaging and early endoscopy in differentiating overlapping enteric infections from VEO-IBD, and suggests that integrating systemic antimicrobials with localized anti-inflammatory agents may be a feasible therapeutic strategy.", "provenance": [ { "field": "n", "quote": "a 5-year-old boy who presented with fever, paroxysmal abdominal pain, and high-volume watery hematochezia" }, { "field": "population", "quote": "a 5-year-old boy who presented with fever, paroxysmal abdominal pain, and high-volume watery hematochezia" }, { "field": "intervention", "quote": "The patient received a combined regimen of systemic intravenous cefotaxime sodium and localized therapy comprising dexamethasone retention enemas and mesalazine suppositories" }, { "field": "primaryOutcome", "quote": "with symptom resolution within 10 days" }, { "field": "result", "quote": "with symptom resolution within 10 days" } ] }, { "id": "pmid:42680252", "pmid": "42680252", "doi": "10.1016/j.mayocp.2026.04.024", "nctId": null, "pmcid": null, "title": "Primary Care Management of Ileal Pouch Disorders: Diagnosis, Treatment, and Referral", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "Mayo Clin Proc", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people living with an ileal pouch after surgery for ulcerative colitis or familial polyposis", "intervention": "not applicable (review of diagnosis and management approaches)", "comparator": "not applicable", "primaryOutcome": "", "result": "This is a general review describing symptoms and management of pouch disorders, not a study testing an intervention; it does not address bright red bleeding when wiping in the general population", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing management guidance rather than a study testing a treatment or reporting outcome data relevant to the question asked.", "directness": "indirect", "limitations": "This abstract concerns a specific surgical population (ileal pouch patients) and does not address bright red bleeding in the general population; no original data or outcomes are reported.", "followUp": "", "plainFinding": "Not relevant to this question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42680252/", "sourceText": "Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment of patients with ulcerative colitis and familial adenomatous polyposis. As the incidence of ulcerative colitis rises globally, increasing numbers of patients live long term with IPAA. Whereas most patients with IPAA achieve good functional outcomes, studies suggest that up to 80% will experience pouchitis during their lifetime, among other inflammatory and structural pouch-related complications. Patients with pouch disorders present with nonspecific gastrointestinal symptoms that may include increased stool frequency, urgency, abdominal or pelvic discomfort, tenesmus, rectal bleeding, and difficulty in evacuating the pouch. Common inflammatory conditions include acute or intermittent pouchitis, chronic antibiotic-dependent pouchitis, chronic antibiotic-refractory pouchitis, cuffitis, and Crohn-like disease of the pouch. Structural complications, such as anastomotic leaks, strictures, and fistulas, may also occur and be manifested with obstructive or infectious symptoms. Primary care clinicians play an important role in the early recognition and initial management of pouch-related complications. For example, patients with mild suspected pouchitis and no alarm features may be treated with empirical antibiotic therapy with close follow-up. Topical mesalamine may be used for suspected cuffitis. However, persistent symptoms, recurrent pouchitis, suspected Crohn-like disease of the pouch, or signs of structural complications warrant prompt referral to subspecialist care.", "provenance": [ { "field": "population", "quote": "patients with IPAA" }, { "field": "result", "quote": "Patients with pouch disorders present with nonspecific gastrointestinal symptoms that may include increased stool frequency, urgency, abdominal or pelvic discomfort, tenesmus, rectal bleeding, and difficulty in evacuating the pouch." }, { "field": "intervention", "quote": "patients with mild suspected pouchitis and no alarm features may be treated with empirical antibiotic therapy with close follow-up" }, { "field": "comparator", "quote": "Topical mesalamine may be used for suspected cuffitis." } ] }, { "id": "pmid:42656448", "pmid": "42656448", "doi": "10.3389/fcimb.2026.1916422", "nctId": null, "pmcid": "PMC13506766", "title": "A case series study of fever-diarrhea-hematochezia triad as the first presentation in plasma EBV DNA-positive diseases", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Front Cell Infect Microbiol", "year": 2026, "design": "case-series", "n": null, "nField": "not-reported", "population": "adults with fever, diarrhea and bright red blood in stool who also tested positive for EBV virus in their blood", "intervention": "various treatments tried (corticosteroids, chemotherapy, surgery, stem cell transplant)", "comparator": "", "primaryOutcome": "diagnosis found and whether patients survived", "result": "most patients were seriously ill with an EBV-related disease, often misdiagnosed at first, and most died, though aggressive treatment helped a few survive long-term", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series of patients with a rare, severe illness, so it cannot reliably show what helps and does not apply to common causes of this symptom.", "directness": "indirect", "limitations": "Retrospective case series with no control group, exact number of patients not stated, and population is a rare severe EBV-related illness rather than typical causes of bright red blood on wiping.", "followUp": "", "plainFinding": "Describes rare, severe EBV illness, not common causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42656448/", "sourceText": "AIMS: To characterize the clinical spectrum and outcomes of fever-diarrhea-hematochezia triad as the first presentation in plasma EBV DNA-positive diseases (EBV-FDH). METHODS: This retrospective case series study was conducted at Qilu Hospital of Shandong University. We identified patients aged ≥14 years presenting with the triad of fever (>38 °C), diarrhea (≥3 loose stools/day), and hematochezia, accompanied by plasma EBV DNA positivity (≥500 copies/mL). All cases underwent a standardized diagnostic protocol including comprehensive laboratory tests, imaging, endoscopic and histopathological evaluation. Final diagnoses were established through multidisciplinary consensus. RESULTS: The cohort (mean age 46.5 years; 71.4% male) frequently had immune abnormalities (50%). Lymphadenopathy (78.6%) and weight loss (50%) were common. Laboratory examinations revealed universal hypocholesterolemia, with reduced ApoB and elevated Lp(a)​ further characterizing the lipid-metabolic disturbance. Endoscopy revealed widespread ulcers. Diagnoses included CAEBV, ENKTL, IBD, etc. Misdiagnosis occurred in 57.1% of cases. Treatments varied (corticosteroids, chemotherapy, surgery). Treatment strategies were heterogeneous. Despite high overall mortality (64.3%), five patients achieved long-term survival, including one who received intensive therapies such as hematopoietic stem cell transplantation and combination chemotherapy, suggesting a potential benefit of aggressive intervention in selected cases. CONCLUSIONS: EBV-FDH is a severe syndrome with high mortality, often misdiagnosed initially. A high clinical suspicion and multimodal evaluation are crucial. Aggressive treatment, including surgery and HSCT, can enable survival in select patients.", "provenance": [ { "field": "population", "quote": "patients aged ≥14 years presenting with the triad of fever (>38 °C), diarrhea (≥3 loose stools/day), and hematochezia, accompanied by plasma EBV DNA positivity (≥500 copies/mL)" }, { "field": "intervention", "quote": "Treatments varied (corticosteroids, chemotherapy, surgery)" }, { "field": "primaryOutcome", "quote": "To characterize the clinical spectrum and outcomes of fever-diarrhea-hematochezia triad as the first presentation in plasma EBV DNA-positive diseases" }, { "field": "result", "quote": "Despite high overall mortality (64.3%), five patients achieved long-term survival, including one who received intensive therapies such as hematopoietic stem cell transplantation and combination chemotherapy, suggesting a potential benefit of aggressive intervention in selected cases." }, { "field": "result", "quote": "Misdiagnosis occurred in 57.1% of cases." } ] }, { "id": "pmid:42633996", "pmid": "42633996", "doi": "10.18926/AMO/71069", "nctId": null, "pmcid": null, "title": "Hemorrhage from a Jejunal Lymphangioma", "firstAuthor": "Ishikami", "multipleAuthors": true, "journal": "Acta Med Okayama", "year": 2026, "design": "case-series", "n": null, "nField": "not-reported", "population": "a patient with severe anemia from active gastrointestinal bleeding", "intervention": "double-balloon endoscopy for diagnosis and laparoscopic-assisted surgical removal", "comparator": "none", "primaryOutcome": "finding the source of bleeding and stopping it", "result": "a rare benign tumor in the small intestine was found to be causing the bleeding and was successfully removed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general", "directness": "indirect", "limitations": "only one patient described, and the bleeding source was in the small intestine rather than from the rectum/anus as in typical bright red blood on wiping", "followUp": "", "plainFinding": "Rare small bowel tumor removed, bleeding stopped", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42633996/", "sourceText": "Lymphangioma is a benign tumor arising from lymphatic vessel proliferation and most commonly occurs in the head, neck, or axilla. Involvement of the small intestine is rare and is often overlooked as a source of obscure gastrointestinal bleeding. Because jejunal lymphangiomas frequently present with nonspecific symptoms and may escape detection by conventional upper and lower gastrointestinal endoscopy or cross-sectional imaging, diagnosis is often delayed. Advances in balloon-assisted enteroscopy have enabled direct visualization of small intestinal lesions, facilitating accurate diagnosis and appropriate therapeutic decision-making. Here, we report a case of jejunal lymphangioma presenting with severe anemia due to active bleeding, which was detected by double-balloon endoscopy and successfully managed by laparoscopic-assisted resection. This case highlights the importance of considering small intestinal lymphangioma in the differential diagnosis of unexplained gastrointestinal bleeding and underscores the clinical utility of deep enteroscopy in identifying rare but clinically significant small bowel tumors.", "provenance": [ { "field": "n", "quote": "we report a case of jejunal lymphangioma" }, { "field": "population", "quote": "presenting with severe anemia due to active bleeding" }, { "field": "intervention", "quote": "detected by double-balloon endoscopy and successfully managed by laparoscopic-assisted resection" }, { "field": "comparator", "quote": "successfully managed by laparoscopic-assisted resection" }, { "field": "primaryOutcome", "quote": "severe anemia due to active bleeding, which was detected by double-balloon endoscopy" }, { "field": "result", "quote": "successfully managed by laparoscopic-assisted resection" } ] }, { "id": "pmid:42618835", "pmid": "42618835", "doi": "10.1007/s11912-026-01815-1", "nctId": null, "pmcid": "PMC13490218", "title": "Early-Onset Colorectal Cancer: From Epidemiologic Shift to Life-Course Carcinogenesis and Age-Attuned Care", "firstAuthor": "Grześkiewicz-Szostak", "multipleAuthors": true, "journal": "Curr Oncol Rep", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Adults under age 50 diagnosed with colorectal (bowel) cancer", "intervention": "Earlier screening and faster investigation of warning symptoms like rectal bleeding", "comparator": "Older-onset (conventional) colorectal cancer and standard screening age thresholds", "primaryOutcome": "Whether bleeding and other symptoms lead to timely diagnosis of bowel cancer in young adults", "result": "Rectal bleeding and other red-flag symptoms are often dismissed or underestimated in younger adults, causing delayed cancer diagnosis", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review summarizing other studies' findings rather than a new study that directly tested why bleeding occurs, so it carries limited weight for a specific causal answer.", "directness": "indirect", "limitations": "It is a review article synthesizing existing literature, not a controlled study, and does not quantify bleeding causes in a defined bleeding population.", "followUp": "", "plainFinding": "Bleeding can signal bowel cancer in young adults.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42618835/", "sourceText": "PURPOSE OF REVIEW: Early-onset colorectal cancer (EOCRC), conventionally defined as colorectal cancer diagnosed before the age of 50 years, has become one of the most important and unsettling epidemiologic shifts in gastrointestinal oncology. This review critically synthesizes recent evidence on EOCRC epidemiology, risk architecture, life-course carcinogenesis, molecular and microbiome-associated mechanisms, diagnostic delay, screening limitations, treatment considerations, and survivorship needs, with the aim of reframing EOCRC as an age-attuned clinical and biological challenge rather than a simple early presentation of conventional colorectal cancer. RECENT FINDINGS: Recent population-based analyses confirm that EOCRC incidence is increasing across multiple countries and birth cohorts, with a disproportionate contribution of distal colon and rectal cancers. These data suggest that the rise of EOCRC is unlikely to be explained by improved detection alone and instead points toward changing generational exposures. Contemporary studies have moved the field beyond hereditary predisposition as the dominant explanatory model: although germline syndromes remain essential to identify, most EOCRC is sporadic or incompletely explained by known inherited risk. Recent literature increasingly implicates metabolic dysfunction, obesity, westernized dietary patterns, early-life exposures, inflammation, antibiotic-associated microbial disruption, and host-microbiome disequilibrium. Particularly important are emerging genomic data linking colibactin-associated mutational signatures to younger-onset disease, supporting the hypothesis that microbial genotoxicity may imprint early driver events long before clinical diagnosis. In parallel, recent clinical studies show that EOCRC is frequently symptomatic, yet diagnosis is commonly delayed because alarm features such as rectal bleeding, abdominal pain, altered bowel habits, and anaemia are often underestimated in younger adults. EOCRC is best understood as a heterogeneous, life-course disease shaped by the convergence of inherited susceptibility, environmental and metabolic exposures, microbiome-mediated biology, tumour site, diagnostic-system factors, and survivorship context. Lowering the average-risk screening age to 45 years is necessary but insufficient, because many cases still occur below routine screening thresholds. A modern EOCRC strategy must therefore combine risk-adapted prevention, improved family-history capture, timely investigation of red-flag symptoms, systematic germline and tumour profiling, and treatment planning that accounts for decades of survivorship. Future progress will depend on moving beyond age alone toward integrated models that connect epidemiology, exposome biology, microbial mutagenesis, precision early detection, and age-specific care.", "provenance": [ { "field": "population", "quote": "Early-onset colorectal cancer (EOCRC), conventionally defined as colorectal cancer diagnosed before the age of 50 years" }, { "field": "intervention", "quote": "Lowering the average-risk screening age to 45 years is necessary but insufficient" }, { "field": "comparator", "quote": "reframing EOCRC as an age-attuned clinical and biological challenge rather than a simple early presentation of conventional colorectal cancer" }, { "field": "primaryOutcome", "quote": "diagnosis is commonly delayed because alarm features such as rectal bleeding, abdominal pain, altered bowel habits, and anaemia are often underestimated in younger adults" }, { "field": "result", "quote": "diagnosis is commonly delayed because alarm features such as rectal bleeding, abdominal pain, altered bowel habits, and anaemia are often underestimated in younger adults" } ] }, { "id": "pmid:42522103", "pmid": "42522103", "doi": "10.1111/jgh.70503", "nctId": null, "pmcid": "PMC13534276", "title": "The Effect of Nexpowder in Reducing Post-ESD Coagulation Syndrome in Proximal Colon Lesions: A Retrospective Multicenter Study", "firstAuthor": "Lee", "multipleAuthors": true, "journal": "J Gastroenterol Hepatol", "year": 2026, "design": "retrospective", "n": 75, "nField": "reported", "population": "patients who had colon polyp/tumor removal surgery (ESD) for high-risk proximal colon lesions", "intervention": "applying Nexpowder (a hemostatic powder) to the wound after colon tumor removal", "comparator": "no powder applied (standard care)", "primaryOutcome": "rate of post-procedure coagulation syndrome (pain, fever, inflammation needing antibiotics)", "result": "Coagulation syndrome occurred in 2.9% of patients given the powder versus 20.0% of control patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized study with a small number of patients and events, so it cannot rule out bias or chance.", "directness": "indirect", "limitations": "Retrospective design, small sample size, non-randomized allocation between groups, from a different condition (colon tumor removal, not hemorrhoidal bleeding).", "followUp": "", "plainFinding": "Fewer complications after colon tumor removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42522103/", "sourceText": "BACKGROUND: Endoscopic submucosal dissection (ESD) is an established curative treatment for lateral spreading tumors and early colorectal cancer, but it can cause procedure-related complications such as post-ESD coagulation syndrome (PECS), which may increase healthcare utilization, prolong hospitalization, and raise medical costs. Nexpowder (Nextbiomedical Co. Ltd., Incheon, Republic of Korea), a highly adhesive hemostatic powder approved by the U.S. FDA for nonvariceal upper gastrointestinal bleeding, has demonstrated efficacy in preventing rebleeding. This study aimed to evaluate the prophylactic efficacy of Nexpowder in preventing PECS after colorectal ESD for high-risk proximal lesions. METHODS: This retrospective multicenter study included patients who underwent colorectal ESD between April 2023 and October 2024 for PECS high-risk lesions, excluding those with perforation, muscular injury, or prophylactic clipping. Nexpowder was applied prophylactically in 35 patients (46.7%), while 40 patients (53.3%) served as controls. PECS was defined as postprocedural abdominal pain, fever, and elevated inflammatory markers requiring antibiotics. RESULTS: PECS occurred in nine patients overall. The incidence was significantly lower in the Nexpowder group (2.9% [CI 0.3-12.6]) than in the control group (20.0% [CI 9.9-34.2]; p = 0.032). All cases resolved with conservative treatment, and no surgical intervention was required. CONCLUSION: The application of Nexpowder was associated with a significant reduction in the incidence of PECS after high-risk colorectal ESD. This study provides the first clinical evidence that a topical barrier agent may serve as a simple and effective preventive strategy for PECS.", "provenance": [ { "field": "population", "quote": "patients who underwent colorectal ESD between April 2023 and October 2024 for PECS high-risk lesions" }, { "field": "intervention", "quote": "Nexpowder was applied prophylactically in 35 patients (46.7%)" }, { "field": "comparator", "quote": "40 patients (53.3%) served as controls" }, { "field": "primaryOutcome", "quote": "PECS was defined as postprocedural abdominal pain, fever, and elevated inflammatory markers requiring antibiotics." }, { "field": "result", "quote": "The incidence was significantly lower in the Nexpowder group (2.9% [CI 0.3-12.6]) than in the control group (20.0% [CI 9.9-34.2]; p = 0.032)." }, { "field": "n", "quote": "Nexpowder was applied prophylactically in 35 patients (46.7%), while 40 patients (53.3%) served as controls." } ] }, { "id": "pmid:42485228", "pmid": "42485228", "doi": "10.1093/ibd/izag126", "nctId": null, "pmcid": null, "title": "Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study", "firstAuthor": "Ünal", "multipleAuthors": true, "journal": "Inflamm Bowel Dis", "year": 2026, "design": "retrospective", "n": 50, "nField": "reported", "population": "hospitalized patients with severe ulcerative colitis who did not respond to steroids and infliximab", "intervention": "upadacitinib (a newer oral medication) as a third-line rescue treatment", "comparator": "no comparison group; all patients received upadacitinib after prior treatments failed", "primaryOutcome": "clinical remission, symptom response, and need for colon removal surgery over 48 weeks", "result": "stool frequency, rectal bleeding, and inflammation markers improved rapidly by week 1 and remained improved to week 48; 22% of patients still needed colectomy", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so it cannot prove upadacitinib caused the improvement rather than natural recovery or other factors.", "directness": "indirect", "limitations": "Retrospective design, no control group, and this is a specific hospitalized population with severe treatment-resistant ulcerative colitis, not a general population with rectal bleeding.", "followUp": "48 weeks", "plainFinding": "Bleeding eased with rescue drug.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42485228/", "sourceText": "BACKGROUND: Acute severe active ulcerative colitis (ASUC) often requires rescue therapy when standard medical treatment fails. Data on the use of upadacitinib (UPA) as a rescue option after failure of steroids and infliximab (IFX) and on the long-term outcomes of UPA treatment up to 48 weeks, remain scarce. METHODS: We evaluated hospitalized patients with ASUC (Truelove and Witts criteria) who received UPA following the failure of intravenous corticosteroids (IV-CS) and IFX. Outcomes included UPA persistence, clinical remission (CR), partial Mayo score (pMAYO) ≤ 2, clinical response (≥3-point reduction in pMAYO), and colectomy rates over 48 weeks of follow-up. RESULTS: Fifty patients with ASUC from 11 centers (male, 54%) received UPA treatment following IV-CS/IFX failure. Prior IFX exposure was 86%, and > 50% of the patients had received ≥ 2 biologics. Continuation was 52% overall (week 4, 90%; week 48, 52%). Discontinuation was due to primary nonresponse (42%), secondary loss of response (46%), or other causes (13%). Adverse events related to UPA occurred in 24% of patients and almost all were nonsevere. Stool frequency, rectal bleeding, pMayo score, and C-reactive protein (CRP) improved rapidly by week 1 and were thereafter maintained to week 48. Colectomy occurred in 22% of patients (nearly half of them in week 1). Week 1 CRs were 60%/30% while the week 48 CR rate was 51%. Higher baseline CRP predicted colectomy; no factor affected UPA persistence. CONCLUSION: In this multicenter cohort of patients with ASUC who failed IV-CS and IFX rescue, third-line UPA was associated with a low colectomy rate and sustained response up to 1 year, with an acceptable safety profile. UPA may provide sufficient disease control to prevent or delay colectomy, or to serve as a bridge to alternative therapies. SUMMARY: In this retrospective multicenter cohort (11 centers), 50 patients with severe ulcerative colitis refractory to intravenous corticosteroids and infliximab received upadacitinib. Improved symptoms and C-reactive protein (CRP) levels occurred by week 1 and persisted to week 48; colectomy occurred in 22% and adverse events in 24% of patients.", "provenance": [ { "field": "n", "quote": "Fifty patients with ASUC from 11 centers" }, { "field": "population", "quote": "hospitalized patients with ASUC (Truelove and Witts criteria) who received UPA following the failure of intravenous corticosteroids (IV-CS) and IFX" }, { "field": "intervention", "quote": "third-line UPA was associated with a low colectomy rate and sustained response up to 1 year" }, { "field": "comparator", "quote": "In this retrospective multicenter cohort (11 centers), 50 patients with severe ulcerative colitis refractory to intravenous corticosteroids and infliximab received upadacitinib." }, { "field": "primaryOutcome", "quote": "Outcomes included UPA persistence, clinical remission (CR), partial Mayo score (pMAYO) ≤ 2, clinical response (≥3-point reduction in pMAYO), and colectomy rates over 48 weeks of follow-up." }, { "field": "result", "quote": "Stool frequency, rectal bleeding, pMayo score, and C-reactive protein (CRP) improved rapidly by week 1 and were thereafter maintained to week 48." } ] }, { "id": "pmid:42455494", "pmid": "42455494", "doi": "10.1007/s10620-026-10095-5", "nctId": null, "pmcid": null, "title": "Comparison of PEG-Based and Non-PEG Bowel Preparation for Emergency Colonoscopy in Acute Lower Gastrointestinal Bleeding: A Real-World Cohort Study with IPTW Analysis", "firstAuthor": "Bai", "multipleAuthors": true, "journal": "Dig Dis Sci", "year": 2026, "design": "retrospective", "n": 157, "nField": "reported", "population": "patients with acute lower gastrointestinal bleeding having emergency colonoscopy", "intervention": "bowel cleansing with PEG (polyethylene glycol) solution before colonoscopy", "comparator": "bowel cleansing without PEG (non-PEG laxative approach)", "primaryOutcome": "rate of finding the bleeding source on colonoscopy and rate of stopping the bleeding", "result": "After adjusting for differences between groups, diagnosis rates, finding signs of recent bleeding, and stopping bleeding were similar between PEG and non-PEG groups, though PEG gave better bowel cleanliness and more complete exams", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized study of methods for colonoscopy prep in people already diagnosed with bleeding, so it carries little weight and doesn't address causes of bleeding.", "directness": "indirect", "limitations": "Retrospective design, use of statistical adjustment (IPTW) rather than randomization, and findings were etiology-dependent, meaning results varied depending on the type of bleeding source.", "followUp": "", "plainFinding": "Prep method didn't change bleeding-source detection", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42455494/", "sourceText": "PURPOSE: The optimal bowel preparation for acute lower gastrointestinal bleeding (ALGIB) in the emergency remains uncertain. This study aimed to compare the efficacy and safety of oral versus non-oral laxative approaches for emergency colonoscopy in ALGIB patients. METHODS: We retrospectively analyzed 157 patients undergoing emergency colonoscopy for ALGIB, stratified into PEG (n = 67) and non-PEG (n = 90) groups. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline confounders, including pre-procedural suspected etiology. Primary outcomes were endoscopic diagnosis (including definitive and presumptive) and hemostasis rates. Secondary outcomes included bowel preparation quality, procedural completion, and medical resource utilization. Post hoc analyses were performed by categorizing etiologies into focal/subtle and diffuse/obvious types. RESULTS: After IPTW adjustment, overall core outcomes including endoscopic diagnosis (86.5% vs. 80.3%), stigmata of recent hemorrhage (SRH) detection (42.7% vs. 43.9%) and hemostasis (12.5% vs. 16.9%) were comparable between groups (all adjusted P > 0.05). The PEG group demonstrated significantly higher rates of adequate bowel preparation (BBPS ≥ 6: 70.6% vs. 31.8%, P < 0.001) and cecal intubation (86.2% vs. 55.9%, P = 0.001), with no significant differences between groups in procedural efficiency or resource utilization (all P > 0.05). However, outcomes were significantly etiology-dependent. Diffuse/obvious lesions were associated with significantly higher definite diagnosis rates (64.3% vs. 38.6%, P = 0.004) but lower cecal intubation success (66.1% vs. 84.3%, P = 0.017) compared to focal/subtle lesions. CONCLUSION: Clinical outcomes in ALGIB are fundamentally etiology-dependent. While PEG and non-PEG strategies achieve comparable overall diagnostic and therapeutic yields, their distinct clinical utilities vary across lesion types. These findings advocate for a stratified, etiology-driven approach to bowel preparation. Future efforts should prioritize the development of pre-procedural predictive models to refine individualized management strategies.", "provenance": [ { "field": "n", "quote": "157 patients undergoing emergency colonoscopy for ALGIB, stratified into PEG (n = 67) and non-PEG (n = 90) groups" }, { "field": "population", "quote": "patients undergoing emergency colonoscopy for ALGIB" }, { "field": "intervention", "quote": "stratified into PEG (n = 67) and non-PEG (n = 90) groups" }, { "field": "comparator", "quote": "stratified into PEG (n = 67) and non-PEG (n = 90) groups" }, { "field": "primaryOutcome", "quote": "Primary outcomes were endoscopic diagnosis (including definitive and presumptive) and hemostasis rates" }, { "field": "result", "quote": "overall core outcomes including endoscopic diagnosis (86.5% vs. 80.3%), stigmata of recent hemorrhage (SRH) detection (42.7% vs. 43.9%) and hemostasis (12.5% vs. 16.9%) were comparable between groups (all adjusted P > 0.05)" } ] }, { "id": "pmid:42430297", "pmid": "42430297", "doi": "10.12659/AJCR.951726", "nctId": null, "pmcid": "PMC13367095", "title": "An 18-Year-Old Man with Bleeding From a Meckel's Diverticulum of the Terminal Ileum Diagnosed by 99mTc-Pertechnetate Scintigraphy (Meckel's Scan)", "firstAuthor": "Alswiket", "multipleAuthors": true, "journal": "Am J Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "an 18-year-old man with sudden rectal bleeding", "intervention": "99mTc-pertechnetate scintigraphy (Meckel's scan) to find the bleeding source", "comparator": "other tests tried first (CT scan, sigmoidoscopy, colonoscopy, endoscopy, capsule endoscopy)", "primaryOutcome": "finding the cause of the bleeding", "result": "the Meckel's scan found a Meckel's diverticulum that other tests had missed, and it was surgically removed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show how common this cause is or how reliable the test is in general.", "directness": "indirect", "limitations": "only one patient; a case report cannot establish how often this explains bright red bleeding on wiping, which is usually from much more common causes like hemorrhoids or fissures.", "followUp": "", "plainFinding": "Rare cause found: Meckel's diverticulum.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42430297/", "sourceText": "BACKGROUND Meckel's diverticulum represents the most common congenital anomaly of the gastrointestinal tract in the pediatric population. Although it is rarely symptomatic, painless rectal bleeding is the most common manifestation among pediatric patients. In contrast, Meckel's diverticulum is considerably rare in adults, in whom intestinal obstruction and diverticulitis are more frequent complications than bleeding. When it is suspected, a Meckel's scan is the most sensitive and specific diagnostic tool. Surgical excision remains the treatment of choice for Meckel's diverticulum. This report describes the case of an 18-year-old man with bleeding from a Meckel's diverticulum of the terminal ileum diagnosed by 99mTc-pertechnetate scintigraphy (Meckel's scan). CASE REPORT We report the case of an 18-year-old male patient who presented to the emergency department with a 24-hour history of 4 episodes of fresh rectal bleeding, associated with dizziness, nausea, palpitations, and a loss of consciousness. The patient underwent an extensive diagnostic workup, including computed tomography scan, sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy, and capsule endoscopy, none of which revealed any abnormalities. A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum on day 4 of admission, followed by a successful laparoscopic segmental resection on day 10 of admission. CONCLUSIONS Meckel's diverticulum, a common etiology of lower gastrointestinal bleeding in pediatric patients, presents a diagnostic challenge in adults, requiring a heightened index of suspicion. Clinical suspicion should be raised in cases with inconclusive initial investigations, particularly in younger adults.", "provenance": [ { "field": "population", "quote": "an 18-year-old male patient who presented to the emergency department with a 24-hour history of 4 episodes of fresh rectal bleeding" }, { "field": "intervention", "quote": "A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum" }, { "field": "comparator", "quote": "computed tomography scan, sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy, and capsule endoscopy, none of which revealed any abnormalities" }, { "field": "primaryOutcome", "quote": "diagnosed by 99mTc-pertechnetate scintigraphy (Meckel's scan)" }, { "field": "result", "quote": "A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum on day 4 of admission, followed by a successful laparoscopic segmental resection on day 10 of admission." }, { "field": "n", "quote": "An 18-Year-Old Man" } ] }, { "id": "pmid:42397354", "pmid": "42397354", "doi": "10.1097/SGA.0000000000000964", "nctId": null, "pmcid": null, "title": "Lead Time and Tailored Messaging Promote Early-Onset Colorectal Cancer Prevention and Screening", "firstAuthor": "Morrow", "multipleAuthors": true, "journal": "Gastroenterol Nurs", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people of screening age for colorectal cancer, including those under 50 with symptoms", "intervention": "tailored messaging and lead-time education to promote colorectal cancer screening and prevention", "comparator": "", "primaryOutcome": "", "result": "not reported as a study result; the abstract states that rectal bleeding, along with other symptoms, should prompt diagnostic colonoscopy regardless of age", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative discussion of screening guidelines and messaging strategies, not an original research study with data on causes of bleeding.", "directness": "indirect", "limitations": "The abstract offers general commentary and guideline recommendations rather than original data on causes of rectal bleeding.", "followUp": "", "plainFinding": "Rectal bleeding warrants colonoscopy evaluation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42397354/", "sourceText": "The American Cancer Society predicts 158,850 new cases of colorectal cancer and 52,230 deaths in 2026. Rates have declined for both men and women since 2011, particularly among those over age 65. This decline is likely due to reduced smoking and increased uptake of screening. Unfortunately, there has been an increase among those younger than age 55 years since the mid-1990s, likely due to the lifestyle of those born after 1950. Early-onset colorectal cancer is defined as a diagnosis before the age of 50 years. Guidelines now recommend screening for average-risk patients begin at age 45 years (formerly 50 years). High-risk patients should start screening at age 40 years, and possibly earlier. Patients need to learn about this recent change. A high index of suspicion is helpful when any patient presents with complaints of unexplained weight loss, abdominal pain, bloating, change in bowel habits, or rectal bleeding. These patients should be referred, regardless of age, for a diagnostic colonoscopy. Primary care providers can improve their practice's screening rates using evidence-based strategies. The gastroenterology nurse is in a key position to implement lead-time messaging with tailored messages to promote on-time screening and primary prevention through diet and lifestyle.", "provenance": [ { "field": "population", "quote": "Early-onset colorectal cancer is defined as a diagnosis before the age of 50 years." }, { "field": "intervention", "quote": "implement lead-time messaging with tailored messages to promote on-time screening and primary prevention through diet and lifestyle" }, { "field": "result", "quote": "These patients should be referred, regardless of age, for a diagnostic colonoscopy." }, { "field": "result", "quote": "A high index of suspicion is helpful when any patient presents with complaints of unexplained weight loss, abdominal pain, bloating, change in bowel habits, or rectal bleeding." } ] }, { "id": "pmid:42370147", "pmid": "42370147", "doi": "10.3389/fonc.2026.1819975", "nctId": null, "pmcid": "PMC13293901", "title": "Coexistence of rectal adenocarcinoma and rectal and lymph node tuberculosis: a case report with a limited narrative review", "firstAuthor": "Shi", "multipleAuthors": true, "journal": "Front Oncol", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 72-year-old man with a history of pulmonary tuberculosis presented with three months of intermittent hematochezia and tenesmus", "intervention": "not a treatment study; describes diagnosis and treatment of coexisting rectal cancer and tuberculosis", "comparator": "", "primaryOutcome": "correct diagnosis and outcome after treatment of rectal adenocarcinoma with concurrent rectal/lymph node tuberculosis", "result": "surgery and anti-tuberculosis therapy were successful, with no tumor recurrence or new tuberculosis at one year", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot tell us how common or likely any cause of bleeding is in general.", "directness": "indirect", "limitations": "single case, no control group, cannot establish how often rectal bleeding is due to cancer versus tuberculosis versus other causes.", "followUp": "one year", "plainFinding": "Rare case: cancer plus hidden tuberculosis.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42370147/", "sourceText": "BACKGROUND: Rectal cancer concurrent with regional tuberculosis is a rare clinical entity. Due to its similar clinical symptoms and imaging features, it is frequently misdiagnosed, which profoundly complicates patient management. CASE PRESENTATION: A 72-year-old man with a history of pulmonary tuberculosis presented with three months of intermittent hematochezia and tenesmus. Because the patient self-reported the tuberculosis as cured and initial imaging showed no active pulmonary or evident extrapulmonary lesions, preoperative molecular tuberculosis screening was not initiated. Preoperative imaging and biopsy confirmed rectal adenocarcinoma, alongside clinically suspected (but not histologically proven) pulmonary metastases. After neoadjuvant chemoradiotherapy, further chemotherapy was halted due to severe myelosuppression. A Hartmann procedure was performed after stable disease was confirmed. Postoperative pathology showed rectal adenocarcinoma with no lymph node metastasis (0/24) but unexpectedly revealed granulomatous inflammation in lymph nodes and rectal tissue. TB DNA PCR was positive, providing molecular evidence supporting concurrent tuberculosis. The patient developed postoperative anal discharge and a clinically suspected tuberculosis-related presacral infectious process, which improved after local irrigation and systemic anti-tuberculosis therapy. At one year, there was no tumor recurrence or new tuberculosis. CONCLUSION: In patients with a history of pulmonary tuberculosis who present with rectal cancer, the possibility of concurrent rectal and lymph node tuberculosis should be carefully considered. This case highlights the significant diagnostic overlap between these conditions, the high risk of delayed tuberculosis recognition, and its critical impact on postoperative management. Maintaining a high index of suspicion and utilizing comprehensive pathological and molecular evaluations are essential for accurate differential diagnosis and optimized patient care.", "provenance": [ { "field": "population", "quote": "A 72-year-old man with a history of pulmonary tuberculosis presented with three months of intermittent hematochezia and tenesmus." }, { "field": "n", "quote": "A 72-year-old man with a history of pulmonary tuberculosis presented with three months of intermittent hematochezia and tenesmus." }, { "field": "intervention", "quote": "A Hartmann procedure was performed after stable disease was confirmed." }, { "field": "result", "quote": "At one year, there was no tumor recurrence or new tuberculosis." }, { "field": "primaryOutcome", "quote": "Postoperative pathology showed rectal adenocarcinoma with no lymph node metastasis (0/24) but unexpectedly revealed granulomatous inflammation in lymph nodes and rectal tissue." } ] }, { "id": "pmid:42367594", "pmid": "42367594", "doi": "10.1159/000552164", "nctId": null, "pmcid": "PMC13299156", "title": "Colonic Leishmaniasis Mimicking a Malignant Stricture: Initial Presentation of Human Immunodeficiency Virus Infection - A Case Report", "firstAuthor": "Souto", "multipleAuthors": true, "journal": "GE Port J Gastroenterol", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "39-year-old man newly diagnosed with HIV and severe immune suppression", "intervention": "none (diagnostic colonoscopy and surgery)", "comparator": "none", "primaryOutcome": "cause of severe rectal bleeding (hematochezia)", "result": "Bleeding was caused by a colonic lesion from visceral leishmaniasis infection, requiring emergency bowel surgery", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single unusual case report in a severely immunosuppressed HIV patient, so it says little about typical causes of bleeding when wiping.", "directness": "indirect", "limitations": "Single case report in a patient with advanced HIV and a rare parasitic infection; not representative of typical causes of bright red bleeding on wiping.", "followUp": "", "plainFinding": "Rare parasite infection caused severe bleeding", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42367594/", "sourceText": "Colonic involvement in visceral leishmaniasis (VL) is exceptionally rare. We report a case of a 39-year-old man who presented with anorexia, weight loss, and diarrhea. Imaging revealed hepatosplenomegaly and extensive retroperitoneal lymphadenopathy, while laboratory tests showed pancytopenia and renal dysfunction. He was newly diagnosed with human immunodeficiency virus (CD4+ count: 3 cells/μL), and VL was confirmed by identification of amastigotes and positive PCR in bone marrow aspirate. During hospitalization, he developed severe hematochezia. Colonoscopy revealed a pseudotumoral, ulcerated, and stricturing lesion in the ascending colon; histology confirmed colonic leishmaniasis. The patient progressed to hemorrhagic shock, requiring urgent right hemicolectomy. This case underscores an uncommon and fulminant presentation of VL in the setting of profound immunosuppression, highlighting the importance of considering parasitic infections in the differential diagnosis of gastrointestinal bleeding in HIV-positive individuals.", "provenance": [ { "field": "population", "quote": "a 39-year-old man who presented with anorexia, weight loss, and diarrhea" }, { "field": "n", "quote": "We report a case of a 39-year-old man" }, { "field": "intervention", "quote": "Colonoscopy revealed a pseudotumoral, ulcerated, and stricturing lesion in the ascending colon; histology confirmed colonic leishmaniasis." }, { "field": "comparator", "quote": "The patient progressed to hemorrhagic shock, requiring urgent right hemicolectomy." }, { "field": "primaryOutcome", "quote": "During hospitalization, he developed severe hematochezia." }, { "field": "result", "quote": "histology confirmed colonic leishmaniasis. The patient progressed to hemorrhagic shock, requiring urgent right hemicolectomy." } ] }, { "id": "pmid:42327595", "pmid": "42327595", "doi": null, "nctId": null, "pmcid": "PMC13278059", "title": "Investigating Iron Deficiency Anaemia in the Elderly", "firstAuthor": "Galea", "multipleAuthors": true, "journal": "Ulster Med J", "year": 2026, "design": "prospective-cohort", "n": 92, "nField": "reported", "population": "elderly patients aged 75 and older referred to a gastroenterology clinic because of iron deficiency anaemia", "intervention": "different diagnostic investigations for iron deficiency anaemia such as endoscopy, OGD, and CT colonography", "comparator": "no control group; comparison was between different investigation strategies and patient comorbidity levels", "primaryOutcome": "diagnosis of underlying cause of iron deficiency anaemia and one-year mortality", "result": "many elderly patients were too frail for full investigation, only a minority had cancer found, and higher comorbidity and living in a care home predicted higher one-year death risk", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a small single-group observational study without a comparison group, so it can't show what actually causes bright red rectal bleeding.", "directness": "indirect", "limitations": "small sample size, no control group, frailty prevented investigation in 13% of patients, and the study focuses on anaemia work-up rather than the cause of visible rectal bleeding.", "followUp": "one year", "plainFinding": "Not about bright red bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42327595/", "sourceText": "INTRODUCTION: Iron deficiency anaemia (IDA) is often attributed to gastrointestinal (GI) blood loss and warrants thorough investigation. In elderly, endoscopy carries increased risk, especially in those with multiple comorbidities and poor functional status. This study aimed to evaluate the outcomes of elderly patients with IDA, identify underlying causes, and assess one-year mortality. METHODOLOGY: Patients ≥75 years referred to gastroenterology for investigation of IDA were recruited. Demographics, comorbidities, antiplatelet/antithrombotic use, investigations performed, and one-year mortality were recorded. RESULTS: 92 patients were recruited. Mean patient age was 81.2 years (SD: +/- 4.02) with a female preponderance (70.7%). Mean Charlson Comorbidity Index (CCI) was 5.96 (SD +/- 1.93). Frailty precluded any investigation in 13% of patients. 26% underwent upper and lower GI assessment (14% had bidirectional endoscopy and 12% had oesophagogastroduodenoscopy (OGD) + computed tomography (CT) colonography). Malignancy was diagnosed in 6.5%. Overall, one-year mortality rate was 28% (CCI mean score: 6.7). Mortality was statistically significantly higher for patients living in care homes (p=0.03). Higher CCI was associated with increased risk of one-year mortality, and each additional CCI point increased odds of dying within one year by 40% (OR = 1.40, 95% CI: 1.10-1.79, p=0.007). CONCLUSION: Elderly patients referred for investigation of IDA frequently have a high CCI score, making endoscopy a high-risk procedure. A high CCI score and living in a care home are independent risk factors for one-year mortality. Alternative strategies including trans-nasal endoscopy and CT colonography, should be considered as first-line tests to balance diagnostic yield, prognosis and procedural safety.", "provenance": [ { "field": "n", "quote": "92 patients were recruited" }, { "field": "population", "quote": "Patients ≥75 years referred to gastroenterology for investigation of IDA were recruited." }, { "field": "intervention", "quote": "26% underwent upper and lower GI assessment (14% had bidirectional endoscopy and 12% had oesophagogastroduodenoscopy (OGD) + computed tomography (CT) colonography)." }, { "field": "comparator", "quote": "Alternative strategies including trans-nasal endoscopy and CT colonography, should be considered as first-line tests to balance diagnostic yield, prognosis and procedural safety." }, { "field": "primaryOutcome", "quote": "This study aimed to evaluate the outcomes of elderly patients with IDA, identify underlying causes, and assess one-year mortality." }, { "field": "result", "quote": "Overall, one-year mortality rate was 28% (CCI mean score: 6.7)." } ] }, { "id": "pmid:42326116", "pmid": "42326116", "doi": "10.7759/cureus.109274", "nctId": null, "pmcid": "PMC13281479", "title": "Paraneoplastic Myeloperoxidase (MPO)-Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis Revealing Colon Adenocarcinoma in a Patient With Controlled HIV Infection: A Case Report", "firstAuthor": "Cespedes Useche", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 61-year-old man with well-controlled HIV infection", "intervention": "no intervention for rectal bleeding; this is a case report about vasculitis and colon cancer diagnosis", "comparator": "none", "primaryOutcome": "diagnosis of the underlying cause of symptoms including hematochezia", "result": "the bleeding (hematochezia) was found to be caused by a colon mass that was confirmed as stage IIIA colorectal adenocarcinoma", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or likely this cause is for other people with bright red bleeding.", "directness": "indirect", "limitations": "This is a single case report; findings in one unusual patient (with HIV and an associated autoimmune vasculitis) may not apply to the general population with rectal bleeding.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42326116/", "sourceText": "The relationship between antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and solid malignancies is uncommon and poses significant diagnostic challenges, particularly in individuals with underlying immune dysregulation, such as human immunodeficiency virus (HIV) infection. A 61-year-old man with well-controlled HIV infection presented with nephritic syndrome and palpable purpura. Laboratory evaluation revealed active urinary sediment and positive myeloperoxidase (MPO)-ANCA. Alternative causes of vasculitis were reasonably excluded based on clinical, serological, and histopathological evaluation. Skin biopsy demonstrated leukocytoclastic vasculitis, while renal biopsy showed pauci-immune necrotizing glomerulonephritis. During hospitalization, the patient developed hematochezia, for which a colonoscopy was performed, and a mass was identified in the ascending colon. Histopathological analysis confirmed stage IIIA colorectal adenocarcinoma. Treatment included glucocorticoids, plasmapheresis, and azathioprine, followed by right hemicolectomy and adjuvant CAPEOX chemotherapy. Partial improvement in the cutaneous lesions and glomerular filtration rate was observed following vasculitis-directed therapy, the patient achieved complete resolution of both the renal and cutaneous manifestations only after right hemicolectomy and adjuvant CAPEOX chemotherapy. This case is consistent with a possible paraneoplastic link between MPO-AAV and colorectal adenocarcinoma. In patients with HIV infection, distinguishing true vasculitis from incidental autoantibody positivity is challenging. The temporal relationship and improvement with cancer-directed therapy raise the possibility that malignancy may act as a trigger for clinically overt vasculitis. Recognition of this relationship may help guide appropriate management and avoid unnecessary or prolonged immunosuppression.", "provenance": [ { "field": "n", "quote": "A 61-year-old man with well-controlled HIV infection" }, { "field": "population", "quote": "A 61-year-old man with well-controlled HIV infection presented with nephritic syndrome and palpable purpura." }, { "field": "intervention", "quote": "Treatment included glucocorticoids, plasmapheresis, and azathioprine, followed by right hemicolectomy and adjuvant CAPEOX chemotherapy." }, { "field": "comparator", "quote": "Treatment included glucocorticoids, plasmapheresis, and azathioprine, followed by right hemicolectomy and adjuvant CAPEOX chemotherapy." }, { "field": "primaryOutcome", "quote": "During hospitalization, the patient developed hematochezia, for which a colonoscopy was performed, and a mass was identified in the ascending colon." }, { "field": "result", "quote": "Histopathological analysis confirmed stage IIIA colorectal adenocarcinoma." } ] }, { "id": "pmid:42322762", "pmid": "42322762", "doi": "10.1016/j.phymed.2026.158385", "nctId": null, "pmcid": null, "title": "Lichang decoction suppresses AOM+DSS-induced colitis-associated cancer via regulating intestinal flora and suppressing the Wnt/β-catenin signaling pathway", "firstAuthor": "Xie", "multipleAuthors": true, "journal": "Phytomedicine", "year": 2026, "design": "animal", "n": null, "nField": "not-reported", "population": "Mice with chemically induced colitis-associated colon cancer (not human patients)", "intervention": "Lichang Decoction (a traditional Chinese herbal formula)", "comparator": "Untreated mice or 5-fluorouracil-treated mice", "primaryOutcome": "Tumor number/size, inflammation, and gut microbiota changes", "result": "Reduced tumor burden, inflammation, and bleeding (hematochezia) in mice via gut microbiota and Wnt/β-catenin pathway changes", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an animal study using mice with a specific induced cancer model, not a human study of rectal bleeding from common causes like hemorrhoids or fissures.", "directness": "indirect", "limitations": "Animal model only, specific to colitis-associated cancer rather than common causes of bright red rectal bleeding in humans such as hemorrhoids or anal fissures; not tested in humans.", "followUp": "", "plainFinding": "Herbal mix reduced cancer-related bleeding in mice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42322762/", "sourceText": "BACKGROUND: Lichang Decoction (LCD), a traditional Chinese medicine formula clinically used for intestinal disorders, has shown anti-inflammatory potential; however, its therapeutic efficacy and underlying mechanism in colitis-associated colorectal cancer (CAC) remain unclear. PURPOSE: The objective of this study is to investigate the effects and mechanisms of LCD in an AOM+DSS-induced CAC mouse model. METHODS: The primary constituents of LCD were analyzed using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS). An azoxymethane/dextran sulfate sodium (AOM+DSS)-induced CAC mouse model was established and treated with low- or high-dose LCD, or 5-fluorouracil (5-Fu). Clinical symptoms, tumor burden, histopathological changes and inflammatory responses were evaluated. Intestinal barrier integrity was assessed by tight junction and mucus-related markers. Transcriptomic analysis, quantitative PCR and Western blotting were performed to investigate the Wnt/β-catenin signaling pathway. Gut microbiota alterations were analyzed by 16S rRNA sequencing, and fecal microbiota transplantation (FMT) was conducted to determine the causal role of microbiota in LCD-mediated protection. RESULTS: LCD treatment significantly alleviated weight loss, diarrhea and hematochezia, reduced disease activity index scores, and markedly suppressed tumor number and size in CAC mice. LCD attenuated colonic inflammation by decreasing serum and tissue levels of IL-1β, TNF-α, IL-6 and IFN-γ, while reducing CD11b⁺ and MPO⁺ inflammatory cell infiltration. Moreover, LCD restored intestinal barrier function and increased goblet cell abundance. Mechanistically, transcriptomic, molecular analyses and molecular docking revealed that LCD significantly inhibited aberrant activation of the Wnt/β-catenin pathway, evidenced by reduced expression of Wnt4, β-catenin, c-Myc and cyclin D1. However, LCD treatment in HCT116 cells did not affect the Wnt/β-catenin pathway. Additionally, LCD reshaped gut microbiota composition by suppressing tumor-associated bacterial taxa (Bacillota and Bacteroidota) and enriching beneficial Verrucomicrobiota. Correlation and functional prediction analyses linked microbial modulation to Wnt/β-catenin signaling and tumor progression. Importantly, FMT derived from LCD exerted an inhibitory effect on tumor progression in pseudo-germ-free CAC mice, but direct administration of LCD in pseudo-germ-free CAC mouse model did not demonstrate a significant tumor-suppressive effect. CONCLUSION: LCD effectively suppresses CAC by remodeling gut microbiota to inhibit Wnt/β-catenin signaling, thereby alleviating inflammation, restoring intestinal barrier function and restraining tumor progression. These findings indicate that LCD represents a viable therapeutic intervention for CAC treatment.", "provenance": [ { "field": "population", "quote": "An azoxymethane/dextran sulfate sodium (AOM+DSS)-induced CAC mouse model was established" }, { "field": "intervention", "quote": "treated with low- or high-dose LCD, or 5-fluorouracil (5-Fu)" }, { "field": "comparator", "quote": "treated with low- or high-dose LCD, or 5-fluorouracil (5-Fu)" }, { "field": "primaryOutcome", "quote": "Clinical symptoms, tumor burden, histopathological changes and inflammatory responses were evaluated." }, { "field": "result", "quote": "LCD treatment significantly alleviated weight loss, diarrhea and hematochezia, reduced disease activity index scores, and markedly suppressed tumor number and size in CAC mice." } ] }, { "id": "pmid:42306028", "pmid": "42306028", "doi": "10.7759/cureus.110918", "nctId": null, "pmcid": "PMC13268708", "title": "Fever of Unknown Origin as an Isolated Manifestation of Ulcerative Colitis Despite Clinical and Radiographic Remission: A Case Report", "firstAuthor": "Memon", "multipleAuthors": false, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "68-year-old woman with HIV and ulcerative colitis", "intervention": "fever evaluation during ulcerative colitis treatment (vedolizumab, mesalamine, prednisone)", "comparator": "none", "primaryOutcome": "cause of persistent fever", "result": "fever was caused by ulcerative colitis itself even though bowel symptoms and scans looked improved, after infections and other causes were ruled out", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show what causes bleeding or how common this is in general", "directness": "indirect", "limitations": "single case report; fever without bowel symptoms is described as very rare, so findings may not apply to typical patients", "followUp": "", "plainFinding": "Not about rectal bleeding at all.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42306028/", "sourceText": "Fever is a recognized manifestation of active ulcerative colitis (UC); however, isolated fever in the absence of GI symptoms or objective evidence of active colonic inflammation is exceedingly uncommon. The diagnostic challenge is amplified in immunocompromised patients receiving biologic therapy, in whom occult infection must be rigorously excluded. We present a 68-year-old woman with a history of well-controlled HIV infection and recently diagnosed UC who was initiated on vedolizumab, mesalamine, and a prednisone taper in the outpatient setting. She presented with persistent daily fevers and initial concern for an infectious etiology of pyrexia. Ulcerative colitis appeared to be well treated, with outpatient CT demonstrating resolution of colitis, and the patient denied diarrhea, abdominal pain, hematochezia, or other symptoms suggestive of active disease. An extensive infectious workup, including blood cultures, viral studies, fungal biomarkers, Lyme disease testing, tick-borne testing, and autoimmune serologies, was negative. During the laboratory evaluation, thrombocytopenia, markedly elevated inflammatory markers, and elevated D-dimer levels were noted. Despite a comprehensive multidisciplinary evaluation, no infectious, malignant, thrombotic, or rheumatologic etiology was identified. Throughout her hospital course, the patient developed sequelae of a severe inflammatory response, including atrial fibrillation. The patient's fevers were ultimately attributed to an atypical systemic inflammatory manifestation of UC. This case highlights a rare presentation of UC manifesting predominantly as fever of unknown origin (FUO) despite apparent clinical and radiographic remission. Clinicians should recognize that significant systemic inflammation may occur even in the absence of overt GI disease activity after exclusion of alternative causes.", "provenance": [ { "field": "population", "quote": "a 68-year-old woman with a history of well-controlled HIV infection and recently diagnosed UC" }, { "field": "intervention", "quote": "was initiated on vedolizumab, mesalamine, and a prednisone taper" }, { "field": "comparator", "quote": "An extensive infectious workup, including blood cultures, viral studies, fungal biomarkers, Lyme disease testing, tick-borne testing, and autoimmune serologies, was negative." }, { "field": "primaryOutcome", "quote": "persistent daily fevers and initial concern for an infectious etiology of pyrexia" }, { "field": "result", "quote": "The patient's fevers were ultimately attributed to an atypical systemic inflammatory manifestation of UC." }, { "field": "n", "quote": "We present a 68-year-old woman" } ] }, { "id": "pmid:42305908", "pmid": "42305908", "doi": "10.1155/crgm/9940087", "nctId": null, "pmcid": "PMC13266272", "title": "An Unusual Case of Pancreatic Ductal Adenocarcinoma With Synchronous Rectal Metastasis in a Younger Female", "firstAuthor": "Adeniran", "multipleAuthors": true, "journal": "Case Rep Gastrointest Med", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 49-year-old woman with stage IV pancreatic cancer that had spread to the rectum", "intervention": "", "comparator": "", "primaryOutcome": "identifying the cause of rectal bleeding and abdominal pain", "result": "bleeding was caused by pancreatic cancer that had spread to the rectum, initially misdiagnosed as gastritis", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single unusual case report and cannot tell you what is likely causing bleeding in most people.", "directness": "indirect", "limitations": "single case report of an extremely rare condition (sixth case reported worldwide); not generalizable to typical causes of rectal bleeding.", "followUp": "14 months", "plainFinding": "Rare cancer cause, not typical", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42305908/", "sourceText": "BACKGROUND: Pancreatic cancer (PC) remains one of the leading causes of cancer mortality in the United States. There has been a concerning trend in recent years where younger females are experiencing a faster annual percentage increase than their male counterparts (2.36% vs. 0.62%). Metastasis of pancreatic ductal adenocarcinoma (PDAC) to the rectum is uncommon, and synchronous rectal metastasis occurs even less frequently. CASE PRESENTATION: We describe a case of a 49-year-old woman with Stage IV PDAC with synchronous rectal metastases. The hallmark of her symptoms was hematochezia and epigastric pain, initially misdiagnosed as gastritis. However, the patient returned with new laboratory and imaging findings of the synchronous pancreatic tail and rectal masses confirmed by histology. Immunohistochemistry was crucial in distinguishing a primary PC from a rectal primary. The patient continues to undergo chemotherapy 14 months after presentation. CONCLUSION: This represents the first documented case in the United States and the sixth reported case of synchronous rectal metastasis from PDAC. It highlights the increasing incidence and the demographic shift of PC among young women in the United States, which needs further investigation. The case adds to our knowledge of the unusual metastatic pattern of PDAC and the need for a multidisciplinary approach, including the role of immunohistochemistry in distinguishing between the primary etiology of malignancy to establish an accurate diagnosis, instituting an appropriate treatment plan, and preventing unwanted treatment and surgeries.", "provenance": [ { "field": "population", "quote": "We describe a case of a 49-year-old woman with Stage IV PDAC with synchronous rectal metastases." }, { "field": "n", "quote": "We describe a case of a 49-year-old woman" }, { "field": "result", "quote": "The hallmark of her symptoms was hematochezia and epigastric pain, initially misdiagnosed as gastritis. However, the patient returned with new laboratory and imaging findings of the synchronous pancreatic tail and rectal masses confirmed by histology." }, { "field": "primaryOutcome", "quote": "Immunohistochemistry was crucial in distinguishing a primary PC from a rectal primary." }, { "field": "followUp", "quote": "The patient continues to undergo chemotherapy 14 months after presentation." } ] }, { "id": "pmid:42304159", "pmid": "42304159", "doi": "10.62713/aic.4612", "nctId": null, "pmcid": null, "title": "Anorectal Melanoma Management Evolution: A Narrative Review", "firstAuthor": "Sassun", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with anorectal melanoma, a very rare cancer", "intervention": "review of surgical and immunotherapy treatments for anorectal melanoma", "comparator": "older treatments like radical surgery and chemotherapy versus newer sphincter-preserving surgery and immunotherapy", "primaryOutcome": "survival and quality of life outcomes with different treatment approaches", "result": "survival gains have been modest and largely confined to specific subgroups, with some improvement using combined immunotherapy and surgery", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a narrative review of a very rare cancer, not a study measuring causes of bleeding, so it offers no reliable evidence for a typical person's symptom.", "directness": "indirect", "limitations": "narrative review without systematic methodology; focuses on a rare cancer rather than common causes of bleeding when wiping; no staging system agreed; high recurrence rates", "followUp": "", "plainFinding": "Rare melanoma can also cause bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42304159/", "sourceText": "Anorectal melanoma (ARM) is one of the rarest and most aggressive subtypes of melanoma, representing less than 1% of all melanomas and 0.1-0.4% of anorectal malignancies. As a mucosal melanoma arising in sun-shielded sites, ARM exhibits distinct molecular features compared with cutaneous melanoma, including low tumor mutational burden, absent ultraviolet signatures, frequent KIT proto-oncogene Receptor Tyrosine Kinase (KIT) mutations (15-25%), and lower immunogenicity. These biological differences contribute to its rapid progression, late diagnosis, and poor response to traditional therapies. Patients typically present with nonspecific symptoms such as rectal bleeding, often resulting in advanced disease at diagnosis, with up to 67% harboring regional or distant metastases. Management of ARM has evolved significantly over the past decades. Historically dominated by radical abdominoperineal resection, surgical treatment has shifted toward sphincter-preserving wide local excision when negative margins can be achieved, driven by comparable survival outcomes and superior functional results regarding bowel, urogenital, and psychological quality of life. However, high positive margin rates remain a major limitation of local excision. Systemic therapy has transitioned from largely ineffective cytotoxic chemotherapy to modern immunotherapy. Immune checkpoint inhibitors have become the cornerstone of treatment, while KIT-mutated tumors may benefit from tyrosine kinase inhibitors. Emerging evidence supports neoadjuvant immunotherapy to improve resectability and downstage tumors, with selected matched cohorts reporting 3-year overall survival rates up to 71-75% when combined with abdominoperineal resection. Survival gains have been modest and largely confined to specific subgroups. Key challenges include the absence of a dedicated staging system, high local recurrence rates, limited durability of responses in metastatic disease, and an immunologically \"cold\" tumor microenvironment. Multidisciplinary team approaches are essential for individualized care. Future progress depends on biomarker-driven trials, integration of novel strategies such as Chimeric Antigen Receptor T-Cell (CAR-T) therapy, and stronger international collaborative research to improve outcomes in this challenging malignancy.", "provenance": [ { "field": "population", "quote": "Anorectal melanoma (ARM) is one of the rarest and most aggressive subtypes of melanoma, representing less than 1% of all melanomas" }, { "field": "intervention", "quote": "Immune checkpoint inhibitors have become the cornerstone of treatment, while KIT-mutated tumors may benefit from tyrosine kinase inhibitors." }, { "field": "comparator", "quote": "Historically dominated by radical abdominoperineal resection, surgical treatment has shifted toward sphincter-preserving wide local excision when negative margins can be achieved" }, { "field": "primaryOutcome", "quote": "comparable survival outcomes and superior functional results regarding bowel, urogenital, and psychological quality of life" }, { "field": "result", "quote": "Survival gains have been modest and largely confined to specific subgroups." }, { "field": "result", "quote": "selected matched cohorts reporting 3-year overall survival rates up to 71-75% when combined with abdominoperineal resection" }, { "field": "population", "quote": "Patients typically present with nonspecific symptoms such as rectal bleeding, often resulting in advanced disease at diagnosis" } ] }, { "id": "pmid:42290952", "pmid": "42290952", "doi": "10.1177/11795565261456425", "nctId": null, "pmcid": "PMC13260782", "title": "Schistosomal Colitis as an Uncommon Cause of Hematochezia in a School-Aged Boy: A Case Report", "firstAuthor": "Suleman", "multipleAuthors": true, "journal": "Clin Med Insights Pediatr", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 9-year-old boy living in a schistosomiasis-endemic region with painless rectal bleeding", "intervention": "oral praziquantel treatment", "comparator": "none", "primaryOutcome": "resolution of symptoms after treatment", "result": "the boy responded well to praziquantel treatment after being diagnosed with schistosomal colitis", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single case report so it cannot show how common this cause is or how well treatment works in general", "directness": "indirect", "limitations": "only one patient described, in a tropical disease-endemic area, which may not apply to most people with this symptom", "followUp": "", "plainFinding": "Rare parasite infection caused bleeding, treatable", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42290952/", "sourceText": "Schistosomiasis is a neglected tropical disease with clinical presentations that vary depending on the species involved. Schistosomal colitis is a rare manifestation, with few cases documented in the literature. We report a case of a 9-year-old boy presenting with painless hematochezia and a history of residence in a schistosomiasis-endemic region. Colonoscopy revealed evidence of colitis, and histopathological examination of colon biopsy confirmed schistosomal ova with eosinophilic infiltration in the colonic mucosa. The patient responded well to treatment with oral Praziquantel (40 mg/kg). This case underscores the need for a high index of suspicion and the inclusion of tropical diseases in the differential diagnosis when evaluating patients with lower gastrointestinal bleeding, particularly in endemic areas. Pediatric schistosomal colitis in Africa represents a clinically significant yet often underdiagnosed manifestation of Schistosomiasis, highlighting the need for heightened awareness of its distinctive gastrointestinal presentations, diagnostic challenges, and implications for early intervention in children living in endemic regions.", "provenance": [ { "field": "n", "quote": "a 9-year-old boy" }, { "field": "population", "quote": "a 9-year-old boy presenting with painless hematochezia and a history of residence in a schistosomiasis-endemic region" }, { "field": "intervention", "quote": "treatment with oral Praziquantel (40 mg/kg)" }, { "field": "comparator", "quote": "The patient responded well to treatment with oral Praziquantel" }, { "field": "primaryOutcome", "quote": "The patient responded well to treatment with oral Praziquantel (40 mg/kg)" }, { "field": "result", "quote": "The patient responded well to treatment with oral Praziquantel (40 mg/kg)." } ] }, { "id": "pmid:42287778", "pmid": "42287778", "doi": "10.1016/j.ctarc.2026.101287", "nctId": null, "pmcid": null, "title": "Characterizing symptom patterns in early-onset colorectal cancer: insights from a national inpatient analysis", "firstAuthor": "Samaddar", "multipleAuthors": true, "journal": "Cancer Treat Res Commun", "year": 2026, "design": "retrospective", "n": 18017, "nField": "reported", "population": "adults hospitalized with colorectal cancer, comparing those diagnosed before age 50 (early-onset) to those diagnosed later (late-onset), matched with non-cancer controls", "intervention": "early-onset colorectal cancer (diagnosed before age 50)", "comparator": "late-onset colorectal cancer (diagnosed after age 50) and age-matched non-cancer controls", "primaryOutcome": "how strongly different symptoms (including constipation, anemia, and rectal bleeding) were linked to a colorectal cancer diagnosis", "result": "Constipation was much more strongly linked to early-onset cancer than to late-onset cancer, especially in women under 40, while rectal bleeding and anemia also differed but less dramatically; even so, actual cancer rates among people with these symptoms stayed low", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a large but retrospective hospital-database study using billing codes, so it can show patterns but cannot prove that any one symptom like bleeding actually causes or reliably predicts cancer.", "directness": "indirect", "limitations": "The abstract notes findings come from hospitalized patients, which may over-represent more advanced or complicated disease rather than early detection, and absolute cancer prevalence was low despite strong relative associations.", "followUp": "", "plainFinding": "Bleeding rarely meant cancer in this study.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42287778/", "sourceText": "BACKGROUND: While colorectal cancer (CRC) incidence overall is declining, early-onset CRC (EOCRC, diagnosed before age 50) continues to rise. In response, screening guidelines were lowered from age 50 to 45 in 2021. However, many EOCRC cases still occur under age 45, highlighting the need to identify high-risk individuals beyond current criteria. We hypothesized that EOCRC presents with distinct symptom profiles compared to late-onset CRC (LOCRC). METHODS: We analyzed 2020-2022 National Inpatient Sample data, performing 1:1 age-matched comparisons between CRC patients and controls without CRC. Symptoms were defined using ICD-10 codes. Adjusted odds ratios (aORs) were calculated and stratified by age and sex. Bonferroni correction was applied for 12 symptom groups (p < 0.004). RESULTS: Among 18,017 EOCRC hospitalizations, several symptoms demonstrated differential associations compared to LOCRC, including constipation, iron-deficiency anemia, and hematochezia. Data-driven stratification revealed that constipation showed the strongest divergence between EOCRC and LOCRC (aOR 2.50 vs. 1.12), particularly among women under 40 (aOR 5.72; p < 0.001). Colon cancer was identified in 1.31% of constipation-related hospitalizations in adults aged 40-44, comparable to the 1.07% incidence among all hospitalizations in adults 45-49. CONCLUSIONS: Symptom pattern analysis from a large national inpatient cohort demonstrates distinct clinical presentations of EOCRC. Constipation showed a stronger association in younger adults, particularly women, suggesting a potential role in identifying higher-risk presentations. However, these findings reflect hospitalized encounters and may be enriched for patients with more advanced or complicated disease rather than early-stage detection. Importantly, despite significant relative associations, the absolute prevalence of colorectal cancer among constipation-related hospitalizations remained low, underscoring the need for cautious interpretation and further prospective validation. MICRO ABSTRACT: EOCRC: In this unstructured, symptom-driven national analysis, constipation emerged as a disproportionately stronger association with early-onset colorectal cancer (EOCRC) than with late-onset disease. These findings suggest that data-driven symptom evaluation can uncover clinically relevant signals to inform earlier recognition and diagnosis of EOCRC.", "provenance": [ { "field": "n", "quote": "Among 18,017 EOCRC hospitalizations" }, { "field": "population", "quote": "We analyzed 2020-2022 National Inpatient Sample data, performing 1:1 age-matched comparisons between CRC patients and controls without CRC." }, { "field": "intervention", "quote": "early-onset CRC (EOCRC, diagnosed before age 50)" }, { "field": "comparator", "quote": "We hypothesized that EOCRC presents with distinct symptom profiles compared to late-onset CRC (LOCRC)." }, { "field": "primaryOutcome", "quote": "several symptoms demonstrated differential associations compared to LOCRC, including constipation, iron-deficiency anemia, and hematochezia" }, { "field": "result", "quote": "Constipation showed the strongest divergence between EOCRC and LOCRC (aOR 2.50 vs. 1.12), particularly among women under 40 (aOR 5.72; p < 0.001)." }, { "field": "result", "quote": "the absolute prevalence of colorectal cancer among constipation-related hospitalizations remained low, underscoring the need for cautious interpretation and further prospective validation" } ] }, { "id": "pmid:42282467", "pmid": "42282467", "doi": "10.14309/crj.0000000000002179", "nctId": null, "pmcid": "PMC13252999", "title": "Not Just a Cyst: A Draining Gluteal Lesion Revealing a Rectocutaneous Fistula in Ulcerative Colitis", "firstAuthor": "Sasse", "multipleAuthors": true, "journal": "ACG Case Rep J", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 48-year-old man with poorly controlled ulcerative colitis", "intervention": "pelvic MRI and colonoscopy to investigate rectal pain and a draining buttock lesion", "comparator": "none", "primaryOutcome": "diagnosis of the cause of rectal bleeding and gluteal lesion", "result": "found a rectocutaneous fistula from the rectum into the buttock tissue, caused by severe ulcerative colitis of the rectum and sigmoid colon", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this cause of bleeding is or how well any treatment works.", "directness": "indirect", "limitations": "single case report with no comparison group or outcome data on treatment effectiveness.", "followUp": "", "plainFinding": "Rare fistula from colitis found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42282467/", "sourceText": "We report a 48-year-old man with poorly controlled ulcerative colitis (UC) who presented with severe rectal pain, hematochezia, and a chronically draining lesion on the left buttock. Initial cross-sectional imaging revealed active colitis, and targeted ultrasound of the left buttock suggested a benign epidermal inclusion cyst. Colonoscopy demonstrated continuous Mayo 3 proctosigmoiditis with a normal proximal colon and terminal ileum. While he clinically improved with intravenous corticosteroids, the gluteal lesion persisted. Before discharge, pelvic magnetic resonance imaging unexpectedly revealed a rectocutaneous fistula extending from the distal rectum into the left gluteal soft tissues. This case illustrates that, although rare, rectocutaneous fistulas can complicate UC. Clinicians should include fistulizing disease in the differential diagnosis of any chronically draining perianal or gluteal lesion in UC, and consider early pelvic magnetic resonance imaging when symptoms are discordant with endoscopic findings or fail to resolve with standard therapy.", "provenance": [ { "field": "population", "quote": "a 48-year-old man with poorly controlled ulcerative colitis (UC) who presented with severe rectal pain, hematochezia, and a chronically draining lesion on the left buttock" }, { "field": "n", "quote": "a 48-year-old man with poorly controlled ulcerative colitis" }, { "field": "intervention", "quote": "pelvic magnetic resonance imaging unexpectedly revealed a rectocutaneous fistula extending from the distal rectum into the left gluteal soft tissues" }, { "field": "comparator", "quote": "Initial cross-sectional imaging revealed active colitis, and targeted ultrasound of the left buttock suggested a benign epidermal inclusion cyst" }, { "field": "primaryOutcome", "quote": "Before discharge, pelvic magnetic resonance imaging unexpectedly revealed a rectocutaneous fistula extending from the distal rectum into the left gluteal soft tissues" }, { "field": "result", "quote": "pelvic magnetic resonance imaging unexpectedly revealed a rectocutaneous fistula extending from the distal rectum into the left gluteal soft tissues" } ] }, { "id": "pmid:42274068", "pmid": "42274068", "doi": null, "nctId": null, "pmcid": null, "title": "Lower Gastrointestinal Bleeding Revealing an Early-Stage Primary Anorectal Melanoma: A Case Report", "firstAuthor": "Aksim", "multipleAuthors": true, "journal": "Gulf J Oncolog", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 62-year-old woman with mild rectal bleeding", "intervention": "surgery combined with adjuvant immunotherapy", "comparator": "", "primaryOutcome": "diagnosis and successful treatment of the cause of rectal bleeding", "result": "the bleeding was caused by a rare anorectal melanoma, which was treated successfully with surgery and immunotherapy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, which cannot show how common this cause is or how well treatment works in general.", "directness": "indirect", "limitations": "only one patient is described, so it cannot tell you how likely this rare cause is to explain your bleeding.", "followUp": "", "plainFinding": "Rare melanoma found as cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42274068/", "sourceText": "INTRODUCTION: Anorectal melanomas are rare and agressive malignant tumors of the anorectal region of the digestive tract. Due to their rarity and similarity to other more benign and common conditions, such as hemorrhoids, their diagnosis is often delayed, which worsens the prognosis of this aggressive disease. Histological evaluation with special immunohistochemical (IHC) staining is often essentiel to establish a confirmed diagnosis. In the localized stage, the primary treatment for this condition consists primarily of surgical resection combined with adjuvant immunotherapy. CASE PRESENTATION: We report the case of a 62-year-old women who presented for an etiological evaluation of mild rectal bleeding without other associated signs. Proctological examination revealed the presence of a flashy mass occupying almost the entire anal lumen, with irregular thickening of the anterior anorectal wall during rectal examination. The colonoscopy revealed a friable and ulcerated process in the lower and middle rectum, and several biopsies were performed, confirming the diagnosis of rectal melanoma. The patient was successfully treated with surgery and adjuvant immunotherapy. Discussion/ conclusion: Our case demonstrates the importance of rapid diagnosis and a multidisciplinary therapeutic approach for a better prognosis of malignant rectal melanoma.", "provenance": [ { "field": "n", "quote": "a 62-year-old women" }, { "field": "population", "quote": "We report the case of a 62-year-old women who presented for an etiological evaluation of mild rectal bleeding without other associated signs." }, { "field": "intervention", "quote": "The patient was successfully treated with surgery and adjuvant immunotherapy." }, { "field": "primaryOutcome", "quote": "several biopsies were performed, confirming the diagnosis of rectal melanoma" }, { "field": "result", "quote": "several biopsies were performed, confirming the diagnosis of rectal melanoma. The patient was successfully treated with surgery and adjuvant immunotherapy." } ] }, { "id": "pmid:42255849", "pmid": "42255849", "doi": "10.7759/cureus.108452", "nctId": null, "pmcid": "PMC13242299", "title": "Cytomegalovirus (CMV) Colitis Complicated by a Stricture in an Immunocompetent Adult", "firstAuthor": "Pinto", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "an immunocompetent woman", "intervention": "diagnosis and tissue biopsy for suspected colon cancer", "comparator": "", "primaryOutcome": "cause of a colonic stricture", "result": "the stricture was caused by CMV colitis rather than cancer, diagnosed only after tissue biopsy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common or typical this cause is.", "directness": "indirect", "limitations": "Single case report with no control group or outcome data beyond diagnosis.", "followUp": "", "plainFinding": "Rare colitis mimicked cancer, no bleeding noted.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42255849/", "sourceText": "Although cytomegalovirus (CMV) seropositivity is common in the general population, primary CMV infection in immunocompetent adults is usually asymptomatic or causes only a mild mononucleosis-like illness, and severe symptomatic or tissue-invasive disease is uncommon. CMV colitis may present with nonspecific symptoms, delaying recognition, particularly in immunocompetent patients in whom clinical suspicion is often low. Delayed diagnosis may allow progression to serious complications, including gastrointestinal bleeding, perforation, toxic megacolon, and, less commonly, stricture formation. We report a case of CMV colitis in an immunocompetent woman presenting with a colonic stricture initially presumed to be malignant rather than with the more typical features of abdominal pain, diarrhea, fever, and hematochezia. This case emphasizes the diagnostic challenge of CMV colitis in patients without classic risk factors, particularly when it mimics colonic malignancy and requires tissue diagnosis because noninvasive testing may not reliably exclude disease.", "provenance": [ { "field": "population", "quote": "CMV colitis in an immunocompetent woman" }, { "field": "intervention", "quote": "requires tissue diagnosis because noninvasive testing may not reliably exclude disease" }, { "field": "primaryOutcome", "quote": "presenting with a colonic stricture initially presumed to be malignant" }, { "field": "result", "quote": "We report a case of CMV colitis in an immunocompetent woman presenting with a colonic stricture initially presumed to be malignant rather than with the more typical features of abdominal pain, diarrhea, fever, and hematochezia." }, { "field": "n", "quote": "We report a case of CMV colitis" } ] }, { "id": "pmid:42239962", "pmid": "42239962", "doi": "10.3389/fmed.2026.1829616", "nctId": null, "pmcid": "PMC13226518", "title": "Angiodysplasia as a rare cause of acute hematochezia in a 33-year-old with vascular risk factors: a case report", "firstAuthor": "Shi", "multipleAuthors": true, "journal": "Front Med (Lausanne)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 33-year-old man with chronic alcohol use and poorly controlled high blood pressure", "intervention": "endoscopic titanium clips to stop bleeding from rectal vascular lesions", "comparator": "no comparator (single case)", "primaryOutcome": "whether bleeding stopped and did not come back", "result": "bleeding was stopped with clips and did not return over 6 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show what causes bleeding in general or how common this is.", "directness": "indirect", "limitations": "only one patient was described, there was no comparison group, and the cause (angiodysplasia) is described as an exceedingly rare cause of this kind of bleeding, especially in young people.", "followUp": "6 months", "plainFinding": "Rare vessel abnormality, successfully clipped.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42239962/", "sourceText": "BACKGROUND: Rectal angiodysplasia is a vascular malformation typically associated with the elderly. It is an exceedingly rare cause of acute lower gastrointestinal bleeding (LGIB) in young adults. We present a unique case of massive hematochezia in a 33-year-old, potentially accelerated by long-standing vascular stress. CASE PRESENTATION: A 33-year-old male with a history of chronic alcohol use and poorly controlled hypertension presented with acute, massive hematochezia and symptomatic anemia. Physical examination and initial labs may indicate significant blood loss. Urgent colonoscopy revealed multiple punctate, actively bleeding angiodysplastic lesions localized strictly to the rectum. Given the focal nature of the lesions, hemostasis was achieved using mechanical endoscopic titanium clips. No recurrent bleeding occurred during 6 months of follow-up. CONCLUSION: This single-case observation suggests that angiodysplasia may be considered in differential diagnosis for LGIB even in younger patients, particularly those with systemic vascular risk factors like hypertension and chronic alcohol consumption. Furthermore, it may indicate that mechanical clipping is a highly effective, targeted alternative to thermal ablation for localized rectal vascular lesions.", "provenance": [ { "field": "n", "quote": "A 33-year-old male with a history of chronic alcohol use and poorly controlled hypertension presented with acute, massive hematochezia and symptomatic anemia." }, { "field": "population", "quote": "A 33-year-old male with a history of chronic alcohol use and poorly controlled hypertension" }, { "field": "intervention", "quote": "hemostasis was achieved using mechanical endoscopic titanium clips" }, { "field": "comparator", "quote": "mechanical clipping is a highly effective, targeted alternative to thermal ablation for localized rectal vascular lesions" }, { "field": "primaryOutcome", "quote": "No recurrent bleeding occurred during 6 months of follow-up." }, { "field": "result", "quote": "No recurrent bleeding occurred during 6 months of follow-up." } ] }, { "id": "pmid:42235251", "pmid": "42235251", "doi": "10.1016/j.jss.2026.04.041", "nctId": null, "pmcid": null, "title": "Influence of Patient Demographics, Symptoms, and Initial Provider Type on Timeliness of Rectal Cancer Diagnosis", "firstAuthor": "Huynh", "multipleAuthors": true, "journal": "J Surg Res", "year": 2026, "design": "retrospective", "n": 205, "nField": "reported", "population": "patients who had surgery for rectal cancer", "intervention": "type of first healthcare provider seen (emergency department vs primary care) and presenting symptoms", "comparator": "emergency department visit versus primary care physician visit as the first point of contact", "primaryOutcome": "delay of more than 30 days between symptom onset and first medical evaluation", "result": "72% of patients had a delay in seeing a doctor after symptoms started; younger patients and those with bowel habit changes were more likely to be delayed, and patients who first saw a primary care doctor were more likely to have a delay in getting diagnosed than those who went to the emergency department", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a retrospective chart review from one hospital looking at patterns in care, not a trial testing a treatment, so it can't tell you what causes bleeding or prove cause and effect", "directness": "indirect", "limitations": "single institution, retrospective design, relies on chart review and database data", "followUp": "", "plainFinding": "Cancer diagnosis often delayed via primary care.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42235251/", "sourceText": "INTRODUCTION: Early detection of rectal cancer improves outcomes, yet delays in presentation and diagnosis remain common. We examined whether the type of initial health care provider, presenting symptoms, and patient characteristics contributed to the delayed detection and diagnosis of rectal cancer. METHODS: We conducted a retrospective cohort study of patients undergoing surgical resection for rectal cancer at a single institution (2015-2022) using the American College of Surgeons' National Surgical Quality Improvement Program database with supplemental chart review. Socioeconomic distress was measured using the Distressed Communities Index. The primary outcome was presentation delay, defined as >30 days from symptom onset to first medical evaluation. Secondary outcomes included diagnosis delay, defined as >30 days from symptom onset to tissue diagnosis, and comparisons between emergency department versus primary care physician (PCP) for initial medical presentation. Univariable analyses and multivariable logistic regression were performed. RESULTS: Among 205 patients with available data, 147 (72%) experienced presentation delay. Patients younger than 50 y (29% versus 12%, P = 0.012) and those presenting with changes in bowel habits were more likely to experience delayed presentation (27% versus 5%, P = 0.004). Patients presenting to a PCP were more likely to experience diagnosis delay compared to those presenting to the emergency department (75% versus 55%, P = 0.012). On multivariable analysis, change in bowel habits (odds ratio (OR) 6.45, 95% confidence interval (CI): 1.54-34.83) and age <50 y (OR 3.93, 95% CI: 1.38-12.94) were associated with presentation delay, while diagnosis delay (OR 3.55, 95% CI: 1.47-9.07) and insurance status were associated with presentation to a PCP. CONCLUSIONS: Delayed presentation of rectal cancer is associated with younger age and indolent symptoms, while delays in diagnosis appear to be influenced by health care access pathways. Patients entering care through primary care settings may experience longer time to diagnosis. Efforts should be made to recognize more indolent symptoms, such as rectal bleeding and bowel habit changes, as potential signs of rectal cancer and improve referral processes to expedite evaluation of concerning symptoms.", "provenance": [ { "field": "n", "quote": "Among 205 patients with available data" }, { "field": "population", "quote": "patients undergoing surgical resection for rectal cancer at a single institution" }, { "field": "intervention", "quote": "comparisons between emergency department versus primary care physician (PCP) for initial medical presentation" }, { "field": "comparator", "quote": "Patients presenting to a PCP were more likely to experience diagnosis delay compared to those presenting to the emergency department" }, { "field": "primaryOutcome", "quote": "The primary outcome was presentation delay, defined as >30 days from symptom onset to first medical evaluation." }, { "field": "result", "quote": "Among 205 patients with available data, 147 (72%) experienced presentation delay." }, { "field": "result", "quote": "Patients presenting to a PCP were more likely to experience diagnosis delay compared to those presenting to the emergency department (75% versus 55%, P = 0.012)." } ] }, { "id": "pmid:42231181", "pmid": "42231181", "doi": "10.1186/s12876-026-04976-2", "nctId": null, "pmcid": "PMC13445890", "title": "An unusual superior mesenteric arteriovenous malformation causing obscure gastrointestinal bleeding: a case report", "firstAuthor": "Alashqar", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 71-year-old man with decompensated alcoholic liver cirrhosis and recurrent gastrointestinal bleeding", "intervention": "endovascular embolization of a mesenteric arteriovenous malformation", "comparator": "none", "primaryOutcome": "stopping gastrointestinal bleeding and stabilizing blood counts", "result": "bleeding stopped and hemoglobin stabilized after embolization", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.", "directness": "indirect", "limitations": "Single case report in a patient with advanced liver cirrhosis and multiple other bleeding sources, so findings may not generalize to other causes of bright red rectal bleeding.", "followUp": "", "plainFinding": "Rare vascular cause found and treated.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42231181/", "sourceText": "BACKGROUND: Lower gastrointestinal bleeding (LGIB) frequently presents a diagnostic challenge, particularly in liver cirrhosis and portal hypertension patients, as it accounts for about 20-25% of major gastrointestinal bleeding cases. The presence of multiple possible sources of bleeding, among which vascular abnormalities, increases the risk of recurrent bleeding, and clinically significant anemia. Mesenteric arteriovenous malformations (AVMs) are one of the rare high-flow vascular lesions that may lead to gastrointestinal bleeding through arterial blood being diverted to the veins and venous hypertension. As the findings of an endoscopic examination can be unclear, cross-sectional angiographic imaging is indispensable for diagnosis and treatment planning. CASE PRESENTATION: A 71-year-old man with decompensated alcoholic liver cirrhosis and a history of recurrent gastrointestinal bleeding presented with two days of hematochezia and worsening anemia. Despite prior endoscopic treatment of esophageal varices, gastric antral vascular ectasia, and colonic AVMs, no active bleeding source was identified on repeat endoscopy. Contrast- enhanced computed tomography angiography demonstrated a high-flow mesenteric vascular nidus supplied by the superior mesenteric artery, with early venous drainage into the right renal vein, consistent with a mesenteric arteriovenous malformation. The patient was successfully managed with endovascular embolization, resulting in stabilization of hemoglobin levels and cessation of overt gastrointestinal bleeding. CONCLUSION: In patients with liver cirrhosis having various sites of possible bleeding, mesenteric arteriovenous malformations must be included in the differential diagnosis of obscure or recurrent lower gastrointestinal bleeding. This case highlights an exceptionally rare vascular configuration, with arterial supply from the superior mesenteric artery and anomalous systemic venous drainage into the right renal vein. Comprehensive angiographic imaging is essential for accurate diagnosis, anatomical characterization, and appropriate management of these complex vascular lesions.", "provenance": [ { "field": "population", "quote": "A 71-year-old man with decompensated alcoholic liver cirrhosis and a history of recurrent gastrointestinal bleeding presented with two days of hematochezia and worsening anemia." }, { "field": "intervention", "quote": "The patient was successfully managed with endovascular embolization" }, { "field": "comparator", "quote": "Despite prior endoscopic treatment of esophageal varices, gastric antral vascular ectasia, and colonic AVMs, no active bleeding source was identified on repeat endoscopy." }, { "field": "primaryOutcome", "quote": "resulting in stabilization of hemoglobin levels and cessation of overt gastrointestinal bleeding" }, { "field": "result", "quote": "resulting in stabilization of hemoglobin levels and cessation of overt gastrointestinal bleeding" }, { "field": "n", "quote": "A 71-year-old man with decompensated alcoholic liver cirrhosis" } ] }, { "id": "pmid:42227634", "pmid": "42227634", "doi": null, "nctId": null, "pmcid": null, "title": "[Lower gastrointestinal bleeding]", "firstAuthor": "Khiari", "multipleAuthors": true, "journal": "Rev Prat", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with bleeding from the lower bowel (colon/rectum), often older adults", "intervention": "not an intervention study — this is a review describing diagnosis and treatment approaches for lower bowel bleeding", "comparator": "not reported", "primaryOutcome": "overview of causes and management of lower gastrointestinal bleeding", "result": "The review lists causes (including anorectal disorders, diverticulosis, angiodysplasia, ischemic colitis, tumors) and describes diagnostic/treatment steps (colonoscopy, CT angiography, embolization, surgery), but reports no outcome data comparing treatments.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review summarizing known causes and management steps rather than original research with measured outcomes.", "directness": "indirect", "limitations": "No original data, patient numbers, or outcome results are given; it is a broad overview rather than a study of this specific symptom.", "followUp": "", "plainFinding": "Several possible bowel-bleeding causes listed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42227634/", "sourceText": "Lower gastrointestinal bleeding (LGIB) is a common emergency, defined nowadays as bleeding of colorectal origin. It predominantly affects elderly patients in whom it is associated with increased morbidity and mortality. The main causes include diverticulosis, anorectal disorders, angiodysplasias, ischemic colitis, post-endoscopic resection complications, and tumor-related bleeding. Clinically, lower gastrointestinal bleeding (LGIB) presents with episodes of hematochezia or melena, or sometimes as occult bleeding. Initial assessment of clinico-biological severity and risk of recurrence is essential to determine the need for hospitalization and the timing of diagnostic procedures. Colonoscopy is the reference diagnostic and therapeutic procedure, ideally performed within 24 hours with CT angiography reserved for cases of hemodynamic instability. In case of failure, therapeutic escalation includes repeat endoscopy, arterial embolization, and, as a last resort, surgery. Early multidisciplinary management helps reduce morbidity, mortality, and recurrence.", "provenance": [ { "field": "population", "quote": "It predominantly affects elderly patients in whom it is associated with increased morbidity and mortality." }, { "field": "intervention", "quote": "Colonoscopy is the reference diagnostic and therapeutic procedure, ideally performed within 24 hours with CT angiography reserved for cases of hemodynamic instability." }, { "field": "result", "quote": "The main causes include diverticulosis, anorectal disorders, angiodysplasias, ischemic colitis, post-endoscopic resection complications, and tumor-related bleeding." }, { "field": "primaryOutcome", "quote": "Lower gastrointestinal bleeding (LGIB) is a common emergency, defined nowadays as bleeding of colorectal origin." }, { "field": "comparator", "quote": "In case of failure, therapeutic escalation includes repeat endoscopy, arterial embolization, and, as a last resort, surgery." } ] }, { "id": "pmid:42217226", "pmid": "42217226", "doi": "10.1080/17474124.2026.2683679", "nctId": null, "pmcid": null, "title": "Techniques and outcomes review of the endoscopic management of gastrointestinal bleeding", "firstAuthor": "Gadour", "multipleAuthors": true, "journal": "Expert Rev Gastroenterol Hepatol", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with gastrointestinal bleeding (general review, not specific to bright red blood on wiping)", "intervention": "Endoscopic treatments for GI bleeding (e.g. clips, band ligation, argon plasma coagulation, powders)", "comparator": "Different endoscopic techniques compared with each other / standard care", "primaryOutcome": "Effectiveness of endoscopic techniques in managing GI bleeding", "result": "The abstract summarizes techniques and strategies but does not report a specific quantitative result or outcome comparison", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review of treatment techniques, not a study answering why someone bleeds bright red blood when wiping.", "directness": "indirect", "limitations": "No original data, no participant numbers, no specific findings relevant to the cause of bright red rectal bleeding on wiping; it is an expert overview of endoscopic treatment techniques for GI bleeding in general.", "followUp": "", "plainFinding": "Review of bleeding treatments, not causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42217226/", "sourceText": "INTRODUCTION: Gastrointestinal (GI) bleeding is a frequent and potentially life-threatening emergency that imposes a substantial healthcare burden worldwide. Over the past three decades, advances in endoscopic technology and technique have transformed management, shifting the emphasis from predominantly diagnostic procedures to targeted, minimally invasive therapeutic interventions across the upper, lower, and small bowel. AREAS COVERED: This review synthesizes current evidence and guideline-based strategies for endoscopic management of GI bleeding, with a structured focus on non-variceal and variceal upper GI bleeding, lower GI bleeding, and small bowel bleeding. Key therapeutic modalities include combination therapies for peptic ulcer bleeding, band ligation for esophageal and selected gastric varices, argon plasma coagulation (APC) for vascular malformations and tumor bleeding, and emerging approaches such as over-the-scope clips (OTSC), hemostatic powders, radiofrequency ablation (RFA), and self-expandable metal stents (SEMS). Capsule endoscopy and device-assisted enteroscopy have markedly improved the evaluation and treatment of small bowel bleeding. We also review risk stratification scores, transfusion strategies, and timing of endoscopy, all of which are crucial to optimizing outcomes. EXPERT OPINION: Successful management of GI bleeding demands a personalized approach integrating patient-specific factors, bleeding etiology, and local expertise. Emerging technologies, particularly artificial intelligence (AI)-assisted imaging and novel hemostatic devices, are poised to refine diagnosis, risk prediction, and therapy selection. Nonetheless, clinical judgment, multidisciplinary collaboration, rigorous training, and thoughtful resource allocation remain paramount to ensure safe, effective, and sustainable care in this rapidly evolving field.", "provenance": [ { "field": "population", "quote": "Gastrointestinal (GI) bleeding is a frequent and potentially life-threatening emergency" }, { "field": "intervention", "quote": "combination therapies for peptic ulcer bleeding, band ligation for esophageal and selected gastric varices, argon plasma coagulation (APC) for vascular malformations and tumor bleeding, and emerging approaches such as over-the-scope clips (OTSC), hemostatic powders, radiofrequency ablation (RFA), and self-expandable metal stents (SEMS)" }, { "field": "comparator", "quote": "This review synthesizes current evidence and guideline-based strategies for endoscopic management of GI bleeding" }, { "field": "primaryOutcome", "quote": "We also review risk stratification scores, transfusion strategies, and timing of endoscopy, all of which are crucial to optimizing outcomes." }, { "field": "result", "quote": "Successful management of GI bleeding demands a personalized approach integrating patient-specific factors, bleeding etiology, and local expertise." } ] }, { "id": "pmid:42164831", "pmid": "42164831", "doi": "10.1016/j.gastha.2026.100963", "nctId": null, "pmcid": "PMC13185971", "title": "Overlapping Cytomegalovirus Infection and Inflammatory Pouchitis After Liver Transplantation: When Antivirals Alone Are Insufficient", "firstAuthor": "Fogleman", "multipleAuthors": true, "journal": "Gastro Hep Adv", "year": 2026, "design": "case-series", "n": null, "nField": "not-reported", "population": "A liver transplant patient with chronic pouchitis, ulcerative colitis, and primary sclerosing cholangitis who had rectal bleeding", "intervention": "Antiviral therapy for CMV infection, followed by guselkumab for ongoing inflammation", "comparator": "No comparator (single case)", "primaryOutcome": "Improvement in bleeding and viral levels, and control of pouch inflammation", "result": "Bleeding and viremia improved with antivirals, but inflammation persisted and needed additional treatment with guselkumab", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this cause of bleeding is or how well treatments generally work.", "directness": "indirect", "limitations": "Only one patient described, with a specific and unusual combination of conditions (prior pouch surgery, transplant, CMV infection) not typical of most people with rectal bleeding.", "followUp": "", "plainFinding": "CMV infection caused pouch bleeding here", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42164831/", "sourceText": "Cytomegalovirus (CMV) is an infrequently reported etiology of secondary pouchitis in patients who have undergone total proctocolectomy with ileal pouch-anal anastomosis. We present the case of a patient with chronic antibiotic-dependent pouchitis, ulcerative pancolitis, primary sclerosing cholangitis, and orthotopic liver transplant who presented with hematochezia. Pouchoscopy showed ulcerated mucosa, and histopathology with immunohistochemistry confirmed CMV pouchitis. The patient was treated with antiviral therapy with improvement in bleeding and viremia. However, persistent refractory pouch inflammation ultimately required guselkumab. This case depicts the importance of considering CMV as a secondary etiology of pouchitis, especially in those with refractory or atypical features.", "provenance": [ { "field": "population", "quote": "a patient with chronic antibiotic-dependent pouchitis, ulcerative pancolitis, primary sclerosing cholangitis, and orthotopic liver transplant who presented with hematochezia" }, { "field": "intervention", "quote": "The patient was treated with antiviral therapy with improvement in bleeding and viremia." }, { "field": "comparator", "quote": "We present the case of a patient" }, { "field": "primaryOutcome", "quote": "with improvement in bleeding and viremia" }, { "field": "result", "quote": "The patient was treated with antiviral therapy with improvement in bleeding and viremia. However, persistent refractory pouch inflammation ultimately required guselkumab." } ] }, { "id": "pmid:42164016", "pmid": "42164016", "doi": "10.7759/cureus.109195", "nctId": null, "pmcid": "PMC13186257", "title": "Primary Rectal Squamous Cell Carcinoma: A Rare Gastrointestinal Malignancy Presenting As Hematochezia", "firstAuthor": "Ravella", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 67-year-old man with abdominal cramping, lightheadedness, fatigue, and new rectal bleeding", "intervention": "chemoradiation with 5-fluorouracil, mitomycin C, and radiation therapy", "comparator": "traditional surgical approaches", "primaryOutcome": "diagnosis and treatment approach for the rectal mass causing bleeding", "result": "a rare rectal squamous cell cancer was found and treated with chemoradiation instead of surgery", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot tell you how likely any particular cause of bleeding is for other people", "directness": "indirect", "limitations": "single case report of an extremely rare cancer, no comparison group, and findings cannot be generalized to typical causes of bright red rectal bleeding", "followUp": "", "plainFinding": "Rare cancer found as one cause", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42164016/", "sourceText": "Primary rectal squamous cell carcinoma (SCC) is an extremely rare malignancy. We describe a 67-year-old male with a history of paroxysmal atrial fibrillation who presented with abdominal cramping, lightheadedness, fatigue, and new-onset hematochezia. Colonoscopy revealed a submucosal, ulcerated, partially obstructing mass in the distal rectum. Endoscopic ultrasound demonstrated a hypoechoic mass arising from the muscularis propria with associated lymphadenopathy on MRI of the pelvis. Biopsies confirmed moderately differentiated invasive SCC. The patient was treated with chemoradiation using 5-fluorouracil, mitomycin C, and radiation therapy. This case highlights the importance of considering rectal SCC in the differential diagnosis of rectal masses and hematochezia, as its management has shifted toward definitive chemoradiation with improved outcomes compared to traditional surgical approaches.", "provenance": [ { "field": "n", "quote": "a 67-year-old male" }, { "field": "population", "quote": "a 67-year-old male with a history of paroxysmal atrial fibrillation who presented with abdominal cramping, lightheadedness, fatigue, and new-onset hematochezia" }, { "field": "intervention", "quote": "treated with chemoradiation using 5-fluorouracil, mitomycin C, and radiation therapy" }, { "field": "comparator", "quote": "improved outcomes compared to traditional surgical approaches" }, { "field": "primaryOutcome", "quote": "Biopsies confirmed moderately differentiated invasive SCC" }, { "field": "result", "quote": "its management has shifted toward definitive chemoradiation with improved outcomes compared to traditional surgical approaches" } ] }, { "id": "pmid:42154125", "pmid": "42154125", "doi": "10.1007/s10620-026-09955-x", "nctId": null, "pmcid": null, "title": "Peranal Endoscopic Myectomy for Lower Rectal Lesions with Severe Fibrosis: A Retrospective Study", "firstAuthor": "Ninomiya", "multipleAuthors": true, "journal": "Dig Dis Sci", "year": 2026, "design": "retrospective", "n": 25, "nField": "reported", "population": "patients who had a procedure to remove lower rectal lesions with severe scarring (fibrosis)", "intervention": "peranal endoscopic myectomy (PAEM), a technique to cut out rectal lesions through the muscle layer", "comparator": "unintentional PAEM (done by accident during a different procedure) versus intentional PAEM", "primaryOutcome": "whether the procedure worked well and was safe, including clear removal margins and bleeding afterward", "result": "after the procedure, 56% of patients had bleeding (hematochezia), which was usually self-limited, and intentional PAEM had a higher rate of fully clear removal margins than unintentional PAEM", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a small, retrospective study from one hospital looking at a surgical technique, not a study of why ordinary people bleed when wiping.", "directness": "indirect", "limitations": "retrospective design, small number of patients (25), single center, and it studies bleeding as a complication of a specific rectal surgery rather than general causes of bleeding when wiping", "followUp": "", "plainFinding": "Bleeding common after this rectal surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42154125/", "sourceText": "BACKGROUND AND AIM: Peranal endoscopic myectomy (PAEM), also known as endoscopic intermuscular dissection, enables resection of lower rectal lesions with severe submucosal fibrosis by dissecting the inner circular muscle. We aimed to evaluate the efficacy and safety of PAEM. METHODS: This retrospective study included patients who underwent PAEM for lower rectal lesions between January 2017 and December 2024 at the Osaka International Cancer Institute. PAEM was performed intentionally after October 2023, whereas unintentional PAEM occurred during endoscopic submucosal dissection (ESD) prior to October 2023. Short-term outcomes were assessed, and negative vertical margin rates were compared between groups. RESULTS: Among 242 consecutive patients who underwent ESD for lower rectal lesions, PAEM was performed in 25 patients (unintentional PAEM, 13; intentional PAEM, 12). The median age was 66 years (range, 38-89 years), and 14 patients (56%) were female. En bloc resection was performed for all 25 lesions. Histological examinations showed 19 adenocarcinomas (pTis, 3; pT1, 11; pT2, 5), 3 other tumors, and 3 non-residual tumors (salvage treatment after endoscopic resection). After PAEM, hematochezia occurred in 14 patients (56%), but most cases were self-limited and one patient had hematochezia requiring prolonged hospitalization. The negative vertical margin rate was higher in the intentional PAEM group than in the unintentional PAEM group, with similar findings observed in an additional analysis excluding salvage cases (88% vs. 33%, P = 0.007). CONCLUSIONS: PAEM was feasible and generally safe. Intentional PAEM may facilitate vertical margin control in selected cases with severe fibrosis.", "provenance": [ { "field": "n", "quote": "PAEM was performed in 25 patients (unintentional PAEM, 13; intentional PAEM, 12)" }, { "field": "population", "quote": "patients who underwent PAEM for lower rectal lesions between January 2017 and December 2024" }, { "field": "intervention", "quote": "Peranal endoscopic myectomy (PAEM), also known as endoscopic intermuscular dissection, enables resection of lower rectal lesions with severe submucosal fibrosis by dissecting the inner circular muscle." }, { "field": "comparator", "quote": "PAEM was performed intentionally after October 2023, whereas unintentional PAEM occurred during endoscopic submucosal dissection (ESD) prior to October 2023." }, { "field": "primaryOutcome", "quote": "We aimed to evaluate the efficacy and safety of PAEM." }, { "field": "result", "quote": "After PAEM, hematochezia occurred in 14 patients (56%), but most cases were self-limited and one patient had hematochezia requiring prolonged hospitalization." }, { "field": "result", "quote": "The negative vertical margin rate was higher in the intentional PAEM group than in the unintentional PAEM group, with similar findings observed in an additional analysis excluding salvage cases (88% vs. 33%, P = 0.007)." } ] }, { "id": "pmid:42146941", "pmid": "42146941", "doi": "10.1155/carm/8720602", "nctId": null, "pmcid": "PMC13176111", "title": "A Rare Case of Sterile Retrostyloid Abscess in a Patient With Crohn's Disease: Diagnostic and Therapeutic Insights", "firstAuthor": "Babino", "multipleAuthors": true, "journal": "Case Rep Med", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "44-year-old woman with Crohn's disease on corticosteroids", "intervention": "surgical drainage combined with antibiotics and corticosteroids", "comparator": "none", "primaryOutcome": "resolution of neck abscess and symptoms", "result": "abscess resolved after surgical drainage plus antibiotics and corticosteroids", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether the treatment generally works or explain common causes of rectal bleeding", "directness": "indirect", "limitations": "single case report; abscess was a rare extraintestinal complication, not a direct study of rectal bleeding causes", "followUp": "", "plainFinding": "Not relevant to your bleeding question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42146941/", "sourceText": "INTRODUCTION: Aseptic abscess syndrome is a rare inflammatory disorder of unclear etiology, characterized by sterile lesions densely infiltrated by polymorphonuclear neutrophils. Its frequently associated with inflammatory bowel disease, which includes chronic gastrointestinal disorders such as Crohn's disease and ulcerative colitis, often accompanied by both intestinal and extraintestinal manifestations. Extraintestinal involvement may include musculoskeletal, cutaneous, ocular, oral, and hepatobiliary systems. Although uncommon, aseptic abscess syndrome can precede the onset of inflammatory bowel disease or occur during its course. CASE REPORT: A 44-year-old woman with Crohn's disease receiving corticosteroid therapy is presented with abdominal pain, diarrhea, rectal bleeding, and a painful right lateral cervical swelling with trismus. Contrast-enhanced computed tomography revealed a right retrostyloid abscess. Surgical drainage, combined with antibiotics and corticosteroids, led to clinical resolution. Cultures were negative, confirming the diagnosis of aseptic abscess. CONCLUSION: Retrostyloid abscesses are extremely rare and poorly documented. In patients with inflammatory bowel disease presenting with deep neck abscesses, aseptic abscess syndrome should be considered, as early recognition and multidisciplinary management are essential to prevent serious complications.", "provenance": [ { "field": "n", "quote": "A 44-year-old woman with Crohn's disease receiving corticosteroid therapy is presented" }, { "field": "population", "quote": "A 44-year-old woman with Crohn's disease receiving corticosteroid therapy" }, { "field": "intervention", "quote": "Surgical drainage, combined with antibiotics and corticosteroids, led to clinical resolution." }, { "field": "comparator", "quote": "Surgical drainage, combined with antibiotics and corticosteroids, led to clinical resolution." }, { "field": "primaryOutcome", "quote": "led to clinical resolution" }, { "field": "result", "quote": "Surgical drainage, combined with antibiotics and corticosteroids, led to clinical resolution." } ] }, { "id": "pmid:42143719", "pmid": "42143719", "doi": "10.1093/qjmed/hcag122", "nctId": null, "pmcid": null, "title": "Schistosoma-Associated Colorectal Carcinoma in a Young Male", "firstAuthor": "Das", "multipleAuthors": true, "journal": "QJM", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "19-year-old male with childhood freshwater exposure", "intervention": "none (diagnostic case report)", "comparator": "", "primaryOutcome": "diagnosis and treatment of rectal bleeding cause", "result": "Rectal bleeding was caused by a rare case of colorectal cancer linked to a parasitic infection (schistosomiasis)", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot tell you how likely this cause is for anyone else.", "directness": "indirect", "limitations": "Single case report; findings may not generalise to other patients with rectal bleeding.", "followUp": "", "plainFinding": "Rare case: cancer from parasite infection.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42143719/", "sourceText": "Schistosomiasis is a parasitic disease that causes chronic intestinal inflammation, and certain Schistosoma species are implicated in colorectal carcinoma (CRC) pathogenesis. While common in endemic areas, Schistosoma-associated CRC (SA-CRC) is rarely reported in non-endemic countries. We describe a 19-year-old male with rectal carcinoma, likely linked to childhood freshwater exposure. He presented with rectal bleeding and prolapsing mass, underwent surgery, and histopathology confirmed poorly differentiated adenocarcinoma. Schistosoma parasite eggs were seen on histology and along with the environmental history supported the presumptive diagnosis of SA-CRC. He was treated with neoadjuvant chemoradiotherapy, surgery for the colorectal carcinoma and praziquantel for eradication of Schistosomiasis. This case emphasises the importance of detailed environmental exposure history in young onset CRC and highlights the potential oncogenic role of schistosomiasis.", "provenance": [ { "field": "population", "quote": "We describe a 19-year-old male with rectal carcinoma, likely linked to childhood freshwater exposure." }, { "field": "n", "quote": "We describe a 19-year-old male with rectal carcinoma" }, { "field": "primaryOutcome", "quote": "He presented with rectal bleeding and prolapsing mass, underwent surgery, and histopathology confirmed poorly differentiated adenocarcinoma." }, { "field": "result", "quote": "Schistosoma parasite eggs were seen on histology and along with the environmental history supported the presumptive diagnosis of SA-CRC." }, { "field": "intervention", "quote": "He was treated with neoadjuvant chemoradiotherapy, surgery for the colorectal carcinoma and praziquantel for eradication of Schistosomiasis." } ] }, { "id": "pmid:42141324", "pmid": "42141324", "doi": "10.1007/s10151-026-03342-4", "nctId": null, "pmcid": "PMC13179188", "title": "Bridging the gap: a systematic literature review and meta-analysis on the management of rectal wall defect after transanal excision", "firstAuthor": "Vaghiri", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people who had a rectal tumor removed through the anus with a full-thickness surgical opening left in the rectal wall", "intervention": "stitching the rectal wall opening closed after the tumor removal", "comparator": "leaving the rectal wall opening open to heal on its own", "primaryOutcome": "rates of rectal bleeding and hospital re-admission after surgery", "result": "closing the opening was linked to less rectal bleeding and fewer re-admissions, but took longer to perform, with no difference in other outcomes", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it pools only six non-randomized comparative studies with some heterogeneity, so the evidence is not very strong.", "directness": "indirect", "limitations": "based on six comparative (not randomized) studies with inconsistent protocols; authors say randomized trials with longer-term data are still needed", "followUp": "", "plainFinding": "Stitching surgical opening cuts bleeding", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42141324/", "sourceText": "BACKGROUND: Transanal resection techniques have gained considerable importance in the treatment of benign and malignant rectal neoplasms. However, there is no definitive consensus on whether the rectal defect should be closed or left open after excision. We sought to provide an updated pooled analysis of the management of rectal wall defect after transanal excision. METHODS: In accordance with PRISMA and Cochrane guidelines, this meta-analysis was performed using the PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify studies comparing perioperative outcomes after rectal defect closure versus leaving the defect open following full-thickness (FT) excision. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using Cochrane's Q test. Risk of bias and certainty of evidence were judged by ROBINS-I and GRADE, respectively. RESULTS: Six comparative studies meeting the inclusion criteria were included in the final analysis. Closing the rectal defect was associated with significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I2 = 26%) and re-admission rates (OR = 0.34, 95% CI: 0.16-0.76, p = 0.008; I2 = 0%) compared with the open group, while other outcomes were not significantly different. A prolonged operative time was noted when the rectal wall defect was sutured (SMD = 0.15, 95% CI: 0.03-0.28, p = 0.02; I2 = 44%). CONCLUSIONS: The present analysis revealed that both approaches are safe and technically feasible; however, closing the rectal wall defect after FT excision of rectal neoplasms was associated with lower bleeding and re-admission rates. Nevertheless, randomized studies with homogeneous protocols and consistent long-term outcome data are still needed to provide definitive answers.", "provenance": [ { "field": "population", "quote": "full-thickness (FT) excision" }, { "field": "intervention", "quote": "rectal defect closure" }, { "field": "comparator", "quote": "leaving the defect open following full-thickness (FT) excision" }, { "field": "primaryOutcome", "quote": "significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I2 = 26%) and re-admission rates" }, { "field": "result", "quote": "Closing the rectal defect was associated with significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I2 = 26%) and re-admission rates (OR = 0.34, 95% CI: 0.16-0.76, p = 0.008; I2 = 0%) compared with the open group, while other outcomes were not significantly different." }, { "field": "limitations", "quote": "randomized studies with homogeneous protocols and consistent long-term outcome data are still needed to provide definitive answers" } ] }, { "id": "pmid:42137563", "pmid": "42137563", "doi": "10.3389/fped.2026.1791996", "nctId": null, "pmcid": "PMC13168117", "title": "Ischemic colitis in a child: a case report and narrative review", "firstAuthor": "Zhong", "multipleAuthors": true, "journal": "Front Pediatr", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 6-year-old boy with rectal bleeding", "intervention": "conservative treatment (bowel rest, IV fluids, mucosal protective medicines)", "comparator": "none reported", "primaryOutcome": "resolution of bleeding and symptoms", "result": "complete symptom resolution without recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single child's case report, not a study comparing treatments, so it can't tell us what usually causes bleeding or what works best.", "directness": "indirect", "limitations": "Single pediatric case of a rare condition (ischemic colitis), not generalizable to typical causes of bright red blood when wiping.", "followUp": "", "plainFinding": "Rare cause, fully resolved with care", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42137563/", "sourceText": "INTRODUCTION: Ischemic colitis is extremely rare in preschool-aged children and is still susceptible to misdiagnosis due to atypical symptoms. Misdiagnosis can have serious consequences, including delayed treatment and disease progression, so raising clinical awareness of this condition is critical. This report aims to contribute by providing a relevant case and a narrative overview of ischemic colitis in children. CASE PRESENTATION: A 6-year-old boy presented with recurrent hematochezia for 6 days and mild abdominal pain. Laboratory tests showed elevated inflammatory markers. Colonoscopy revealed segmental mucosal congestion and erosions in the descending and sigmoid colon; pathology confirmed chronic active mucosal inflammation. After excluding infectious colitis and inflammatory bowel disease, ischemic colitis was diagnosed. Conservative management with bowel rest, intravenous fluids, and mucosal protective agents achieved complete symptom resolution without recurrence. CONCLUSION: In conjunction with the accompanying narrative overview, this case underscores that ischemic colitis, though rare, must be considered in the differential diagnosis of unexplained hematochezia in preschool children. The favorable outcome achieved through conservative management aligns with the broader literature synthesis, reinforcing that non-surgical intervention is both feasible and effective in this demographic. This review of the available evidence further highlights the critical need for heightened clinical suspicion to avoid delayed intervention.", "provenance": [ { "field": "population", "quote": "A 6-year-old boy presented with recurrent hematochezia for 6 days and mild abdominal pain." }, { "field": "intervention", "quote": "Conservative management with bowel rest, intravenous fluids, and mucosal protective agents achieved complete symptom resolution without recurrence." }, { "field": "comparator", "quote": "Conservative management with bowel rest, intravenous fluids, and mucosal protective agents achieved complete symptom resolution without recurrence." }, { "field": "primaryOutcome", "quote": "achieved complete symptom resolution without recurrence" }, { "field": "result", "quote": "achieved complete symptom resolution without recurrence" }, { "field": "n", "quote": "A 6-year-old boy presented with recurrent hematochezia for 6 days and mild abdominal pain." } ] }, { "id": "pmid:42129663", "pmid": "42129663", "doi": "10.1186/s12876-026-04921-3", "nctId": null, "pmcid": "PMC13348974", "title": "Effect of preoperative anemia on postoperative outcomes in mixed hemorrhoids: a retrospective observational study", "firstAuthor": "Long", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2026, "design": "retrospective", "n": 127, "nField": "reported", "population": "patients with mixed hemorrhoids who had hemorrhoid surgery", "intervention": "having anemia before surgery", "comparator": "not having anemia before surgery", "primaryOutcome": "complications after hemorrhoid surgery, including pain, bleeding, infection, wound healing and recurrence", "result": "patients with anemia had more pain and worse sleep after surgery, but no difference in bleeding, infection, wound healing or 12-month recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it is a retrospective study of two uneven groups without adjustment for other factors, and the authors themselves say the findings need confirmation in larger studies", "directness": "indirect", "limitations": "observational design, exploratory analysis, no multivariable adjustment, moderate sample size", "followUp": "12 months", "plainFinding": "More post-surgery pain if anemic", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42129663/", "sourceText": "BACKGROUND: Anemia is a common complication of long-term hematochezia in patients with mixed hemorrhoids. This study aimed to evaluate the effect of preoperative anemia on the prognosis of mixed hemorrhoids after Milligan-Morgan hemorrhoidectomy. METHODS: A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy at the Affiliated Hospital of Southwest Medical University from January 2021 to August 2022 participated in this study, comprising 48 patients in the preoperative anemia group and 79 patients in the preoperative non-anemia group. Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months were retrospectively analyzed in the two groups. RESULTS: There were no significant differences in the demographic and baseline clinical characteristics between the two groups (P > 0.05). The visual analog scale pain scores at 12 h (P = 0.018), 1 day (P = 0.010), 3 days (P = 0.034), and 7 days (P = 0.001) after surgery and total analgesic consumption within 7 days (P = 0.036) in the preoperative anemia group were higher than those in the preoperative non-anemia group. The ISI within 7 days in the preoperative anemia group was higher than that in the preoperative non-anemia group (P = 0.046). There were no significant differences in delayed bleeding, wound infection, wound edema (P = 0.740), urinary retention (P = 0.648), anal stenosis, or wound healing time (P = 1.101) between the two groups. There were no significant differences in recurrence (prolapse or bleeding) rates within 12 months between the two groups (P = 0.513). CONCLUSIONS: In this retrospective observational study, preoperative anemia was associated with higher postoperative pain scores and poorer sleep quality within 7 days after Milligan-Morgan hemorrhoidectomy. However, no significant associations were observed between preoperative anemia and other postoperative complications, wound healing time, or 12-month recurrence rates. Given the observational design and the exploratory nature of the analysis, these findings should be interpreted with caution and require confirmation in larger, adequately powered studies with multivariable adjustment.", "provenance": [ { "field": "n", "quote": "A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy" }, { "field": "population", "quote": "patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy" }, { "field": "intervention", "quote": "48 patients in the preoperative anemia group" }, { "field": "comparator", "quote": "79 patients in the preoperative non-anemia group" }, { "field": "primaryOutcome", "quote": "Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months" }, { "field": "result", "quote": "preoperative anemia was associated with higher postoperative pain scores and poorer sleep quality within 7 days after Milligan-Morgan hemorrhoidectomy. However, no significant associations were observed between preoperative anemia and other postoperative complications, wound healing time, or 12-month recurrence rates." }, { "field": "followUp", "quote": "recurrence rates (prolapse or bleeding) within 12 months" } ] }, { "id": "pmid:42116387", "pmid": "42116387", "doi": "10.1097/MD.0000000000048604", "nctId": null, "pmcid": "PMC13166636", "title": "Rectal metastasis from primary small-cell lung cancer: A case report and literature review", "firstAuthor": "Zhai", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "73-year-old woman with small-cell lung cancer that had spread to the rectum", "intervention": "chemotherapy (4 courses)", "comparator": "none", "primaryOutcome": "rectal bleeding and tumor response", "result": "bleeding stopped and tumor shrank partially after chemotherapy", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show what usually causes rectal bleeding or what treatment works in general.", "directness": "indirect", "limitations": "Single case report; this is an extremely rare cause of rectal bleeding (metastatic lung cancer), not representative of typical causes.", "followUp": "", "plainFinding": "Rare lung cancer spread caused bleeding; chemo helped.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42116387/", "sourceText": "RATIONALE: Small-cell lung cancer (SCLC) is a subtype of primary lung cancer that has a very poor overall survival rate because of its propensity for metastasis and incredibly high proliferation rate. For most patients with lung cancer, metastatic disease is discovered at the time of initial diagnosis. About 70% of individuals with SCLC already have metastases in their brain, liver, lymph nodes, and bones at the time of diagnosis. Rectal metastases are uncommon. PATIENT CONCERNS: In this case report, we described a 73-year-old female patient who was diagnosed with neuroendocrine SCLC based on a lung biopsy obtained by needle. The patient had blood in the stool, accompanied by loss of appetite and pain around the umbilicus for 6 months. The symptoms gradually worsened. DIAGNOSES: Rectal pathological results revealed that metastatic poorly differentiated neuroendocrine carcinoma originated from the lung. INTERVENTIONS: The patient underwent 4 courses of chemotherapy. OUTCOMES: The hematochezia then subsided, and radiological evaluation of the rectal metastases and primary lung tumors suggested a partial response. LESSONS: When a rectal tumor is identified, it is important to differentiate metastatic diseases and make a definitive diagnosis through detailed immunohistochemical evaluation and systemic imaging surveillance.", "provenance": [ { "field": "n", "quote": "a 73-year-old female patient" }, { "field": "population", "quote": "a 73-year-old female patient who was diagnosed with neuroendocrine SCLC based on a lung biopsy obtained by needle" }, { "field": "intervention", "quote": "The patient underwent 4 courses of chemotherapy." }, { "field": "comparator", "quote": "The patient underwent 4 courses of chemotherapy." }, { "field": "primaryOutcome", "quote": "The hematochezia then subsided, and radiological evaluation of the rectal metastases and primary lung tumors suggested a partial response." }, { "field": "result", "quote": "The hematochezia then subsided, and radiological evaluation of the rectal metastases and primary lung tumors suggested a partial response." } ] }, { "id": "pmid:42097658", "pmid": "42097658", "doi": "10.1136/bmjopen-2025-107468", "nctId": null, "pmcid": "PMC13157786", "title": "Variations in symptoms, endoscopy use and emergency diagnosis of colorectal cancer by body mass index: a retrospective cohort study using linked electronic health records in England", "firstAuthor": "Kurland", "multipleAuthors": true, "journal": "BMJ Open", "year": 2026, "design": "retrospective", "n": 5571, "nField": "reported", "population": "patients with symptomatic colorectal cancer diagnosed in England between 2011 and 2015", "intervention": "having a higher body mass index (overweight or obesity)", "comparator": "having a normal body mass index", "primaryOutcome": "how patients were diagnosed with colorectal cancer (emergency vs urgent referral) and symptoms/endoscopy use before diagnosis", "result": "Patients with obesity or overweight were more likely to be referred urgently and less likely to be diagnosed as a cancer emergency than normal-weight patients", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a retrospective study using health records, which can show patterns but cannot prove that weight itself causes differences in how bleeding or cancer gets diagnosed.", "directness": "indirect", "limitations": "Retrospective cohort design using linked administrative records, which cannot establish causation and may have incomplete symptom recording.", "followUp": "", "plainFinding": "Higher BMI linked to more urgent cancer referral.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42097658/", "sourceText": "OBJECTIVES: Body mass index (BMI) confers a higher risk of colorectal cancer (CRC) and may influence cancer diagnostic pathways. We investigated variations in diagnostic pathways by BMI category among patients with symptomatic CRC. DESIGN: Retrospective cohort study using linked cancer registry, primary, and secondary care data. SETTING: England PARTICIPANTS: 5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: Route to CRC diagnosis (emergency presentation and fast-track referrals among patients with new-onset red flag symptoms), presenting symptoms and pre-diagnostic endoscopy use. RESULTS: Red-flag symptoms (change in bowel habit, rectal bleeding) were more frequently recorded among patients with rectal cancer with obesity and overweight versus normal weight (65.2% and 65.5% vs 56.8%, respectively). Among colon cancer patients endoscopy during the year pre-diagnosis was used in a greater proportion of patients with obesity versus normal weight (72.8% vs 64.4%, p<0.001). Among patients with colon cancer with red-flag symptoms, being overweight versus normal weight was associated with higher odds of fast-track referral compared with diagnosis through other routes (OR: 1.48, 95% CI 1.16 to 1.88). Obesity was associated with lower odds of emergency presentation, compared with normal weight (colon 23.6% vs 32.1%; adjusted OR: 0.72, 95% CI 0.57 to 0.90; rectum 8.3% vs 14.8%; OR: 0.57, 95% CI 0.35 to 0.92). CONCLUSIONS: Patients with CRC with higher BMI are more likely to be referred urgently and less likely to experience emergency cancer diagnosis than normal weight patients.", "provenance": [ { "field": "n", "quote": "5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015" }, { "field": "population", "quote": "5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015" }, { "field": "intervention", "quote": "Body mass index (BMI) confers a higher risk of colorectal cancer (CRC) and may influence cancer diagnostic pathways" }, { "field": "comparator", "quote": "patients with obesity versus normal weight" }, { "field": "primaryOutcome", "quote": "Route to CRC diagnosis (emergency presentation and fast-track referrals among patients with new-onset red flag symptoms), presenting symptoms and pre-diagnostic endoscopy use." }, { "field": "result", "quote": "Patients with CRC with higher BMI are more likely to be referred urgently and less likely to experience emergency cancer diagnosis than normal weight patients." } ] }, { "id": "pmid:42071876", "pmid": "42071876", "doi": "10.1097/MD.0000000000048345", "nctId": null, "pmcid": "PMC13124400", "title": "Idiopathic mesenteric phlebosclerosis: A case report", "firstAuthor": "Rao", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "A 59-year-old man with abdominal pain and blood in stool", "intervention": "Conservative (non-surgical) medical treatment", "comparator": "None", "primaryOutcome": "Abdominal pain and rectal bleeding improvement, plus imaging/colonoscopy findings", "result": "Abdominal pain and bleeding improved, with imaging and colonoscopy showing improvement", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show whether the treatment caused the improvement or reliably applies to others.", "directness": "indirect", "limitations": "Single case report, no comparison group, rare and unusual condition (idiopathic mesenteric phlebosclerosis) rather than typical causes of rectal bleeding.", "followUp": "", "plainFinding": "Rare bowel vein disease; bleeding improved with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42071876/", "sourceText": "RATIONALE: Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease with unclear etiology and pathogenesis. Although most IMP patients have a long-term history of traditional Chinese herbal medicine use, this article reports a case without such a special medical history, which may provide new insights into the disease's etiology. PATIENT CONCERNS: A 59-year-old middle-aged man was admitted to the gastroenterology department due to recurrent upper abdominal pain for 1 month. The fecal occult blood test was weakly positive. DIAGNOSES: No significant abnormalities were found in tumor markers, Epstein-Barr virus, cytomegalovirus, T-SPOT, tuberculosis antibodies, or coagulation function. Computed tomography revealed edema and thickening of the intestinal wall in the ascending colon and part of the transverse colon, accompanied by narrowing of the lumen. Multiple calcifications were observed in the right mesenteric vessels, associated with the affected areas. Colonoscopy findings: a circumferential ulcer was noted in the ascending colon at a distance of 75 to 60 cm from the anus, with partial cyanosis of the mucosa and nodular changes. During hospitalization, a series of tests was conducted, and the final diagnosis was IMP. INTERVENTIONS: The patient received conservative treatment during hospitalization. OUTCOMES: After conservative treatment, the patient's abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition. To date, the patient has not experienced any significant discomfort during follow-up. LESSON: Diagnosing IMP requires familiarity with its characteristic features and the ability to interpret relevant imaging findings. It is important to note that long-term use of traditional Chinese herbal medicine is not always the cause. Further research, including the analysis of more clinical cases and the performance of animal experiments, is needed to fully understand the etiology and pathogenesis of IMP.", "provenance": [ { "field": "population", "quote": "A 59-year-old middle-aged man was admitted to the gastroenterology department due to recurrent upper abdominal pain for 1 month." }, { "field": "intervention", "quote": "The patient received conservative treatment during hospitalization." }, { "field": "comparator", "quote": "The patient received conservative treatment during hospitalization." }, { "field": "primaryOutcome", "quote": "After conservative treatment, the patient's abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition." }, { "field": "result", "quote": "After conservative treatment, the patient's abdominal pain and hematochezia improved, and the findings of computed tomography and colonoscopy also showed improvement in the condition." }, { "field": "n", "quote": "A 59-year-old middle-aged man was admitted to the gastroenterology department" } ] }, { "id": "pmid:42066739", "pmid": "42066739", "doi": "10.1016/j.canep.2026.103088", "nctId": null, "pmcid": null, "title": "Advanced adenomas among young endurance runners: A prospective hypothesis-generating prevalence study", "firstAuthor": "Swain", "multipleAuthors": true, "journal": "Cancer Epidemiol", "year": 2026, "design": "prospective-cohort", "n": 94, "nField": "reported", "population": "Runners aged 35 to 50 who had completed multiple marathons or ultramarathons, with no colonoscopy in the last 10 years", "intervention": "Colonoscopy screening in endurance runners", "comparator": "Historical rate of advanced adenomas in average-risk adults aged 40-49 undergoing routine screening colonoscopy", "primaryOutcome": "Prevalence of advanced colorectal adenomas (precancerous polyps)", "result": "Advanced adenomas were found in 15.0% of runners, compared with a historical rate of 1.2% in average-risk screening populations", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a small, single-arm study with no direct control group, compared only to a historical benchmark, and the authors themselves call it hypothesis-generating.", "directness": "indirect", "limitations": "No concurrent control group; compared to historical screening rates; small sample; authors state findings are hypothesis-generating and limited by differences in symptom profile and risk factors between groups", "followUp": "", "plainFinding": "Higher polyp risk in runners.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42066739/", "sourceText": "BACKGROUND: Extreme long-distance running can produce recurrent gastrointestinal stress, including splanchnic hypoperfusion, mucosal injury, and post-exercise rectal bleeding, but its relationship to colorectal neoplasia is unclear. We therefore prospectively estimated the prevalence of advanced adenomas in endurance runners aged 35-50 years. This prevalence estimate is hypothesis-generating. METHODS: In this prospective, single-center, single-arm prevalence (cross-sectional) study (NCT05419531), participants had completed at least 2 ultramarathons (50 km or longer) or at least 5 marathons and had no colonoscopy within 10 years; key exclusions were inflammatory bowel disease, familial adenomatous polyposis, or Lynch syndrome. Participants completed a questionnaire and underwent colonoscopy. Advanced adenomas were defined as lesions 10 mm or larger, villous or tubulovillous histology (or > 25% villous component), or high-grade dysplasia. Prevalence was compared with a 1.2% historical rate reported in asymptomatic, average-risk adults aged 40-49 undergoing screening colonoscopy. RESULTS: Participants were recruited and consented from November 2022 to November 2024, and 94 participants (54.3% female; median age, 42 years) underwent colonoscopy between December 2022 and January 2025. Adenomas were found in 39 participants (41.5%), and advanced adenomas in 14 (15.0%; 95% binomial CI, 8.4-23.7%); no cancers were detected. Most advanced lesions were right-sided. The average number of adenomas per participant with non-advanced adenomatous polyps was 1.8. The average number of adenomas found amongst the participants with advanced adenomas was slightly higher at 2.2. CONCLUSIONS: In this endurance-runner sample, advanced adenomas were observed at a prevalence of 15.0% overall. Compared with historical screening benchmarks, prevalence appeared higher, supporting further evaluation of colorectal neoplasia risk in endurance runners. However, differences in symptom profile and other risk factors between this study population and historical screening populations limit direct comparability, and the findings should be considered hypothesis-generating. Larger controlled studies and mechanistic work are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT05419531.", "provenance": [ { "field": "n", "quote": "94 participants (54.3% female; median age, 42 years) underwent colonoscopy" }, { "field": "population", "quote": "participants had completed at least 2 ultramarathons (50 km or longer) or at least 5 marathons and had no colonoscopy within 10 years" }, { "field": "intervention", "quote": "Participants completed a questionnaire and underwent colonoscopy." }, { "field": "comparator", "quote": "Prevalence was compared with a 1.2% historical rate reported in asymptomatic, average-risk adults aged 40-49 undergoing screening colonoscopy." }, { "field": "primaryOutcome", "quote": "we therefore prospectively estimated the prevalence of advanced adenomas in endurance runners aged 35-50 years" }, { "field": "result", "quote": "advanced adenomas in 14 (15.0%; 95% binomial CI, 8.4-23.7%); no cancers were detected" } ] }, { "id": "pmid:42059448", "pmid": "42059448", "doi": "10.14309/ctg.0000000000001043", "nctId": null, "pmcid": "PMC13400040", "title": "Prophylactic Clip Closure to Prevent Bleeding After Colorectal Endoscopic Submucosal Dissection: A Cost-Effectiveness Study", "firstAuthor": "Ramai", "multipleAuthors": true, "journal": "Clin Transl Gastroenterol", "year": 2026, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "patients who had a colon polyp removed using endoscopic submucosal dissection", "intervention": "placing a clip to close the wound after the procedure", "comparator": "not placing a clip after the procedure", "primaryOutcome": "cost per quality-adjusted life year gained", "result": "clipping cost about $88,843 per extra quality-adjusted life year, below the $100,000 cutoff", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a computer model based on assumed probabilities and costs, not real patient outcomes being measured directly.", "directness": "indirect", "limitations": "findings are based on model assumptions and may not reflect real-world practice.", "followUp": "", "plainFinding": "Clip cost-effective after bowel procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42059448/", "sourceText": "INTRODUCTION: Endoscopic submucosal dissection (ESD) enables en-bloc resection of large and complex colorectal neoplasms but is associated with a clinically significant risk of delayed bleeding. Prophylactic clip closure of post-ESD mucosal defects reduces bleeding risk; however, its routine use remains unclear. We evaluated the cost-effectiveness of prophylactic clipping after colorectal ESD. METHODS: We developed a decision-analytic Markov model comparing colorectal ESD with prophylactic clip closure vs ESD without closure. The model incorporated probabilities of delayed bleeding, subsequent management pathways, costs, and health utilities. The primary outcome was the incremental cost-effectiveness ratio, evaluated against a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). Deterministic (1-way, 2-way, and threshold) and probabilistic sensitivity analyses (10,000 Monte Carlo simulations) were performed. RESULTS: In the base-case analysis, prophylactic clipping was more effective and more costly than no clipping, yielding an incremental cost-effectiveness ratio of $88,843/QALY. The incremental cost was $1,102 with a QALY gain of 0.01. One-way sensitivity analyses demonstrated robust findings; clipping remained cost-effective provided total costs were below $8,943, and no clipping was favored only if delayed bleeding risk without clips fell below 3.12%. Probabilistic sensitivity analysis showed prophylactic clipping was the preferred strategy in 83.8% of simulations at a willingness-to-pay of $100,000/QALY. DISCUSSION: Prophylactic clip closure after colorectal ESD seems to be a cost-effective strategy, with the potential to reduce delayed bleeding at an acceptable incremental cost. However, these findings are based on model assumptions and should be interpreted in the context of these parameters.", "provenance": [ { "field": "population", "quote": "colorectal ESD" }, { "field": "intervention", "quote": "prophylactic clip closure of post-ESD mucosal defects" }, { "field": "comparator", "quote": "ESD without closure" }, { "field": "primaryOutcome", "quote": "The primary outcome was the incremental cost-effectiveness ratio, evaluated against a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY)." }, { "field": "result", "quote": "prophylactic clipping was more effective and more costly than no clipping, yielding an incremental cost-effectiveness ratio of $88,843/QALY" }, { "field": "limitations", "quote": "these findings are based on model assumptions and should be interpreted in the context of these parameters." } ] }, { "id": "pmid:42058479", "pmid": "42058479", "doi": "10.15766/mep_2374-8265.11596", "nctId": null, "pmcid": "PMC13123434", "title": "The Development and Evaluation of a Clinical Reasoning Case for Second-Year Medical Students", "firstAuthor": "Kirchberg", "multipleAuthors": true, "journal": "MedEdPORTAL", "year": 2026, "design": "prospective-cohort", "n": 92, "nField": "reported", "population": "second-year medical students", "intervention": "a clinical reasoning teaching case about hematochezia (rectal bleeding) as part of a course", "comparator": "students' own responses before the teaching session", "primaryOutcome": "students' confidence, attitudes, and knowledge about clinical reasoning and hematochezia", "result": "Confidence and attitudes improved significantly, and knowledge scores increased with one item reaching significance", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a medical education study about teaching students, not a clinical study of patients with bleeding, so it cannot tell you why bleeding happens.", "directness": "indirect", "limitations": "Only 92 of 123 students completed both surveys, and this is a self-reported confidence/knowledge survey, not a clinical outcome study.", "followUp": "", "plainFinding": "Not about why you bleed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42058479/", "sourceText": "INTRODUCTION: Clinical reasoning is a cornerstone of diagnostic and therapeutic decision-making, yet it is infrequently taught in preclinical medical education and is often taught implicitly. METHODS: To address this gap, we developed a clinical reasoning case focused on hematochezia as part of a year-long longitudinal clinical reasoning course for second-year preclinical medical students. The session combined large-group instruction with small-group learning activities that emphasized core reasoning skills, including problem representation, illness scripts, differential diagnoses, and diagnostic and management planning. A pre- and postintervention survey measured changes in students' confidence and attitudes about clinical reasoning skills and concepts and knowledge of hematochezia. RESULTS: Of the 123 medical students who attended the case, 92 completed both surveys (74.8% response rate). Confidence improved significantly in all domains (P < .01 for problem representation; P < .0001 for others). Students' attitudes toward case-based learning also improved (P < .0001). Knowledge scores increased for all items, with 1 reaching statistical significance (P < .05). DISCUSSION: Integrating formal clinical reasoning instruction into preclinical medical education through case-based learning is an effective strategy for teaching second-year medical students essential clinical reasoning skills.", "provenance": [ { "field": "population", "quote": "second-year preclinical medical students" }, { "field": "n", "quote": "Of the 123 medical students who attended the case, 92 completed both surveys (74.8% response rate)." }, { "field": "intervention", "quote": "a clinical reasoning case focused on hematochezia as part of a year-long longitudinal clinical reasoning course for second-year preclinical medical students" }, { "field": "comparator", "quote": "A pre- and postintervention survey measured changes in students' confidence and attitudes" }, { "field": "primaryOutcome", "quote": "changes in students' confidence and attitudes about clinical reasoning skills and concepts and knowledge of hematochezia" }, { "field": "result", "quote": "Confidence improved significantly in all domains (P < .01 for problem representation; P < .0001 for others). Students' attitudes toward case-based learning also improved (P < .0001). Knowledge scores increased for all items, with 1 reaching statistical significance (P < .05)." } ] }, { "id": "pmid:42050610", "pmid": "42050610", "doi": "10.1186/s13256-026-06068-x", "nctId": null, "pmcid": "PMC13262091", "title": "Detection and surgical intervention in anorectal malignant melanoma: a case report", "firstAuthor": "Hu", "multipleAuthors": true, "journal": "J Med Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 54-year-old woman with rectal bleeding and changed bowel habits", "intervention": "surgical removal of the rectum and anus (abdominoperineal resection) for anorectal malignant melanoma", "comparator": "none", "primaryOutcome": "tumor recurrence and complications after surgery", "result": "no tumor recurrence or complications six months after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show what usually causes rectal bleeding or how well treatments work in general.", "directness": "indirect", "limitations": "Single case report with only six months of follow-up; findings cannot be generalized.", "followUp": "six months", "plainFinding": "Rare melanoma found after bleeding; surgery removed it.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42050610/", "sourceText": "BACKGROUND: Anorectal malignant melanoma (ARMM), a rare and highly aggressive subtype of mucosal melanoma, accounts for < 0.1% of all colorectal malignancies. Characterized by nonspecific clinical manifestations and the absence of early diagnostic biomarkers, ARMM is frequently diagnosed at advanced stages, resulting in a dismal prognosis with a 5-year survival rate below 20%. Despite recent advances in immunotherapy and targeted therapies, critical knowledge gaps persist regarding its pathogenesis, standardized therapeutic protocols, and prognostic prediction models. CASE PRESENTATION: We present a case of a 54-year-old Chinese female patient who was referred to our hospital with a two-month history of rectal bleeding secondary to altered bowel habits. On digital rectal examination, a mass measuring approximately 3 cm in diameter was palpated on the left lateral wall of the rectum, which was located 3.2 cm from the anal verge. Endoscopy revealed a protruding lesion. Histopathological examination of the biopsy samples confirmed the diagnosis of ARMM. Comprehensive staging with computed tomography and magnetic resonance imaging revealed no locoregional or distant metastases. The patient underwent abdominoperineal resection, which proceeded without complications. The definitive diagnosis was malignant melanoma of the lower anal canal, at stage T2aN0M0, I B. During the six months follow-up period, there was no evidence of tumor recurrence or long-term postoperative complications in the patient. CONCLUSIONS: This case underscores the importance of early diagnosis and appropriate management of anorectal malignant melanoma to optimize patient outcomes.", "provenance": [ { "field": "population", "quote": "a 54-year-old Chinese female patient who was referred to our hospital with a two-month history of rectal bleeding secondary to altered bowel habits" }, { "field": "intervention", "quote": "The patient underwent abdominoperineal resection, which proceeded without complications." }, { "field": "comparator", "quote": "CASE PRESENTATION" }, { "field": "primaryOutcome", "quote": "During the six months follow-up period, there was no evidence of tumor recurrence or long-term postoperative complications in the patient." }, { "field": "result", "quote": "there was no evidence of tumor recurrence or long-term postoperative complications in the patient" }, { "field": "n", "quote": "a 54-year-old Chinese female patient" } ] }, { "id": "pmid:42040372", "pmid": "42040372", "doi": "10.1002/ccr3.72340", "nctId": null, "pmcid": "PMC13108412", "title": "Multiple Myeloma Presenting as Lower Gastrointestinal Bleeding: A Case Report", "firstAuthor": "Arabi", "multipleAuthors": true, "journal": "Clin Case Rep", "year": 2026, "design": "case-series", "n": null, "nField": "not-reported", "population": "a 46-year-old man with gastrointestinal bleeding and severe anemia", "intervention": "bortezomib-based chemotherapy and supportive care after diagnosis of multiple myeloma", "comparator": "", "primaryOutcome": "finding the cause of unexplained GI bleeding and anemia", "result": "endoscopy did not find a cause, but hematologic and imaging tests confirmed multiple myeloma, and the patient was successfully treated", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this cause is or how reliable the treatment is for others.", "directness": "indirect", "limitations": "Single case report with no comparison group; cannot determine how often myeloma causes this type of bleeding or whether treatment works reliably for others.", "followUp": "", "plainFinding": "Rare blood cancer causing bleeding", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42040372/", "sourceText": "Multiple myeloma (MM) is a malignant hematologic neoplasm that primarily affects the bone marrow and can invade other organs, leading to diverse clinical manifestations. Presentation with gastrointestinal bleeding as the initial symptom is exceptionally rare. We report a case of MM in a 46-year-old man who presented with gastrointestinal bleeding and severe anemia. Routine endoscopic evaluation was inconclusive, but further hematologic and imaging investigations confirmed multiple myeloma. The patient was successfully treated with bortezomib-based chemotherapy and supportive care. This case emphasizes the importance of considering plasma cell dyscrasias in patients with unexplained GI bleeding and anemia, particularly when conventional gastrointestinal causes are excluded.", "provenance": [ { "field": "population", "quote": "a case of MM in a 46-year-old man who presented with gastrointestinal bleeding and severe anemia" }, { "field": "intervention", "quote": "The patient was successfully treated with bortezomib-based chemotherapy and supportive care" }, { "field": "primaryOutcome", "quote": "Routine endoscopic evaluation was inconclusive, but further hematologic and imaging investigations confirmed multiple myeloma" }, { "field": "result", "quote": "Routine endoscopic evaluation was inconclusive, but further hematologic and imaging investigations confirmed multiple myeloma" }, { "field": "result", "quote": "The patient was successfully treated with bortezomib-based chemotherapy and supportive care" } ] }, { "id": "pmid:42037797", "pmid": "42037797", "doi": "10.7759/cureus.105869", "nctId": null, "pmcid": "PMC13109740", "title": "Pedunculated Polypoidal Anal Canal Lymphangioma in an Adult Male: A Report of a Rare Case and Review of the Literature", "firstAuthor": "Thiagarajan", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "an adult male in his early twenties with a polyp in the anal canal", "intervention": "complete excision of the polypoid lesion", "comparator": "none reported", "primaryOutcome": "diagnosis and outcome after removal of the anal canal lesion", "result": "complete excision was performed and confirmed as a lymphangioma, with excellent outcomes", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this cause of bleeding is or compare treatments.", "directness": "indirect", "limitations": "Single case report with no control group or comparison, and the patient did not present with the symptom of bright red bleeding that prompted this question.", "followUp": "", "plainFinding": "Rare benign tumor, not bleeding-related.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42037797/", "sourceText": "Lymphangiomas are benign malformations of the lymphatic system and are often misdiagnosed due to relatively vague and nonspecific symptoms. They most commonly involve the mucous membranes and skin of the head and neck region in pediatric patients. Gastrointestinal tract and anal canal involvement are exceedingly rare, with very limited cases reported in the literature. An adult male in his early twenties presented with complaints of a bloating sensation in his abdomen. Routine investigations were performed. Colonoscopy revealed a solitary, small, pedunculated, polypoid lesion at the 9 o'clock position. Complete excision of the lesion was performed and sent for histopathological examination (HPE), which showed numerous thin-walled, dilated, multicystic cavernous lymphatic channels. On immunohistochemical examination (IHC), the spaces were lined by flattened endothelial cells stained by D2-40 and CD31. Anal canal lymphangiomas are rare, especially in adults. Previously reported cases involved patients aged 32-69 years, making our case among the youngest described, in their early twenties. Unlike common presentations of rectal bleeding or discomfort, our patient reported a bloating sensation. Colonoscopy revealed a polypoidal lesion at the 9 o'clock position of the anal canal. The diagnosis of anal lymphangioma was established and confirmed by IHC with D2-40 and CD31. This case represents the spectrum of age and symptoms of anal lymphangiomas and highlights the need to consider them as an important differential in young adults when dealing with anal canal polyps. Complete excision remains curative with excellent outcomes. This case underscores the need to consider lymphangioma in the differential diagnosis of perianal masses and highlights the pivotal role of histopathology along with immunohistochemical analysis in establishing an accurate diagnosis, which is necessary for formulating appropriate management.", "provenance": [ { "field": "population", "quote": "An adult male in his early twenties presented with complaints of a bloating sensation in his abdomen." }, { "field": "intervention", "quote": "Complete excision of the lesion was performed and sent for histopathological examination (HPE)" }, { "field": "comparator", "quote": "Complete excision remains curative with excellent outcomes." }, { "field": "primaryOutcome", "quote": "The diagnosis of anal lymphangioma was established and confirmed by IHC with D2-40 and CD31." }, { "field": "result", "quote": "Complete excision remains curative with excellent outcomes." }, { "field": "n", "quote": "An adult male in his early twenties presented with complaints of a bloating sensation in his abdomen." } ] }, { "id": "pmid:42011576", "pmid": "42011576", "doi": "10.19540/j.cnki.cjcmm.20251210.702", "nctId": null, "pmcid": null, "title": "[Untargeted metabolomics reveals therapeutic mechanism of Fuzi Lizhong Pills on oxazolone-induced ulcerative colitis in mice]", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Zhongguo Zhong Yao Za Zhi", "year": 2026, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with chemically induced colon inflammation (ulcerative colitis model)", "intervention": "Fuzi Lizhong Pills (a Chinese herbal medicine)", "comparator": "untreated model mice", "primaryOutcome": "disease severity including weight loss, diarrhea, bleeding, colon damage and inflammation markers", "result": "the herbal treatment reduced bleeding, diarrhea, weight loss and colon inflammation in mice compared to untreated diseased mice", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a mouse experiment using a chemically induced disease model, not a study of humans with this symptom, so it tells us little about a person's bleeding when wiping.", "directness": "indirect", "limitations": "animal model of a specific artificially induced disease, not human rectal bleeding from ordinary causes; no information on sample size reported", "followUp": "7 consecutive days", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42011576/", "sourceText": "The mouse model of acute ulcerative colitis(UC) was established by skin sensitization via oxazolone(OXZ) combined with rectal enema. Successfully modeled mice were treated with Fuzi Lizhong Pills(FLP) for 7 consecutive days. The therapeutic effects were comprehensively evaluated. Untargeted metabolomics was employed to analyze fecal metabolic profiles, thereby elucidating the therapeutic mechanism of FLP for UC. The results showed that FLP significantly ameliorated the weight loss, diarrhea, and hematochezia in the mouse model of UC. Compared with the model group, the administration with FLP significantly reduced the DAI score, restored the colon length, repaired the pathological damage of the colon tissue, and reduced mucosal hyperemia, edema, and inflammatory cell infiltration. In terms of immune regulation, FLP significantly downregulated the expression levels of tumor necrosis factor(TNF)-α and interferon(IFN)-γ in the colon tissue and regulated spleen and thymus indices to restore the functional balance of immune organs. Untargeted metabolomics analysis of mouse feces indicated that FLP restored the levels of 126 differential metabolites, which were mainly involved in nicotinate and nicotinamide metabolism, propanoate metabolism, and phenylalanine metabolism pathways. In conclusion, FLP exhibits significant therapeutic effects on OXZ-induced UC in mice by regulating immune-inflammatory responses and correcting metabolic disorders.", "provenance": [ { "field": "population", "quote": "The mouse model of acute ulcerative colitis(UC) was established by skin sensitization via oxazolone(OXZ) combined with rectal enema" }, { "field": "intervention", "quote": "Successfully modeled mice were treated with Fuzi Lizhong Pills(FLP) for 7 consecutive days" }, { "field": "comparator", "quote": "Compared with the model group" }, { "field": "primaryOutcome", "quote": "The therapeutic effects were comprehensively evaluated" }, { "field": "result", "quote": "FLP significantly ameliorated the weight loss, diarrhea, and hematochezia in the mouse model of UC" }, { "field": "followUp", "quote": "treated with Fuzi Lizhong Pills(FLP) for 7 consecutive days" } ] }, { "id": "pmid:41974235", "pmid": "41974235", "doi": "10.1016/j.jep.2026.121657", "nctId": null, "pmcid": null, "title": "Sanghuangporus vaninii extract exerts dual anti-tumor effects in colitis-associated colorectal cancer by direct cytotoxicity and macrophage reprogramming via the PPARγ/NF-κB axis", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "J Ethnopharmacol", "year": 2026, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with colitis-associated colorectal cancer (induced by AOM/DSS)", "intervention": "Sanghuangporus vaninii (SH) mushroom extract", "comparator": "untreated AOM/DSS mice", "primaryOutcome": "tumor development and inflammation in the colon", "result": "SH extract reduced tumor number and inflammation and improved survival in mice", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is an animal and lab study, not a human study, so it cannot tell you why you personally are bleeding.", "directness": "indirect", "limitations": "Animal model only, no human data, does not address the symptom of bright red blood when wiping.", "followUp": "", "plainFinding": "Mushroom extract reduced tumors in mice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41974235/", "sourceText": "ETHNOPHARMACOLOGICAL RELEVANCE: Sanghuangporus vaninii (SH) is a medicinal mushroom used in traditional Chinese medicine to treat conditions described in ancient texts as \"Zheng Jia Ji Ju\" and \"Xue Li\". These terms are understood to be analogous to tumors and hematochezia, respectively. Nevertheless, the therapeutic potential and precise mechanisms of SH in inhibiting colitis-associated malignant transformation remain to be elucidated. AIM OF THE STUDY: This study aimed to evaluate the antitumor effect of SH on colitis-associated colorectal cancer (CAC) and to delineate the fundamental mechanisms. MATERIALS AND METHODS: The therapeutic efficacy of SH was validated using an AOM/DSS-induced CAC mouse model. Cytokine levels were quantified by ELISA. To identify the potential targets of SH, a network pharmacology approach was utilized. Subsequently, in vitro assays assessed the effects of SH on the viability, colony formation, along with cell cycle distribution of colorectal cancer (CRC) cells. A macrophage-CRC cell co-culture system was established to model an inflammatory microenvironment. The molecular mechanisms were elucidated through a series of assays, including flow cytometry, immunohistochemistry (IHC), immunofluorescence (IF), western blotting (WB), RT-qPCR, and co-immunoprecipitation (Co-IP). RESULTS: SH treatment dose-dependently suppressed colitis-associated carcinogenesis in AOM/DSS mice, improving body weight, colon length, and survival, while reducing tumor number and disease activity index. In colon tissues and serum, SH rebalanced the cytokine profile by suppressing positive regulators of inflammation (IL-6, IL-1β, TNF-α) and enhancing negative regulators of inflammation (IL-10, TGF-β). Network pharmacological analysis identified the PPARγ/NF-κB axis as the core pathway. This was validated in vitro and in vivo, where SH inhibited CRC cell proliferation, triggered cell cycle arrest, and promoted macrophage polarization towards an anti-inflammatory and pro-repair M2 phenotype. Mechanistically, WB, IHC, IF, and Co-IP confirmed that SH upregulated PPARγ expression and enhanced its interaction with NF-κB p65, thereby inhibiting NF-κB activation and its downstream inflammatory and proliferative signaling. CONCLUSION: SH ameliorates CAC through a dual mechanism: directly inhibiting tumor cell proliferation and modulating tumor-associated macrophages towards an anti-inflammatory, tissue-repair phenotype. These effects depend critically on activation of the PPARγ/NF-κB axis, which effectively intervenes in the inflammation-to-cancer cascade.", "provenance": [ { "field": "population", "quote": "AOM/DSS-induced CAC mouse model" }, { "field": "intervention", "quote": "Sanghuangporus vaninii (SH)" }, { "field": "comparator", "quote": "SH treatment dose-dependently suppressed colitis-associated carcinogenesis in AOM/DSS mice" }, { "field": "primaryOutcome", "quote": "evaluate the antitumor effect of SH on colitis-associated colorectal cancer (CAC)" }, { "field": "result", "quote": "SH treatment dose-dependently suppressed colitis-associated carcinogenesis in AOM/DSS mice, improving body weight, colon length, and survival, while reducing tumor number and disease activity index." } ] }, { "id": "pmid:41943394", "pmid": "41943394", "doi": "10.1177/19427891251411924", "nctId": null, "pmcid": "PMC13060022", "title": "Knowledge, Symptom Awareness, and Referral Practices of Primary Care Providers in Early-Onset Colorectal Cancer", "firstAuthor": "Townsend", "multipleAuthors": true, "journal": "Popul Health Manag", "year": 2026, "design": "retrospective", "n": 1490, "nField": "reported", "population": "primary care providers in the United States", "intervention": "assessing primary care providers' awareness of colorectal cancer symptoms and their referral practices for patients under 50", "comparator": "no comparator group; descriptive survey only", "primaryOutcome": "providers' symptom awareness and referral/diagnostic practices for early-onset colorectal cancer", "result": "About 45% of providers would refer patients with rectal bleeding to colonoscopy or offer a stool test, and most would first do a workup and check family history rather than refer immediately", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a self-reported survey of doctors' practices, not a study of patients or of what actually causes bleeding, so it can't tell you why someone bleeds.", "directness": "indirect", "limitations": "Relies on self-reported survey data from providers rather than actual patient outcomes or diagnoses; does not study the bleeding itself or its causes.", "followUp": "", "plainFinding": "Doesn't explain causes of bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41943394/", "sourceText": "Colorectal cancer (CRC) incidence and death rates are increasing among people under age 50 in the United States. In addition to promoting on-time screening for average-risk adults starting at age 45, CRC signs and symptoms may need timely assessment by a health care provider to rule out other conditions and identify a diagnosis. The objective of this study was to examine primary care providers' (PCPs') awareness of CRC-related symptoms and their diagnostic approaches for patients under age 50 using the 2023 DocStyles panel survey. This survey included 1490 PCPs practicing in the United States. A descriptive analysis was conducted to examine symptom awareness and referral practices. Log binomial regression was used to examine predictors of greater symptom awareness. Symptom awareness of early-onset CRC was highest for changes in bowel habits (79%) and lowest for abdominal pain (43%). Fewer obstetricians/gynecologists and physician assistants were aware of CRC signs and symptoms. Most PCPs would complete a workup and assess patients for family history of cancer for patients presenting with rectal bleeding/bloody stools, iron deficiency anemia, or changes in bowel habits. Around 45% of PCPs would refer patients with rectal bleeding/bloody stools to diagnostic colonoscopy or offer a stool-based screening test. Some PCPs may benefit from additional training on signs and symptoms of early-onset CRC and evidence-based guidelines for symptom assessment. These findings indicate that many PCPs prefer to complete a medical workup and assess for family history of cancer as first steps, and most would not immediately refer patients to diagnostic colonoscopy.", "provenance": [ { "field": "n", "quote": "This survey included 1490 PCPs practicing in the United States." }, { "field": "population", "quote": "primary care providers' (PCPs') awareness of CRC-related symptoms and their diagnostic approaches for patients under age 50" }, { "field": "intervention", "quote": "examine primary care providers' (PCPs') awareness of CRC-related symptoms and their diagnostic approaches for patients under age 50 using the 2023 DocStyles panel survey" }, { "field": "comparator", "quote": "A descriptive analysis was conducted to examine symptom awareness and referral practices." }, { "field": "primaryOutcome", "quote": "Symptom awareness of early-onset CRC was highest for changes in bowel habits (79%) and lowest for abdominal pain (43%)." }, { "field": "result", "quote": "Around 45% of PCPs would refer patients with rectal bleeding/bloody stools to diagnostic colonoscopy or offer a stool-based screening test." } ] }, { "id": "pmid:41942892", "pmid": "41942892", "doi": "10.1186/s12876-026-04800-x", "nctId": null, "pmcid": "PMC13182074", "title": "Evaluating clinicopathological pattern and management of colorectal cancer for adult patients presenting at Queen Elizabeth Central Hospital: a 10-year retrospective review", "firstAuthor": "Masina", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2026, "design": "retrospective", "n": 192, "nField": "reported", "population": "adult patients diagnosed with colorectal cancer at a hospital in Malawi", "intervention": "various treatments including surgery and chemotherapy for colorectal cancer", "comparator": "no comparison group described", "primaryOutcome": "patterns of symptoms, diagnosis, and treatment of colorectal cancer", "result": "rectal bleeding was one of the main symptoms, seen in 78 of 192 patients, most of whom were diagnosed at an advanced stage", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a retrospective review of cancer patients, not a study designed to find out how often bright red bleeding is caused by cancer versus other things, and many cases lacked confirmed histology.", "directness": "indirect", "limitations": "retrospective design, single hospital, 42.71% of cases had no histology report confirming the cancer diagnosis", "followUp": "", "plainFinding": "Bleeding occurred in some cancer patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41942892/", "sourceText": "BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer mortality and the third prevalent cancer globally. In Sub-Saharan Africa (SSA), the incidence is increasing. This retrospective cross-sectional study evaluated clinicopathological pattern and management of CRC for adult patients presenting at Queen Elizabeth Central Hospital (QECH), Malawi. METHODS: The review of oncology and surgical register books identified patients diagnosed with CRC who presented between 2012 and 2022. The variables assessed were age, sex, HIV status, symptoms, family history, diagnostic approach, tumour site, histological diagnosis, treatment modality, and length of hospital stay (LOHS). RESULTS: There were 192 patients identified with CRC. The median age was 45 years [interquartile range (IQR) = 43.5–60], with slight male predominance at 100 (52.08%). There were 23 (11.98%) patients with HIV infection and all were on treatment. Abdominal pain and rectal bleeding were the predominant symptoms occuring in 100 (52.08%) and 78 (40.63%) respectively. The mean duration of signs and symptoms was 7.6 months (SD = 4.6). Over half of the patients, 113 (58.85%) were in clinical stage IV. The majority were diagnosed at laparotomy 116 (60.42%), followed by colonoscopy 19 (9.90%). Out of the 192 participants, 110 (57.29%) had histology reports confirming CRC, while 82 (42.71%) had no histology reports. All the available histology reports showed adenocarcinoma. Surgery was the main treatment for 155 (80.73%) patients while chemotherapy was offered to 81 (42.19%) patients. CONCLUSION: CRC at QECH is predominantly diagnosed in young patients at advanced stages. Screening younger age groups could improve with early diagnosis and management.", "provenance": [ { "field": "n", "quote": "There were 192 patients identified with CRC." }, { "field": "population", "quote": "adult patients presenting at Queen Elizabeth Central Hospital (QECH), Malawi" }, { "field": "intervention", "quote": "Surgery was the main treatment for 155 (80.73%) patients while chemotherapy was offered to 81 (42.19%) patients." }, { "field": "comparator", "quote": "This retrospective cross-sectional study evaluated clinicopathological pattern and management of CRC" }, { "field": "primaryOutcome", "quote": "evaluated clinicopathological pattern and management of CRC for adult patients" }, { "field": "result", "quote": "Abdominal pain and rectal bleeding were the predominant symptoms occuring in 100 (52.08%) and 78 (40.63%) respectively." } ] }, { "id": "pmid:41938454", "pmid": "41938454", "doi": "10.1097/RC9.0000000000000370", "nctId": null, "pmcid": "PMC13045975", "title": "Colocolic intussusception caused by a descending colon lipoma in an adult: a rare case report", "firstAuthor": "Acharya", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 47-year-old man with abdominal pain, loose stools, and fresh rectal bleeding", "intervention": "surgical removal of a colon lipoma causing intussusception (left hemicolectomy)", "comparator": "", "primaryOutcome": "diagnosis and treatment outcome of the bowel blockage causing bleeding", "result": "the bleeding and symptoms were caused by a rare benign fatty tumor making part of the bowel fold into itself, fixed by surgery", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this cause is or how well treatment generally works.", "directness": "indirect", "limitations": "Single case report; no control group; findings cannot be generalized to typical causes of rectal bleeding.", "followUp": "", "plainFinding": "Rare bowel tumor caused bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41938454/", "sourceText": "INTRODUCTION: Adult intussusception is an uncommon clinical condition, accounting for only 5% of all intussusception cases and typically involving an identifiable pathological lead point, most often a neoplasm. Colocolic intussusception caused by a benign lipoma of the descending colon is exceptionally rare. CASE PRESENTATION: A 47-year-old male presented with a 10-day history of intermittent periumbilical abdominal pain, loose stools, and fresh rectal bleeding. Imaging revealed a colocolic intussusception with a 5 × 4 cm fat-density lesion in the descending colon, suggestive of a submucosal lipoma. Exploratory laparotomy confirmed transverse-to-descending colonic intussusception with a lipoma serving as the lead point. Left hemicolectomy with side-to-side colocolic anastomosis was performed. Histopathology confirmed a benign submucosal lipoma. DISCUSSION: Unlike pediatric cases, adult intussusception is usually secondary to an organic lesion. Lipomas are rare benign tumors, and those in the descending colon causing colocolic intussusception are especially unusual. Diagnosis often requires imaging, with CT scans being the gold standard. Surgical resection is the definitive treatment due to the high likelihood of pathology and risk of complications. KEY CLINICAL MESSAGE: Colocolic intussusception due to descending colon lipoma is a rare but important differential in adults presenting with nonspecific abdominal symptoms and rectal bleeding. Timely imaging and surgical intervention are crucial for optimal outcomes. CONCLUSION: This case highlights the importance of maintaining high clinical suspicion and utilizing imaging in adults with vague gastrointestinal symptoms. Prompt surgical management of lipoma-induced intussusception can prevent severe complications.", "provenance": [ { "field": "population", "quote": "A 47-year-old male presented with a 10-day history of intermittent periumbilical abdominal pain, loose stools, and fresh rectal bleeding." }, { "field": "intervention", "quote": "Left hemicolectomy with side-to-side colocolic anastomosis was performed." }, { "field": "primaryOutcome", "quote": "Imaging revealed a colocolic intussusception with a 5 × 4 cm fat-density lesion in the descending colon, suggestive of a submucosal lipoma." }, { "field": "result", "quote": "Exploratory laparotomy confirmed transverse-to-descending colonic intussusception with a lipoma serving as the lead point." }, { "field": "n", "quote": "A 47-year-old male presented" } ] }, { "id": "pmid:41903361", "pmid": "41903361", "doi": "10.1016/j.suronc.2026.102406", "nctId": null, "pmcid": null, "title": "Rectal predominance and annular wall thickening: Abdominal computed tomography and clinical characteristics of colorectal cancer in a resource-limited setting", "firstAuthor": "Saleh", "multipleAuthors": true, "journal": "Surg Oncol", "year": 2026, "design": "case-series", "n": 60, "nField": "reported", "population": "patients suspected of having colorectal cancer referred for abdominal CT at a hospital", "intervention": "abdominal CT scan to detect and stage suspected colorectal cancer", "comparator": "histology results (biopsy diagnosis)", "primaryOutcome": "how well CT scan findings matched actual colorectal cancer diagnosis, and which symptoms were linked to cancer", "result": "CT scan correctly identified cancer with 88.9% sensitivity and 91.7% specificity, and bleeding from the back passage (hematochezia) was significantly linked to confirmed cancer cases", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a small, single-centre study of only 60 patients with exploratory statistical associations, so its findings are not strong enough to draw firm conclusions.", "directness": "indirect", "limitations": "Small sample size, cross-sectional design, single hospital setting, and the authors state associations should be considered exploratory due to small sample size and multiple comparisons.", "followUp": "", "plainFinding": "Rectal bleeding linked to colorectal cancer risk", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41903361/", "sourceText": "BACKGROUND: Colorectal cancer (CRC) is the second-leading cause of cancer deaths worldwide, and its incidence is rising in developing countries. In resource-limited settings, abdominal CT scans are commonly used to detect and stage CRC before treatment. This study examined CT scan results and associated factors in patients suspected of having CRC at Muhimbili National Hospital between August 2019 and February 2020. METHODOLOGY: This was a cross-sectional, hospital-based study of 60 patients with suspected CRC who were referred to our centre for abdominal CT. Clinical characteristics, abdominal CT findings, and histology results were recorded in a structured questionnaire. Categorical and numerical data were analyzed using frequency distribution tables, and the Chi-square (X2) test was used to assess the association between the independent and dependent variables. Multivariate logistic regression was performed to evaluate independent associations after adjusting for age and sex. RESULTS: Most participants were over 40 years old (more females than males, 1.4:1). An unhealthy diet was common (71.7%). Main symptoms: constipation (61.7%) and hematochezia (58.3%). Among 60 suspected patients, colorectal tumours were confirmed in 56.7%, mostly rectal (26.7%), often with annular thickening (46.7%) and heterogeneous enhancement (43.3%). Abdominal CT showed good performance (sensitivity 88.9%, specificity 91.7%, accuracy 90.0%). Significant associations were found with lower education (p = 0.04), alcohol use (p = 0.02), and hematochezia (p = 0.03). These associations should be considered exploratory, given the small sample size and multiple comparisons performed. CONCLUSION: CRC is present in the majority of patients with suspected cases who follow an unhealthy diet, occurring most commonly in the rectum and presenting as annular wall thickening on abdominal CT. This association is also linked to educational attainment and alcohol consumption.", "provenance": [ { "field": "n", "quote": "This was a cross-sectional, hospital-based study of 60 patients with suspected CRC" }, { "field": "population", "quote": "patients suspected of having CRC at Muhimbili National Hospital between August 2019 and February 2020" }, { "field": "intervention", "quote": "abdominal CT scans are commonly used to detect and stage CRC before treatment" }, { "field": "comparator", "quote": "Clinical characteristics, abdominal CT findings, and histology results were recorded in a structured questionnaire" }, { "field": "primaryOutcome", "quote": "Abdominal CT showed good performance (sensitivity 88.9%, specificity 91.7%, accuracy 90.0%)" }, { "field": "result", "quote": "Significant associations were found with lower education (p = 0.04), alcohol use (p = 0.02), and hematochezia (p = 0.03)." } ] }, { "id": "pmid:41871608", "pmid": "41871608", "doi": "10.1055/a-2814-4950", "nctId": null, "pmcid": "PMC13286675", "title": "External validation and optimization of the Limoges score to improve the delayed bleeding risk prediction after colorectal endoscopic submucosal dissection: the Delayed Bleeding ESD (DEBE) score", "firstAuthor": "Albéniz", "multipleAuthors": true, "journal": "Endoscopy", "year": 2026, "design": "prospective-cohort", "n": 4767, "nField": "reported", "population": "adults who had a colorectal endoscopic submucosal dissection (a procedure to remove colon growths)", "intervention": "a new risk-scoring tool called DEBE score using patient and procedure factors before the procedure", "comparator": "the existing Limoges bleeding risk score", "primaryOutcome": "clinically significant delayed bleeding after the colon procedure", "result": "the new DEBE score predicted delayed bleeding better than the older score, with acceptable but not excellent accuracy", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a large study of a specific endoscopic procedure, not of general rectal bleeding, so it doesn't tell you why an ordinary person sees blood on wiping.", "directness": "indirect", "limitations": "abstract does not describe limitations such as missing data, follow-up completeness, or population restriction beyond the ESD setting", "followUp": "", "plainFinding": "Not relevant to bleeding on wiping", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41871608/", "sourceText": "BACKGROUND: The Limoges Bleeding Score estimates an individual's risk of clinically significant delayed bleeding (CSDB) after colorectal endoscopic submucosal dissection (ESD). We aimed to validate and update this model in a Western setting. METHODS: Procedural data and complications were prospectively recorded in French-Belgian (FECCO) and Spanish cohorts. The Limoges score was externally validated. A revised Western score was derived. Score performance was determined by discrimination and calibration. Internal validation was performed using bootstrapping and leave-one-out cross-validation. The score's performance was independently assessed in both cohorts. RESULTS: 4767 ESDs were included: 33.7 % rectal and 37.7 % proximal; median lesion size 50 mm; mean patient age 68.1 years; American Society of Anesthesiologists (ASA) score I-II 72.9 %; anticoagulants 10.9 %, and antiplatelets 17.0 %. CSDB prevalence was 6.8 %. The performance of the Limoges score was modest. A new score called DEBE (Delayed Bleeding ESD) was developed: age ≥ 75 years (2 points), lesion size ≥ 50 mm (5 points), ASA classification III-IV (4 points), location in the rectum (2 points) or proximal colon (1 point), anticoagulants (7 points) and antiplatelets (3 points). The DEBE score ranged from 0 to 23 points and categorized the patients into two groups (low risk 3.9 %; medium-high risk 14.2 %). The score showed acceptable discrimination (area under the curve 0.712), adequate calibration, and consistent performance after internal validation. CONCLUSIONS: The DEBE score, based on seven preprocedural variables, allowed a personalized assessment of bleeding risk. It determined the individual CSDB risk, identified patients who would benefit from prophylactic treatment, and defined those who require monitoring after ESD.", "provenance": [ { "field": "population", "quote": "4767 ESDs were included" }, { "field": "intervention", "quote": "A new score called DEBE (Delayed Bleeding ESD) was developed: age ≥ 75 years (2 points), lesion size ≥ 50 mm (5 points), ASA classification III-IV (4 points), location in the rectum (2 points) or proximal colon (1 point), anticoagulants (7 points) and antiplatelets (3 points)." }, { "field": "comparator", "quote": "The Limoges score was externally validated." }, { "field": "primaryOutcome", "quote": "The Limoges Bleeding Score estimates an individual's risk of clinically significant delayed bleeding (CSDB) after colorectal endoscopic submucosal dissection (ESD)." }, { "field": "result", "quote": "The score showed acceptable discrimination (area under the curve 0.712), adequate calibration, and consistent performance after internal validation." }, { "field": "n", "quote": "4767 ESDs were included" } ] }, { "id": "pmid:41860832", "pmid": "41860832", "doi": "10.1371/journal.pone.0345079", "nctId": null, "pmcid": "PMC13004350", "title": "Analysis of 6-week mortality and influencing factors in patients with liver cirrhosis and portal vein thrombosis complicated by acute gastrointestinal bleeding", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "PLoS One", "year": 2026, "design": "retrospective", "n": 232, "nField": "reported", "population": "patients with liver cirrhosis and portal vein thrombosis who had acute gastrointestinal bleeding", "intervention": "not applicable (observational risk factor analysis)", "comparator": "patients who survived vs those who died within 6 weeks", "primaryOutcome": "death within 6 weeks of gastrointestinal bleeding", "result": "higher ALP levels and failure of initial treatment within 5 days were linked to greater risk of dying within 6 weeks", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a retrospective study of a specific, more severe condition (cirrhosis with vein clots and major bleeding), so it mainly shows risk factors for death rather than answering why someone sees bright red blood when wiping.", "directness": "indirect", "limitations": "retrospective design; studies a specific high-risk population (cirrhosis with portal vein thrombosis) rather than general rectal bleeding", "followUp": "6 weeks", "plainFinding": "Unrelated: death risk in liver disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41860832/", "sourceText": "OBJECTIVE: To explore the 6-week mortality of acute gastrointestinal bleeding in patients with liver cirrhosis and portal vein thrombosis and to analyze its influencing factors. METHODS: This was a retrospective study. We retrospectively screened 232 patients with liver cirrhosis and portal vein thrombosis complicated by acute gastrointestinal bleeding who were admitted to West China Hospital of Sichuan University from January 1，2020 to November30，2022. Of the 232 patients, 75 had their first bleeding. Additionally, the patients were divided into a mortality group (n = 34) and a non-mortality group (n = 198) based on whether they died within 6 weeks of the onset of gastrointestinal bleeding. Baseline general information, laboratory indicators, and other clinical data of the two groups were compared, and the independent risk factors for 6-week mortality in patients with liver cirrhosis and portal vein thrombosis complicated by acute gastrointestinal bleeding were analyzed. RESULTS: There were significant differences between the two groups in terms of the etiology of liver cirrhosis, HCC, 5-day treatment failure rate (8.62%), TBiL, ALT, BUN, Na, eGFR, DBiL, AST, GGT, ALP, CR, WBC, PLT, and PT(p < 0.05). Multivariate logistic regression analysis revealed that elevated ALP levels showed a positive association with 6-week mortality [OR=1.01, 95% CI (1.01, 1.01), p < 0.01] and 5-day treatment failure showed a positive association with 6-week mortality [OR=11.27, 95% CI (3.45, 36.81),p < 0.01]. CONCLUSION: Elevated ALP and 5-day treatment failure were found to be independent risk factors for 6-week mortality in patients with cirrhosis and portal vein thrombosis complicated by acute gastrointestinal bleeding.", "provenance": [ { "field": "n", "quote": "232 patients with liver cirrhosis and portal vein thrombosis complicated by acute gastrointestinal bleeding" }, { "field": "population", "quote": "patients with liver cirrhosis and portal vein thrombosis complicated by acute gastrointestinal bleeding" }, { "field": "primaryOutcome", "quote": "6-week mortality of acute gastrointestinal bleeding in patients with liver cirrhosis and portal vein thrombosis" }, { "field": "result", "quote": "elevated ALP levels showed a positive association with 6-week mortality [OR=1.01, 95% CI (1.01, 1.01), p < 0.01] and 5-day treatment failure showed a positive association with 6-week mortality [OR=11.27, 95% CI (3.45, 36.81),p < 0.01]" }, { "field": "comparator", "quote": "the patients were divided into a mortality group (n = 34) and a non-mortality group (n = 198)" }, { "field": "intervention", "quote": "This was a retrospective study." } ] }, { "id": "pmid:41832104", "pmid": "41832104", "doi": "10.1016/j.soncn.2026.152205", "nctId": null, "pmcid": null, "title": "Waiting in the Shadows: Diagnostic Delays and Illness Perceptions in Colorectal Cancer Patients", "firstAuthor": "Tanrıkulu", "multipleAuthors": true, "journal": "Semin Oncol Nurs", "year": 2026, "design": "retrospective", "n": 114, "nField": "reported", "population": "patients diagnosed with colorectal cancer attending an oncology outpatient clinic", "intervention": "no treatment tested; patients were surveyed about their symptoms and time to seeking medical care", "comparator": "no comparison group", "primaryOutcome": "time between first noticing symptoms and seeking medical help, and factors linked to delay", "result": "patients waited an average of 7.3 months before seeking help, with 60.6% delaying more than a month, mainly because they did not know the signs of colorectal cancer", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a small, single-clinic cross-sectional survey relying on patient recall, so it can show patterns but not prove cause or test a treatment", "directness": "indirect", "limitations": "cross-sectional design, single clinic, reliance on patient self-report of symptom timing, no control group", "followUp": "", "plainFinding": "Many patients delayed seeking care", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41832104/", "sourceText": "OBJECTIVE: This study aimed to determine the time between the onset of initial symptoms and the decision to seek medical help, identify patient-related factors contributing to delays, and assess the relationship between diagnostic delays and illness perception among patients with colorectal cancer. METHODS: A cross‑sectional study at a medical oncology outpatient clinic included 114 patients with colorectal cancer. Data collection instruments included a structured questionnaire and the Brief Illness Perception Scale. RESULTS: The mean time from symptom onset to seeking medical help was 7.3 ± 11.0 months (range: 1-62.5). A delay of more than one month was observed in 60.6% of patients, with 31.6% experiencing a significantly prolonged delay. Most participants (76.3%) reported being unaware of the signs and symptoms of colorectal cancer, and only 16.7% had undergone a screening test. The most common reported complaints included changes in bowel habits (22.0%), rectal bleeding (15.3%), fatigue (13.1%), and abdominal pain (11.2%). Diagnostic delay was significantly associated with lower educational levels and changes in bowel habits (P < .05). The mean Brief Illness Perception Scale score was 21.7 ± 11.4, indicating moderate perceived threat. No statistically significant association was found between patients' illness perceptions and the duration of delay in seeking medical care (P > 05). Patients most often attributed their illness to stress (56.7%), diet (43.1%), and sadness (23.5%). CONCLUSIONS: Despite experiencing symptoms indicative of colorectal cancer, many individuals delayed seeking medical help, primarily due to a lack of awareness of early signs. IMPLICATIONS FOR NURSING PRACTICE: Findings underscore the need for public education and early screening efforts to promote timely diagnosis and improve outcomes in colorectal cancer.", "provenance": [ { "field": "n", "quote": "included 114 patients with colorectal cancer" }, { "field": "population", "quote": "patients with colorectal cancer" }, { "field": "intervention", "quote": "A structured questionnaire and the Brief Illness Perception Scale" }, { "field": "primaryOutcome", "quote": "the time between the onset of initial symptoms and the decision to seek medical help" }, { "field": "result", "quote": "The mean time from symptom onset to seeking medical help was 7.3 ± 11.0 months (range: 1-62.5). A delay of more than one month was observed in 60.6% of patients" }, { "field": "result", "quote": "Most participants (76.3%) reported being unaware of the signs and symptoms of colorectal cancer" }, { "field": "comparator", "quote": "The most common reported complaints included changes in bowel habits (22.0%), rectal bleeding (15.3%), fatigue (13.1%), and abdominal pain (11.2%)." } ] }, { "id": "pmid:41798667", "pmid": "41798667", "doi": "10.1016/j.radcr.2026.01.098", "nctId": null, "pmcid": "PMC12966855", "title": "Recurrent ileocolic variceal hemorrhage treated with superselective Onyx embolization: A case report", "firstAuthor": "Babaei", "multipleAuthors": true, "journal": "Radiol Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "35-year-old woman with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis with recurrent rectal bleeding and severe anemia", "intervention": "Superselective embolization using Onyx followed by glue embolization", "comparator": "none", "primaryOutcome": "Stopping the bleeding from ileocolic and appendicular varices", "result": "Complete cessation of bleeding after embolization", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often this treatment works or whether it applies to other people.", "directness": "indirect", "limitations": "Only one patient described, no comparison group, and this cause of bleeding (ectopic varices from liver disease) is rare and different from common causes of bright red blood when wiping.", "followUp": "", "plainFinding": "Rare vein bleeding stopped by embolization.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41798667/", "sourceText": "Ileocolic and appendicular varices are rare causes of lower gastrointestinal bleeding and are frequently missed on endoscopic evaluation. We present the case of a 35-year-old woman with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis who presented with recurrent hematochezia and severe anemia. Contrast enhanced CT with venous-phase imaging revealed clusters of enhancing ileal varices, and angiography demonstrated ileocolic and appendicular varices with a significant portosystemic shunt draining into the inferior vena cava. Superselective embolization using Onyx followed by glue embolization resulted in complete cessation of bleeding. This case highlights the diagnostic value of multiphase contrast-enhanced CT including venous phase imaging and the effectiveness of minimally invasive endovascular treatment for rare ectopic varices.", "provenance": [ { "field": "n", "quote": "a 35-year-old woman with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis" }, { "field": "population", "quote": "a 35-year-old woman with ulcerative colitis, primary sclerosing cholangitis, and cirrhosis who presented with recurrent hematochezia and severe anemia" }, { "field": "intervention", "quote": "Superselective embolization using Onyx followed by glue embolization" }, { "field": "comparator", "quote": "Superselective embolization using Onyx followed by glue embolization resulted in complete cessation of bleeding." }, { "field": "primaryOutcome", "quote": "resulted in complete cessation of bleeding" }, { "field": "result", "quote": "Superselective embolization using Onyx followed by glue embolization resulted in complete cessation of bleeding." } ] }, { "id": "pmid:41779539", "pmid": "41779539", "doi": "10.1590/S0004-2803.24612025-064", "nctId": null, "pmcid": "PMC12956266", "title": "CHANGING PATTERNS IN THE EPIDEMIOLOGY OF ACUTEGASTROINTESTINAL BLEEDING IN BRAZIL OVER THE LAST 12 YEARS", "firstAuthor": "Pereira", "multipleAuthors": true, "journal": "Arq Gastroenterol", "year": 2026, "design": "retrospective", "n": 2145, "nField": "reported", "population": "patients admitted to a hospital in Brazil with gastrointestinal bleeding over a 12-year period", "intervention": "none - this is a descriptive study of bleeding causes and outcomes, not a treatment", "comparator": "comparison between two time periods (2012-2017 vs 2018-2023), not a treatment comparator", "primaryOutcome": "causes of bleeding and death rates, and how these changed over time", "result": "hemorrhoids were one of the common causes of lower gastrointestinal bleeding, and overall death rates from bleeding fell over time", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a single-center retrospective review of hospitalized bleeding patients, not a study designed to explain why someone sees blood when wiping.", "directness": "indirect", "limitations": "abstract does not address outpatient or non-hospitalized bleeding, and does not isolate hemorrhoids as a specific research question - it is a broad descriptive review of hospitalized GI bleeding causes", "followUp": "", "plainFinding": "Hemorrhoids are one common cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41779539/", "sourceText": "BACKGROUND: Gastrointestinal bleeding (GIB) is one of the leading causes of hospitalization attributed to digestive disorders. Little is known about etiology and outcomes of GIB and temporal trends in the incidence of upper GIB (UGIB) and lower GIB (LGIB) in Brazil. OBJECTIVE: To investigate the main causes and mortality of patients admitted to a tertiary care hospital in Brazil with UGIB and LGIB, as well as to assess trends in epidemiology and outcomes of GIB over time. METHODS: All patients admitted to the Gastrointestinal (GI) Unit of the Portuguese Hospital of Salvador, Bahia, Brazil with the diagnosis of GIB between January 2012 and December 2023 were retrospectively investigated. All patients with GIB were classified as non-variceal (NUGIB), variceal (VUGIB) UGIB and LGIB according to standard criteria and managed according to an institutional protocol. Demographics, type and etiology of GIB and in-hospital mortality were evaluated in two different periods, between 2012-2017 (period 1) and 2018-2023 (period 2). RESULTS: 2.145 patients (1.214 males, mean age 70+16 years) were admitted, 1.185 in period 1 and 960 in period 2. Most of the patients had hematochezia and melena. NUGIB, VUGIB, LGIB and mid-GIB were observed in 37.5%, 14.4%, 40.3% and 5.6% of the patients, respectively. The remaining 47 subjects were not investigated due to advanced age or comorbidity. The most common etiologies for UGIB and LGIB were, respectively, esophagogastric varices (EV), duodenal (DU) and gastric ulcer (GU), and colonic diverticular disease (CDD), actinic proctocolitis (APC) and hemorrhoids (HE). Changes in the frequency of LGIB (42.1% vs 38.0% in period 2, P<0.0001) and mid-GIB (3.8% vs 7.9% in period 2, P<0.0001) were recorded over time. Age (68.7+15.6 vs 71+15.7 years in period 2, P=0.001) and gender (54,1% vs 59.1% of males in period 2, P=0.01) were also shown to vary as well as a significant decrease in mortality in recent years (14,2% vs 10.1% of deaths in period 2, P=0.005). CONCLUSIONS: EV, DU, GU and CDD, APC and HE were the most frequent causes of UGB and LGIB, respectively. Shifts in demographics, frequency of LGIB and mid-GIB and mortality were demonstrated in recent years.", "provenance": [ { "field": "n", "quote": "2.145 patients (1.214 males, mean age 70+16 years) were admitted" }, { "field": "population", "quote": "All patients admitted to the Gastrointestinal (GI) Unit of the Portuguese Hospital of Salvador, Bahia, Brazil with the diagnosis of GIB between January 2012 and December 2023 were retrospectively investigated." }, { "field": "intervention", "quote": "retrospectively investigated" }, { "field": "comparator", "quote": "between 2012-2017 (period 1) and 2018-2023 (period 2)" }, { "field": "primaryOutcome", "quote": "Demographics, type and etiology of GIB and in-hospital mortality were evaluated in two different periods" }, { "field": "result", "quote": "colonic diverticular disease (CDD), actinic proctocolitis (APC) and hemorrhoids (HE)" }, { "field": "result", "quote": "a significant decrease in mortality in recent years (14,2% vs 10.1% of deaths in period 2, P=0.005)" } ] }, { "id": "pmid:41752772", "pmid": "41752772", "doi": "10.3390/medicina62020374", "nctId": null, "pmcid": "PMC12942456", "title": "Age-Specific Colonoscopic Yield and Symptom-Based Risk Stratification in Symptomatic Adults: A Bicenter Omani Analysis to Inform Early Detection and Screening Strategies for Colorectal Neoplasia", "firstAuthor": "Alzaabi", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2026, "design": "retrospective", "n": 2041, "nField": "reported", "population": "adults having colonoscopy for symptoms like bleeding or pain in Oman, split into under 50 and 50 and older", "intervention": "having rectal bleeding as a symptom before colonoscopy", "comparator": "not having rectal bleeding as a symptom", "primaryOutcome": "finding advanced colorectal neoplasia (pre-cancer or cancer) on colonoscopy", "result": "in adults under 50, rectal bleeding was linked to more than double the odds of having advanced colorectal neoplasia", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a retrospective look-back at colonoscopy records from referral hospitals, not a trial, so it can show links but not prove how risky any one person's bleeding is", "directness": "direct", "limitations": "cohort was mostly symptomatic patients referred to tertiary hospitals, so it cannot say what screening age is best, and authors state it cannot determine optimal screening thresholds", "followUp": "", "plainFinding": "Bleeding linked to higher cancer risk", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41752772/", "sourceText": "Background and Objectives: Colorectal cancer (CRC) is the most common gastrointestinal malignancy in Oman and among the top three cancers nationally, with an increasing burden of early-onset CRC (EOCRC) diagnosed before age 50. Despite national CRC guidelines, the lack of an organized screening program means most cases are detected symptomatically and at advanced stages. This study evaluated age-related differences in colonoscopic findings and advanced neoplasia risk in symptomatic adults to inform early detection and screening strategy development. Materials and Methods: A cross-sectional analysis of 2041 colonoscopies performed at two national tertiary referral centers, Sultan Qaboos University Hospital and Royal Hospital, was conducted (2018-2021). Patients were categorized by age (<50 vs. ≥50 years). Outcomes included adenoma detection rate (ADR), advanced premalignant lesions (APL), colorectal cancer (CRC), and advanced colorectal neoplasia (ACRN; APL and/or CRC). Associations between presenting symptoms and ACRN were analyzed using univariable logistic regression, and diagnostic yield was estimated via number needed to scope (NNS). The cohort was predominantly symptomatic (71.9%), with 15.8% screening and 12.3% surveillance procedures. Results: Of 2041 procedures, 742 (36.3%) were in patients <50 years. ADR, APL, CRC, and ACRN were significantly higher in those ≥50 years (14.9%, 7.5%, 5.8%, and 13.3%) than in younger adults (8.5%, 3.2%, 2.7%, and 5.9%; all p < 0.01). Among younger adults, rectal bleeding (OR 2.17, 95% CI 1.15-4.08, p = 0.026) and abdominal pain (OR 2.14, 95% CI 1.15-3.98, p = 0.022) were significantly associated with ACRN. Diagnostic efficiency (NNS) was highest for loss of appetite in both age groups (4.7 in <50 vs. 2.8 in ≥50 years). Despite lower overall rates, a substantial burden of advanced neoplasia was observed in symptomatic adults <50 years (5.9% ACRN, 2.7% CRC). Conclusions: This bicenter study demonstrates clear age-related disparities in colorectal neoplasia, with a clinically important burden of advanced disease in symptomatic adults under 50 years. These findings highlight the importance of prompt colonoscopic evaluation for younger adults presenting with alarm symptoms, particularly rectal bleeding and abdominal pain, and provide evidence supporting risk-stratified diagnostic approaches. While age-related differences suggest potential value in earlier screening initiation, our predominantly symptomatic tertiary care cohort cannot directly determine optimal screening age thresholds. Prospective screening trials and cost-effectiveness analyses are needed to establish population-based detection rates and inform evidence-based screening policy development in Oman.", "provenance": [ { "field": "n", "quote": "Of 2041 procedures, 742 (36.3%) were in patients <50 years" }, { "field": "population", "quote": "The cohort was predominantly symptomatic (71.9%), with 15.8% screening and 12.3% surveillance procedures." }, { "field": "intervention", "quote": "Among younger adults, rectal bleeding (OR 2.17, 95% CI 1.15-4.08, p = 0.026) and abdominal pain (OR 2.14, 95% CI 1.15-3.98, p = 0.022) were significantly associated with ACRN." }, { "field": "comparator", "quote": "Associations between presenting symptoms and ACRN were analyzed using univariable logistic regression" }, { "field": "primaryOutcome", "quote": "Outcomes included adenoma detection rate (ADR), advanced premalignant lesions (APL), colorectal cancer (CRC), and advanced colorectal neoplasia (ACRN; APL and/or CRC)." }, { "field": "result", "quote": "rectal bleeding (OR 2.17, 95% CI 1.15-4.08, p = 0.026) and abdominal pain (OR 2.14, 95% CI 1.15-3.98, p = 0.022) were significantly associated with ACRN" } ] }, { "id": "pmid:41683826", "pmid": "41683826", "doi": "10.3390/ijms27031405", "nctId": null, "pmcid": "PMC12897815", "title": "Alleviating Effects of Zophobas morio and Tenebrio molitor Larvae Protein Powder on Dextran Sodium Sulfate-Induced Inflammatory Bowel Disease in Mice", "firstAuthor": "Yang", "multipleAuthors": true, "journal": "Int J Mol Sci", "year": 2026, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with chemically induced colitis (DSS-induced), not human patients", "intervention": "protein powder from Zophobas morio and Tenebrio molitor larvae (edible insect protein)", "comparator": "mice with colitis given no insect protein powder (DSS group)", "primaryOutcome": "disease severity measures including bleeding, diarrhea, weight loss, colon damage and inflammation", "result": "insect protein powders reduced disease severity, bleeding, diarrhea, and inflammation, and improved gut bacteria balance compared to untreated colitis mice", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is an animal study in mice with a chemically induced disease model, so it may not apply to humans with ordinary rectal bleeding.", "directness": "indirect", "limitations": "Animal model of induced colitis, not a study of humans or of the common causes of bright red rectal bleeding like hemorrhoids or fissures.", "followUp": "", "plainFinding": "May reduce bowel inflammation and bleeding, in mice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41683826/", "sourceText": "Inflammatory Bowel Disease (IBD) is a chronic, recurrent intestinal inflammatory disorder with an unclear etiology. Current pharmaceutical therapies for IBD still have several side effects, necessitating safer and more effective strategies. Edible insects are novel nutritional and bioactive resources with potential anti-inflammatory properties, but the effects of Zophobas morio larvae (ZML) and Tenebrio molitor larvae (TML) on IBD remain insufficiently explored. A 3% dextran sodium sulfate (DSS)-induced mouse colitis model was established to evaluate ZML protein powder (ZMLpp) and TML protein powder (TMLpp). Disease Activity Index (DAI), colon length, spleen weight, histopathology, inflammatory cell infiltration (LCA/MPO staining), inflammatory cytokines (Ccl2, Cxcl1, Ptgs2, Nf-κb), and intestinal microbiota (16S rRNA sequencing) were determined. The result showed that compared with the DSS group, both ZMLpp and TMLpp significantly reduced DAI, mitigated weight loss and hematochezia/diarrhea, restored colon length, attenuated mucosal damage, and preserved goblet cells and crypts, inflammatory cell infiltration, downregulated cytokine expression, improved fecal microbiota dysbiosis, such as increased abundance of beneficial bacteria like Akkermansia. These findings demonstrate that both ZMLpp and TMLpp alleviate DSS-induced colitis by inhibiting inflammation and modulating the microbiota, supporting their application in IBD therapy and the development of anti-colitis functional foods or pharmaceuticals.", "provenance": [ { "field": "population", "quote": "A 3% dextran sodium sulfate (DSS)-induced mouse colitis model was established" }, { "field": "intervention", "quote": "ZML protein powder (ZMLpp) and TML protein powder (TMLpp)" }, { "field": "comparator", "quote": "compared with the DSS group" }, { "field": "primaryOutcome", "quote": "Disease Activity Index (DAI), colon length, spleen weight, histopathology, inflammatory cell infiltration (LCA/MPO staining), inflammatory cytokines (Ccl2, Cxcl1, Ptgs2, Nf-κb), and intestinal microbiota (16S rRNA sequencing) were determined" }, { "field": "result", "quote": "both ZMLpp and TMLpp significantly reduced DAI, mitigated weight loss and hematochezia/diarrhea, restored colon length, attenuated mucosal damage, and preserved goblet cells and crypts, inflammatory cell infiltration, downregulated cytokine expression, improved fecal microbiota dysbiosis" } ] }, { "id": "pmid:41662285", "pmid": "41662285", "doi": "10.1371/journal.pntd.0013972", "nctId": null, "pmcid": "PMC12885289", "title": "Bleeding rectal polyp as an atypical presentation of intestinal schistosomiasis: A case report from Egypt", "firstAuthor": "Elhoseeny", "multipleAuthors": true, "journal": "PLoS Negl Trop Dis", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "28-year-old man from rural Egypt with rectal bleeding and abdominal pain for 3 months", "intervention": "removal of the rectal polyp followed by praziquantel treatment for schistosomiasis", "comparator": "none", "primaryOutcome": "finding the cause of rectal bleeding and recovery after treatment", "result": "a solitary bleeding rectal polyp was found to be caused by intestinal schistosomiasis (a parasite infection), confirmed on tissue exam, and the patient fully recovered after removal of the polyp and praziquantel therapy", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this cause is or how well treatment generally works", "directness": "indirect", "limitations": "only one patient; stool tests for the parasite were repeatedly negative despite the infection being present, so this cause may be easily missed or may not apply to most people with this symptom", "followUp": "not reported beyond stating full clinical recovery after therapy", "plainFinding": "Rare parasite infection caused bleeding polyp.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41662285/", "sourceText": "BACKGROUND: Schistosomiasis remains an important public health challenge in Egypt despite decades of control programs. Intestinal involvement is relatively common but usually presents with diffuse mucosal disease, ulcerations, or multiple polyps. A solitary bleeding rectal polyp as the sole manifestation is exceedingly rare and can be mistaken for inflammatory bowel disease or colorectal neoplasia. This report aims to highlight this diagnostic challenge within the Egyptian context. CASE PRESENTATION: A 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding. Physical examination was unremarkable except for mild lower abdominal tenderness and blood on digital rectal exam. Laboratory tests, including inflammatory markers, were normal; notably, stool microscopy was repeatedly negative for schistosome ova, despite the presence of RBCs and WBCs. Colonoscopy identified a solitary, pedunculated, and ulcerated rectal polyp (1.5 × 3.0 cm) at 20 cm from the anal verge, which was completely resected. Histopathological examination confirmed the diagnosis by demonstrating viable Schistosoma mansoni ova within eosinophilic granulomas and, critically, an adult worm residing in the submucosal vasculature, confirming active infection.The patient achieved full clinical recovery after praziquantel therapy, and this case underscores the importance of integrating parasitological, endoscopic, and histopathological perspectives when managing atypical colorectal lesions in endemic regions. CONCLUSION: This case is a striking example of intestinal schistosomiasis masquerading as a sporadic colorectal neoplasm. In endemic regions like Egypt, schistosomiasis must be considered in the differential diagnosis of solitary rectal polyps, even with negative stool examinations. The definitive diagnosis hinges on histopathological analysis, which is indispensable for guiding correct management and avoiding unnecessary interventions. This report reinforces the ongoing, evolving challenge of schistosomiasis in Egypt post-control programs.", "provenance": [ { "field": "n", "quote": "A 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding." }, { "field": "population", "quote": "A 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding." }, { "field": "intervention", "quote": "which was completely resected" }, { "field": "intervention", "quote": "The patient achieved full clinical recovery after praziquantel therapy" }, { "field": "comparator", "quote": "CASE PRESENTATION" }, { "field": "primaryOutcome", "quote": "Histopathological examination confirmed the diagnosis by demonstrating viable Schistosoma mansoni ova within eosinophilic granulomas and, critically, an adult worm residing in the submucosal vasculature, confirming active infection." }, { "field": "result", "quote": "Colonoscopy identified a solitary, pedunculated, and ulcerated rectal polyp (1.5 × 3.0 cm) at 20 cm from the anal verge, which was completely resected. Histopathological examination confirmed the diagnosis by demonstrating viable Schistosoma mansoni ova within eosinophilic granulomas and, critically, an adult worm residing in the submucosal vasculature, confirming active infection.The patient achieved full clinical recovery after praziquantel therapy" } ] }, { "id": "pmid:41658837", "pmid": "41658837", "doi": "10.7759/cureus.100827", "nctId": null, "pmcid": "PMC12874190", "title": "Human Intestinal Spirochetosis as a Cause of Chronic Diarrhea in an Immunocompetent Patient: A Case Report", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "an immunocompetent patient without risk factors with chronic watery diarrhea and weight loss", "intervention": "a 10-day course of metronidazole", "comparator": "none reported", "primaryOutcome": "resolution of chronic diarrhea", "result": "complete remission of diarrhea after metronidazole treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show whether this applies to other people or to bleeding specifically.", "directness": "indirect", "limitations": "Single case report; the abstract's patient had chronic diarrhea and weight loss, not rectal bleeding as the main problem, and rectal bleeding was only mentioned as a rare possible symptom of the underlying condition in general.", "followUp": "", "plainFinding": "Rare gut infection, diarrhea cured with antibiotics", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41658837/", "sourceText": "Human intestinal spirochetosis (HIS), commonly due to Brachyspira aalborgi or Brachyspira pilosicoli infection, represents the adhesion and colonization of spirochetes to the apical membrane of colonic and rectal epithelial cells. The clinical spectrum can range from asymptomatic to chronic watery diarrhea, abdominal pain, and, in rare cases, rectal bleeding. However, symptomatic cases are usually found in immunocompromised patients. It has been reported to have a high prevalence of human immunodeficiency virus (HIV) infection among homosexual men, cancer patients, and immunotherapy patients. It is also associated with irritable bowel syndrome, eosinophilic enterocolitis, possible colonic polyps, notable sessile serrated adenoma/polyp, and colon cancer. In this case report, an immunocompetent patient without risk factors presented with chronic watery diarrhea and unintentional weight loss of 3.18 kilograms after two months (body weight baseline was 74.5 kilograms, 4% of weight loss in two months). HIS was confirmed by biopsy through colonoscopy. The patient was treated with a 10-day course of metronidazole (500 mg, three times a day) with complete remission of diarrhea. Therefore, our study supports the necessity of considering HIS as part of the differential diagnosis for immunocompetent patients with chronic diarrhea and weight loss, despite risk factors.", "provenance": [ { "field": "population", "quote": "an immunocompetent patient without risk factors presented with chronic watery diarrhea and unintentional weight loss of 3.18 kilograms after two months" }, { "field": "intervention", "quote": "The patient was treated with a 10-day course of metronidazole (500 mg, three times a day)" }, { "field": "comparator", "quote": "The patient was treated with a 10-day course of metronidazole (500 mg, three times a day) with complete remission of diarrhea." }, { "field": "primaryOutcome", "quote": "with complete remission of diarrhea" }, { "field": "result", "quote": "with complete remission of diarrhea" }, { "field": "n", "quote": "an immunocompetent patient without risk factors presented with chronic watery diarrhea" } ] }, { "id": "pmid:41656847", "pmid": "41656847", "doi": "10.11817/j.issn.1672-7347.2025.240653", "nctId": null, "pmcid": "PMC12949933", "title": "[Rare massive upper gastrointestinal bleeding: Three cases of Dieulafoy's disease within diverticula of the descending duodenal and a literature review]", "firstAuthor": "Zhao", "multipleAuthors": true, "journal": "Zhong Nan Da Xue Xue Bao Yi Xue Ban", "year": 2025, "design": "case-series", "n": 3, "nField": "reported", "population": "3 patients with massive upper gastrointestinal bleeding from Dieulafoy's lesions within duodenal diverticula", "intervention": "endoscopic hemoclip placement after diagnosis by emergency gastroscopy/duodenoscopy", "comparator": "medical therapy alone (which was unsatisfactory)", "primaryOutcome": "successful stopping of bleeding", "result": "Hemostasis was achieved in all 3 cases using endoscopic clips after medical treatment failed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny report of just 3 cases, so it cannot show what causes bleeding in most people or how common this is.", "directness": "indirect", "limitations": "Only 3 cases from two hospitals, a rare and severe condition with massive bleeding and hematemesis, not matching typical bright red blood seen only on wiping.", "followUp": "", "plainFinding": "Rare bleeding lesion stopped with clips.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41656847/", "sourceText": "Dieulafoy's disease is a rare condition that can cause acute, life-threatening massive gastrointestinal bleeding and is prone to misdiagnosis and missed diagnosis. From May 2023 to April 2024, 3 patients with Dieulafoy's disease within diverticula of the descending duodenum complicated by upper gastrointestinal bleeding were admitted to the Affiliated Hospital of Zunyi Medical University and Dafang County People's Hospital. Their clinical data and diagnostic and therapeutic processes are reported to enhance awareness of this disease. All patients presented with massive gastrointestinal bleeding, manifested as recurrent hematemesis and hematochezia with large-volume bleeding, and were diagnosed by emergency gastroscopy as having Dieulafoy's disease within diverticula of the descending duodenum. After medical therapy, the outcomes were unsatisfactory in all 3 cases. Endoscopic examination revealed active bleeding located in the descending duodenum; using a side-viewing duodenoscope, the lesions were observed to be within the diverticula of the descending duodenum. Hemostasis was successfully achieved in all cases by endoscopic hemoclip placement. Dieulafoy's disease within diverticula of the descending duodenum complicated by gastrointestinal bleeding is relatively rare in clinical practice. For gastrointestinal bleeding of unclear etiology, endoscopic examination should maintain a high index of suspicion for the descending duodenum, and duodenoscopy should be used when necessary. Particular attention should be paid to rare bleeding causes occurring within diverticula to avoid missed or incorrect diagnoses that could delay treatment.", "provenance": [ { "field": "n", "quote": "3 patients with Dieulafoy's disease within diverticula of the descending duodenum complicated by upper gastrointestinal bleeding were admitted" }, { "field": "population", "quote": "3 patients with Dieulafoy's disease within diverticula of the descending duodenum complicated by upper gastrointestinal bleeding" }, { "field": "intervention", "quote": "Hemostasis was successfully achieved in all cases by endoscopic hemoclip placement." }, { "field": "comparator", "quote": "After medical therapy, the outcomes were unsatisfactory in all 3 cases." }, { "field": "primaryOutcome", "quote": "Hemostasis was successfully achieved in all cases by endoscopic hemoclip placement." }, { "field": "result", "quote": "Hemostasis was successfully achieved in all cases by endoscopic hemoclip placement." } ] }, { "id": "pmid:41640869", "pmid": "41640869", "doi": "10.3748/wjg.v32.i4.114842", "nctId": null, "pmcid": "PMC12865388", "title": "Colonic diverticular hemorrhage: Etiology, diagnostic challenges, and evolving therapeutic strategies", "firstAuthor": "Hui", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "older adults with colon diverticulosis and lower gastrointestinal bleeding", "intervention": "endoscopic treatments (band ligation, clipping) and transcatheter arterial embolization for diverticular bleeding", "comparator": "different treatment approaches compared with each other (band ligation vs clipping, endoscopy vs embolization vs surgery)", "primaryOutcome": "rebleeding and successful control of diverticular bleeding", "result": "Band ligation worked better than clipping at preventing rebleeding, and artery embolization was an effective backup when endoscopy failed", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is an editorial summarizing other research rather than presenting new patient data, so it cannot be weighed like a primary study.", "directness": "indirect", "limitations": "No original patient data, sample size, or study methodology reported; it is an editorial synthesis of existing evidence.", "followUp": "", "plainFinding": "Band ligation beats clipping for diverticular bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41640869/", "sourceText": "Colonic diverticular hemorrhage is a major cause of acute lower gastrointestinal bleeding, particularly in aging populations with increasing prevalence of diverticulosis. Its pathogenesis is multifactorial, involving vascular fragility of the vasa recta, mechanical stress, and patient-related factors such as comorbidities and use of antithrombotic agents. Diagnosis remains challenging due to the intermittent nature of bleeding, with colonoscopy serving as the primary tool and computed tomography angiography providing complementary value for source localization. Endoscopic therapy, especially band ligation, has demonstrated superiority over clipping in reducing rebleeding, while transcatheter arterial embolization has emerged as an effective salvage approach when endoscopic treatment fails. Surgical intervention is reserved for refractory or complicated cases. Recent advances include risk stratification models to guide management and early feeding strategies to accelerate recovery. Despite these improvements, challenges remain in recurrence prevention and individualized treatment selection. This editorial synthesizes current evidence on the etiology, diagnostic modalities, and evolving therapeutic strategies of colonic diverticular hemorrhage, aiming to support clinical decision-making and optimize patient outcomes.", "provenance": [ { "field": "population", "quote": "Colonic diverticular hemorrhage is a major cause of acute lower gastrointestinal bleeding, particularly in aging populations with increasing prevalence of diverticulosis" }, { "field": "intervention", "quote": "Endoscopic therapy, especially band ligation, has demonstrated superiority over clipping in reducing rebleeding, while transcatheter arterial embolization has emerged as an effective salvage approach when endoscopic treatment fails" }, { "field": "comparator", "quote": "band ligation, has demonstrated superiority over clipping in reducing rebleeding" }, { "field": "primaryOutcome", "quote": "reducing rebleeding" }, { "field": "result", "quote": "Endoscopic therapy, especially band ligation, has demonstrated superiority over clipping in reducing rebleeding, while transcatheter arterial embolization has emerged as an effective salvage approach when endoscopic treatment fails" } ] }, { "id": "pmid:41626838", "pmid": "41626838", "doi": "10.14309/ajg.0000000000003940", "nctId": null, "pmcid": null, "title": "Infliximab and Upadacitinib Demonstrate Superior Early Onset of Efficacy in Biologic-Naïve Ulcerative Colitis With Severe Endoscopic Disease", "firstAuthor": "Wong", "multipleAuthors": true, "journal": "Am J Gastroenterol", "year": 2026, "design": "meta-analysis", "n": 1781, "nField": "reported", "population": "biologic-naïve patients with severe ulcerative colitis (endoscopic score 3)", "intervention": "advanced UC drugs (infliximab, adalimumab, golimumab, vedolizumab, ustekinumab, mirikizumab, tofacitinib, upadacitinib)", "comparator": "placebo", "primaryOutcome": "early reduction in stool frequency and rectal bleeding at 2 weeks", "result": "infliximab and upadacitinib had the highest rates of early symptom improvement compared with placebo", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "This pools real trial data from thousands of patients, but it's an after-the-fact comparison across different trials rather than a head-to-head test.", "directness": "indirect", "limitations": "Post hoc analysis combining separate trials with adjustment for baseline differences, not a direct head-to-head trial design.", "followUp": "2 weeks", "plainFinding": "Two UC drugs sped up relief of bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41626838/", "sourceText": "INTRODUCTION: Rapid symptom control is critical in managing ulcerative colitis (UC), especially in patients with severe disease. Although multiple advanced therapies are approved for moderate to severe UC, data comparing their speed of onset are limited. We compared the onset and induction efficacy of advanced therapies for UC among biologic-naïve patients with severe endoscopic disease (Mayo endoscopic score [MES] of 3) and explored differential responses in patients with moderate (MES 2) vs severe endoscopic disease. METHODS: This was a post hoc analysis using individual participant-level data from 11 randomized controlled trials. Biologic-naïve patients with MES 3 disease receiving standard induction regimens of infliximab, adalimumab, golimumab, vedolizumab, ustekinumab, mirikizumab, tofacitinib, or upadacitinib were included. The primary outcome was early PRO-2 response, defined as ≥50% reduction in stool frequency and rectal bleeding scores at 2 weeks postbaseline. Secondary outcomes included postinduction clinical remission and PRO-2 remission. Logistic regression models adjusted for baseline covariates were used. RESULTS: A total of 1,781 biologic-naïve patients with MES 3 disease were included. Infliximab (35.1%) and upadacitinib (32.4%) demonstrated the highest early PRO-2 response rates. Compared with placebo, the highest odds of response were observed with upadacitinib (adjusted odds ratio: 6.38 [95% CI: 2.11-19.23], P = 0.001) and infliximab (adjusted odds ratio 4.49 [95% CI: 2.05-9.85], P < 0.001). At postinduction, infliximab (72.2%) and upadacitinib (59.5%) again demonstrated superior PRO-2 response rates. In comparison to MES 2 patients, those with MES 3 had reduced odds of early and postinduction response for several therapies, particularly ustekinumab, tofacitinib, vedolizumab, and mirikizumab. DISCUSSION: Among biologic-naïve UC patients with severe endoscopic disease, infliximab and upadacitinib had the highest rates of week 2 and postinduction PRO-2 response. Baseline disease activity may help to better inform treatment choices.", "provenance": [ { "field": "population", "quote": "Biologic-naïve patients with MES 3 disease" }, { "field": "n", "quote": "A total of 1,781 biologic-naïve patients with MES 3 disease were included." }, { "field": "intervention", "quote": "receiving standard induction regimens of infliximab, adalimumab, golimumab, vedolizumab, ustekinumab, mirikizumab, tofacitinib, or upadacitinib" }, { "field": "comparator", "quote": "Compared with placebo, the highest odds of response were observed with upadacitinib" }, { "field": "primaryOutcome", "quote": "The primary outcome was early PRO-2 response, defined as ≥50% reduction in stool frequency and rectal bleeding scores at 2 weeks postbaseline." }, { "field": "result", "quote": "Infliximab (35.1%) and upadacitinib (32.4%) demonstrated the highest early PRO-2 response rates." }, { "field": "followUp", "quote": "at 2 weeks postbaseline" } ] }, { "id": "pmid:41608549", "pmid": "41608549", "doi": "10.1093/jscr/rjag016", "nctId": null, "pmcid": "PMC12841601", "title": "Perforated solitary mid-rectal diverticulum diagnosed with colonoscopy: a case report and literature review", "firstAuthor": "Nikolovski", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a woman with rectal bleeding and anemia", "intervention": "surgery combined with antibiotics and supportive care for a perforated rectal diverticulum", "comparator": "", "primaryOutcome": "diagnosis and outcome of rectal bleeding caused by a perforated rectal diverticulum", "result": "the bleeding was caused by a rare perforated rectal diverticulum that led to pelvic infection, treated successfully with surgery and antibiotics", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show how common this cause is or whether treatments generally work.", "directness": "indirect", "limitations": "single case report; findings cannot be generalized to typical causes of bright red rectal bleeding", "followUp": "", "plainFinding": "Rare diverticulum caused bleeding and infection.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41608549/", "sourceText": "Rectal diverticulum is an exceedingly rare clinical entity, typically occurring as a solitary lesion or, less frequently, as up to three diverticula. Its development is often associated with underlying conditions such as obstructive defecation syndrome, rectal malignancy, pelvic floor weakness, chronic rectal impaction, obesity, or infection-related muscular atrophy. Although uncommon, rectal diverticulitis represents a surgical emergency requiring timely recognition and management. In this case, a female patient presented with rectal bleeding and secondary anemia. During the clinical course, the patient developed pelvic sepsis secondary to rectal diverticulitis. Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome. Rectal diverticulitis is a rare but potentially life-threatening condition. Awareness of this entity and early diagnosis are essential to prevent severe complications such as perforation and pelvic sepsis. This case highlights the importance of considering rectal diverticulum in the differential diagnosis of lower gastrointestinal bleeding and pelvic infections.", "provenance": [ { "field": "population", "quote": "a female patient presented with rectal bleeding and secondary anemia" }, { "field": "n", "quote": "a female patient presented with rectal bleeding and secondary anemia" }, { "field": "primaryOutcome", "quote": "This case highlights the importance of considering rectal diverticulum in the differential diagnosis of lower gastrointestinal bleeding and pelvic infections." }, { "field": "result", "quote": "the patient developed pelvic sepsis secondary to rectal diverticulitis. Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome." }, { "field": "intervention", "quote": "Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome." } ] }, { "id": "pmid:41601400", "pmid": "41601400", "doi": "10.1111/apt.70537", "nctId": null, "pmcid": "PMC13089666", "title": "Real-World Performance of FIT Triage for Symptomatic Colonoscopy: Analysis of the UK National Endoscopy Database (NED)", "firstAuthor": "Beaton", "multipleAuthors": true, "journal": "Aliment Pharmacol Ther", "year": 2026, "design": "registry", "n": 447109, "nField": "reported", "population": "adults referred for colonoscopy because of bowel symptoms, including rectal bleeding and iron-deficiency anaemia", "intervention": "using a stool blood test (FIT) to decide who needs a colonoscopy", "comparator": "deciding on colonoscopy based on symptoms alone (such as rectal bleeding)", "primaryOutcome": "how often colonoscopy found cancer or polyps", "result": "a higher FIT stool-blood-test result was strongly linked to finding cancer, while people with iron-deficiency anaemia had higher cancer risk than those with just rectal bleeding; a low FIT result meant very low cancer risk even with bleeding symptoms", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it is a very large real-world national database giving reliable patterns, but it looks at colonoscopy triage strategy rather than directly explaining the cause of a patient's bleeding", "directness": "indirect", "limitations": "observational registry data, FIT only recorded in 45% of cases, and it studies triage strategy rather than the specific causes of bright red rectal bleeding", "followUp": "", "plainFinding": "Low stool-test result means low cancer risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41601400/", "sourceText": "BACKGROUND: The UK has adopted faecal immunochemical testing (FIT) to triage symptomatic colonoscopy referrals. OBJECTIVE: Quantify diagnostic yield and independent effects of FIT, age, sex and symptoms on polyp and cancer detection in symptomatic colonoscopy. DESIGN: Nationwide analysis of prospectively collected colonoscopy reports (June 2023-August 2025) from the National Endoscopy Database. Symptomatic procedures, including iron-deficiency anaemia (IDA), were identified and diagnostic yields calculated. Mixed-effects logistic regression estimated adjusted odds ratios (aORs) with age, sex, symptom group and FIT. Post-estimation margins modelled cancer yield by age, FIT and symptoms. RESULTS: Analysis of 447,109 symptomatic colonoscopies, with FIT recorded in 202,219 (45.2%). Overall cancer yield was 1.9% (95% CI, 1.8-1.9). Cancer yield was 3.8% (95% CI, 3.7-3.9) in FIT ≥ 10, including 2.5% (95% CI, 2.3-2.7) at age 40-49 and 0.6% (95% CI, 0.5-0.7) at age 16-39; yield in FIT < 10 was 0.3% (95% CI, 0.2-0.3). FIT concentration showed a strong, graded association with cancer risk, weaker association with large polyps, and minimal association with small polyps. IDA was associated with higher cancer risk versus rectal bleeding (aOR 2.2, 95% CI, 2.0-2.3; p < 0.01). With FIT < 10, cancer yield exceeded 1% only in IDA patients aged > 80 and remained < 0.5% otherwise. A model combining FIT, age, and IDA detected > 94% of cancers while reducing colonoscopy demand by > 40%. CONCLUSION: This national analysis demonstrates the superiority of FIT-based triage over symptom-based referral, with FIT ≥ 10 identifying high-risk patients, including those aged 40-49, while FIT < 10 indicated very low risk.", "provenance": [ { "field": "population", "quote": "Symptomatic procedures, including iron-deficiency anaemia (IDA), were identified and diagnostic yields calculated." }, { "field": "intervention", "quote": "The UK has adopted faecal immunochemical testing (FIT) to triage symptomatic colonoscopy referrals." }, { "field": "comparator", "quote": "demonstrates the superiority of FIT-based triage over symptom-based referral" }, { "field": "primaryOutcome", "quote": "Quantify diagnostic yield and independent effects of FIT, age, sex and symptoms on polyp and cancer detection in symptomatic colonoscopy." }, { "field": "result", "quote": "FIT concentration showed a strong, graded association with cancer risk, weaker association with large polyps, and minimal association with small polyps. IDA was associated with higher cancer risk versus rectal bleeding (aOR 2.2, 95% CI, 2.0-2.3; p < 0.01)." }, { "field": "n", "quote": "Analysis of 447,109 symptomatic colonoscopies, with FIT recorded in 202,219 (45.2%)." } ] }, { "id": "pmid:41568119", "pmid": "41568119", "doi": "10.2185/jrm.2025-044", "nctId": null, "pmcid": "PMC12816956", "title": "Uncommon cause of hematochezia in older adults: a solitary juvenile polyp in the transverse colon", "firstAuthor": "Takahashi", "multipleAuthors": true, "journal": "J Rural Med", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 78-year-old woman with rectal bleeding", "intervention": "endoscopic removal of a colon polyp", "comparator": "none", "primaryOutcome": "stopping the bleeding and identifying its cause", "result": "a rare benign juvenile polyp was found and removed, bleeding stopped with no recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show what causes bleeding in general or how well treatment works overall", "directness": "indirect", "limitations": "only one patient; a case report cannot establish how common this cause is or predict outcomes for other people", "followUp": "not specified beyond 'no recurrence of bleeding'", "plainFinding": "Rare polyp caused the bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41568119/", "sourceText": "OBJECTIVE: To report a rare case of a solitary juvenile polyp in the transverse colon causing hematochezia in an older patient. PATIENTS AND METHODS: A 78-year-old woman presented with hematochezia. She denied experiencing abdominal pain and had no history of colonoscopy. Colonoscopy performed at a local hospital revealed a 12 mm pedunculated lesion in the transverse colon covered with fresh blood. The patient was then referred for further evaluation. After confirming the cessation of bleeding, the lesion was removed via endoscopic mucosal resection. Histopathological analysis was performed on the resected specimen. RESULTS: The lesion was successfully resected without complications. Histological examination revealed the typical features of juvenile polyps, including stromal expansion, edema, inflammatory cell infiltration, and crypt dilation without cytological atypia. The surgical margins were negative. The patient remained asymptomatic after the procedure and experienced no recurrence of bleeding. CONCLUSION: Juvenile polyps are typically found in children but can occasionally occur in older patients. This case underscores the importance of considering juvenile polyps in the differential diagnosis of lower gastrointestinal bleeding, regardless of patient age. Complete endoscopic and histopathological evaluation is essential for accurate diagnosis and appropriate management.", "provenance": [ { "field": "n", "quote": "A 78-year-old woman presented with hematochezia." }, { "field": "population", "quote": "A 78-year-old woman presented with hematochezia." }, { "field": "intervention", "quote": "the lesion was removed via endoscopic mucosal resection" }, { "field": "comparator", "quote": "A 78-year-old woman presented with hematochezia." }, { "field": "primaryOutcome", "quote": "After confirming the cessation of bleeding, the lesion was removed via endoscopic mucosal resection." }, { "field": "result", "quote": "The patient remained asymptomatic after the procedure and experienced no recurrence of bleeding." } ] }, { "id": "pmid:41555436", "pmid": "41555436", "doi": "10.1186/s12957-025-04181-7", "nctId": null, "pmcid": "PMC12903493", "title": "Rectal melanoma: managing a rare cause of rectal bleeding: case report and review of the literature", "firstAuthor": "Kirchweger", "multipleAuthors": true, "journal": "World J Surg Oncol", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "90-year-old woman with rectal bleeding and changes in bowel habits", "intervention": "palliative coil embolization of the tumor-supplying arteries to control bleeding", "comparator": "no surgical treatment (not feasible due to poor health)", "primaryOutcome": "control of rectal bleeding from a rectal tumor", "result": "Embolization stopped the bleeding, but the patient died three months later from the cancer spreading", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report of one very old patient with a rare cancer, so it tells us little about common causes of bleeding.", "directness": "indirect", "limitations": "Single patient case report of an extremely rare cancer (rectal melanoma), not representative of typical causes of rectal bleeding like hemorrhoids.", "followUp": "three months", "plainFinding": "Rare melanoma found; bleeding stopped with embolization.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41555436/", "sourceText": "BACKGROUND: Anorectal melanoma is rare and has a poor prognosis. Symptoms are often non-specific, such as bloody diarrhea, anal pain or bowel habit changes. Diagnosis requires tissue sample with immunohistochemistry because of the difficulty of clinical differentiation from other tumor entities since many lesions are amelanotic. Many patients are diagnosed at an advanced stage, precluding surgical treatment. Owing to the rareness of the disease and the lack of data there are no clear treatment guidelines available. A 90-year-old female sought emergency care due to rectal bleeding and changes in bowel habits. A CT scan revealed a substantial rectal tumor with nearby lymph node involvement and suspected liver and adrenal gland metastases. Endoscopy revealed a semicircular lesion, which was identified as a necrotic amelanotic tumor expressing Melan-A and S-100; immunohistochemically confirming malignant melanoma. Given the patients' overall condition, the tumor board recommended best supportive care. Recurrent severe bleeding necessitated transfusions, but surgical intervention for symptom control was not feasible due to her general health. Thus, palliative endovascular coil embolization of the tumor -supplying arteries was successfully performed for bleeding control. However, the patient died from disease progression three months later without further bleeding. CONCLUSION: The diagnosis of this rare manifestation of melanoma is technically challenging and rectal melanomas are often clinically misinterpreted as conditions such as hemorrhoidal disease. To date, there is no standardized therapy, but surgical intervention should be considered for local control. The role of adjuvant radiotherapy, chemotherapy, or immunotherapy in this disease has not yet been determined. Coil embolization can be a viable palliative treatment alternative for recurrent bleeding in patients unfit for surgery, which, has not been reported specifically for rectal melanoma.", "provenance": [ { "field": "n", "quote": "A 90-year-old female sought emergency care due to rectal bleeding and changes in bowel habits." }, { "field": "population", "quote": "A 90-year-old female sought emergency care due to rectal bleeding and changes in bowel habits." }, { "field": "intervention", "quote": "palliative endovascular coil embolization of the tumor -supplying arteries was successfully performed for bleeding control" }, { "field": "comparator", "quote": "surgical intervention for symptom control was not feasible due to her general health" }, { "field": "primaryOutcome", "quote": "Recurrent severe bleeding necessitated transfusions" }, { "field": "result", "quote": "the patient died from disease progression three months later without further bleeding" } ] }, { "id": "pmid:41546333", "pmid": "41546333", "doi": null, "nctId": null, "pmcid": null, "title": "[Laparoscopic Resection of an Ectopic Endometriosis-Associated Carcinoma Arising in the Rectum-A Case Report]", "firstAuthor": "Uemura", "multipleAuthors": true, "journal": "Gan To Kagaku Ryoho", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a woman in her seventies with blood and mucus in stool", "intervention": "surgery to remove rectal tumor (laparoscopic resection with hysterectomy) plus chemotherapy", "comparator": "none", "primaryOutcome": "cancer recurrence after treatment", "result": "no cancer recurrence after nearly 4 years of follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, which cannot show what causes bleeding in general or how well treatments work.", "directness": "indirect", "limitations": "single case report; findings from one patient cannot be generalized to explain a symptom or predict treatment outcomes broadly.", "followUp": "3 years and 9 months", "plainFinding": "Rare cancer found, no recurrence after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41546333/", "sourceText": "A woman in her seventies presented with mucous hematochezia. Colonoscopy revealed a poorly differentiated adenocarcinoma in the upper rectum. Immunohistochemical staining showed CK7 positivity and CK20/CDX2 negativity, findings atypical for primary colorectal carcinoma. Contrast-enhanced CT and pelvic MRI demonstrated circumferential thickening of the rectal wall with an adjacent multilocular cystic lesion, raising suspicion of an endometriosis-associated intestinal tumor (EAIT). Laparoscopic low anterior resection with D3 lymphadenectomy was performed along with total hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination revealed submucosal adenocarcinoma with CD10-positive endometrial stromal cells surrounding the tumor, consistent with EAIT. The patient received 6 courses of adjuvant chemotherapy with docetaxel and carboplatin. No recurrence has been detected during 3 years and 9 months of postoperative follow-up. This case may provide valuable insight into the diagnosis and multidisciplinary management of this uncommon disease.", "provenance": [ { "field": "population", "quote": "A woman in her seventies presented with mucous hematochezia." }, { "field": "n", "quote": "A woman in her seventies presented with mucous hematochezia." }, { "field": "intervention", "quote": "Laparoscopic low anterior resection with D3 lymphadenectomy was performed along with total hysterectomy and bilateral salpingo-oophorectomy." }, { "field": "comparator", "quote": "The patient received 6 courses of adjuvant chemotherapy with docetaxel and carboplatin." }, { "field": "primaryOutcome", "quote": "No recurrence has been detected during 3 years and 9 months of postoperative follow-up." }, { "field": "result", "quote": "No recurrence has been detected during 3 years and 9 months of postoperative follow-up." }, { "field": "followUp", "quote": "3 years and 9 months of postoperative follow-up" } ] }, { "id": "pmid:41541172", "pmid": "41541172", "doi": "10.1016/j.ijscr.2025.112119", "nctId": null, "pmcid": "PMC12596942", "title": "A rare presentation of adult colonic intussusception secondary to a descending colon lipoma: A case report", "firstAuthor": "Zelelew", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "54-year-old woman with abdominal pain and rectal bleeding", "intervention": "surgical removal of colon segment (left hemicolectomy)", "comparator": "none", "primaryOutcome": "diagnosis and recovery after surgery", "result": "bleeding was caused by a benign colon lipoma causing bowel telescoping (intussusception); surgery removed it with no cancer found and full recovery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.", "directness": "indirect", "limitations": "single case report; not generalizable; specific rare anatomical cause rather than common cause of rectal bleeding", "followUp": "", "plainFinding": "Rare colon lipoma caused bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41541172/", "sourceText": "INTRODUCTION AND IMPORTANCE: Adult colonic intussusception is a rare and often diagnostically challenging condition, typically associated with a pathological lead point. While malignant tumors are more common causes in adults, benign lesions like colonic lipomas can also be responsible, albeit infrequently. CASE PRESENTATION: We report a case of a 54-year-old woman presenting with intermittent left lower abdominal pain and recent rectal bleeding. Contrast-enhanced abdominal CT demonstrated an incomplete descending colon intussusception with a fat-density mass as the lead point. She underwent a left hemicolectomy. Histopathology revealed a 4.2 × 4.3 cm pedunculated submucosal lipoma with no malignancy. Her postoperative course was uneventful, and she made a full recovery. CLINICAL DISCUSSION: Adult intussusception often requires surgical intervention due to the high likelihood of underlying malignancy. Preoperative imaging, particularly CT, plays a crucial role in diagnosis and identifying the nature of the lead point. In this case, a benign lipoma caused the intussusception, but surgical resection was still warranted to exclude malignancy and relieve symptoms. CONCLUSION: Though rare, colonic lipomas should be considered in adult intussusception cases. Cross-sectional imaging is essential for diagnosis, and surgical resection remains the mainstay of treatment. Early recognition and intervention can lead to excellent outcomes, as demonstrated in this case.", "provenance": [ { "field": "population", "quote": "a 54-year-old woman presenting with intermittent left lower abdominal pain and recent rectal bleeding" }, { "field": "intervention", "quote": "She underwent a left hemicolectomy." }, { "field": "comparator", "quote": "Surgical resection remains the mainstay of treatment." }, { "field": "primaryOutcome", "quote": "Her postoperative course was uneventful, and she made a full recovery." }, { "field": "result", "quote": "Histopathology revealed a 4.2 × 4.3 cm pedunculated submucosal lipoma with no malignancy." }, { "field": "n", "quote": "a 54-year-old woman" } ] }, { "id": "pmid:41493736", "pmid": "41493736", "doi": "10.1007/s10815-025-03775-0", "nctId": null, "pmcid": "PMC12982809", "title": "Urgent fertility preservation following second trimester termination in a patient with pregnancy-associated colorectal cancer: a case report and literature review", "firstAuthor": "Kim", "multipleAuthors": true, "journal": "J Assist Reprod Genet", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 32-year-old pregnant patient diagnosed with advanced colorectal cancer after hematochezia", "intervention": "urgent fertility preservation using ovarian stimulation and embryo freezing after pregnancy termination", "comparator": "no comparator", "primaryOutcome": "feasibility of fertility preservation (oocyte retrieval, fertilization, and euploid embryo creation) before starting chemotherapy", "result": "19 eggs retrieved, 11 fertilized, all reached blastocyst stage, and 5 were genetically normal", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show what causes bleeding or how common it is.", "directness": "indirect", "limitations": "Single case report; no control group; not designed to study causes of rectal bleeding.", "followUp": "", "plainFinding": "Not relevant to rectal bleeding cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41493736/", "sourceText": "We report a case of fertility preservation using random-start controlled ovarian stimulation and embryo cryopreservation in a patient with a recent second trimester termination. A 32-year-old patient at 17 weeks of gestation was diagnosed with advanced colorectal cancer after presenting with hematochezia and acute blood loss anemia. To initiate urgent chemotherapy, the patient underwent an elective termination at 18-week gestation. Random-start controlled ovarian stimulation (COS) was initiated seven days later using a gonadotropin-releasing hormone antagonist protocol. Despite a β-human chorionic gonadotropin level of 52.4 mIU/mL, ovarian stimulation was started. Nineteen oocytes were retrieved after 10 days of ovarian stimulation, of which 15 were mature. Eleven mature oocytes fertilized successfully using intracytoplasmic sperm injection. All 11 embryos developed into the blastocyst stage and underwent biopsy for preimplantation genetic testing for aneuploidy screening. Five blastocysts were found to be euploid. The patient subsequently initiated chemotherapy seven days after her oocyte retrieval. This case highlights the feasibility of random-start COS and embryo cryopreservation for fertility preservation immediately after a second trimester termination in a patient with newly diagnosed colorectal cancer.", "provenance": [ { "field": "n", "quote": "A 32-year-old patient at 17 weeks of gestation was diagnosed with advanced colorectal cancer" }, { "field": "population", "quote": "A 32-year-old patient at 17 weeks of gestation was diagnosed with advanced colorectal cancer after presenting with hematochezia and acute blood loss anemia." }, { "field": "intervention", "quote": "Random-start controlled ovarian stimulation (COS) was initiated seven days later using a gonadotropin-releasing hormone antagonist protocol." }, { "field": "comparator", "quote": "We report a case of fertility preservation using random-start controlled ovarian stimulation and embryo cryopreservation in a patient with a recent second trimester termination." }, { "field": "primaryOutcome", "quote": "This case highlights the feasibility of random-start COS and embryo cryopreservation for fertility preservation immediately after a second trimester termination in a patient with newly diagnosed colorectal cancer." }, { "field": "result", "quote": "Nineteen oocytes were retrieved after 10 days of ovarian stimulation, of which 15 were mature. Eleven mature oocytes fertilized successfully using intracytoplasmic sperm injection. All 11 embryos developed into the blastocyst stage and underwent biopsy for preimplantation genetic testing for aneuploidy screening. Five blastocysts were found to be euploid." } ] }, { "id": "pmid:41476793", "pmid": "41476793", "doi": "10.3389/fphar.2025.1721116", "nctId": null, "pmcid": "PMC12748159", "title": "Total alkaloids of Corydalis saxicola Bunting ameliorate ulcerative colitis through regulation of metabolite networks and gut microbiota", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "Front Pharmacol", "year": 2025, "design": "animal", "n": null, "nField": "not-reported", "population": "mice with chemically-induced colitis (not human patients)", "intervention": "total alkaloids from Corydalis saxicola herb (YTA)", "comparator": "untreated colitis mice", "primaryOutcome": "colitis severity including weight loss, diarrhea, and bloody stool, plus gut bacteria and metabolite changes", "result": "the herbal extract reduced weight loss, diarrhea, and bloody stool, reduced inflammation, and restored gut bacteria balance in mice with induced colitis", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is an animal study using mice with chemically induced colitis, not a human study of rectal bleeding causes or treatments", "directness": "indirect", "limitations": "study was done in mice with drug-induced colitis, not humans, and does not address the original question of why a person bleeds when wiping", "followUp": "7 days", "plainFinding": "Herb extract reduced bleeding in colitis mice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41476793/", "sourceText": "BACKGROUND: Yanhuanglian (YHL), derived from the dried herb of Corydalis saxicola Bunting, can inhibit diarrhea and alleviate bleeding in traditional Chinese medicine. YHL is used to treat dysentery and hematochezia, which are recognized as ulcerative colitis (UC) in traditional Chinese medicine. However, the effectiveness and mechanisms of YHL treating UC remain largely unknown. This study aimed to reveal anti-colitis effect and mechanisms of YHL's total alkaloids (YTA) against UC. METHODS: Three graded doses of YTA were introduced to DSS-induced colitis mice for 7 days to evaluate the anti-colitis effect. Colon, serum, and fecal untargeted metabolomics were applicated to analyze the differential metabolites. 16S rRNA sequencing was used to analyze changes in the gut bacteria, while gut microbiota depletion and fecal microbiota transplantation further verified the effects of gut microbiota. Lactobacillus spp. isolated from the mice feces were screened based on the enrichment abundance of YTA in vivo and in vitro, and the therapeutic effect of Lactobacillus johnsonii enriched with YTA was evaluated in colitis mice. RESULTS: YTA alleviated weight loss, diarrhea, and hematochezia in colitis mice, reducing inflammation and oxidative stress while restoring intestinal barrier impairment. Untargeted metabolomics profiling of colon, serum, and feces demonstrated that YTA restored the disrupted metabolite profiles, with linoleic acid consistently identified as a key differential metabolite. Through the pathway enrichment, linoleic acid metabolism pathway was highlighted. YTA also ameliorated imbalance of the gut microbiota by significantly increasing the abundance of Lactobacillus. Gut microbiota depletion and fecal microbiota transplantation confirmed that the benefits of YTA depended on the presence of gut microbiota. Furthermore, Lactobacillus johnsonii enriched by YTA protected colitis mice against UC. CONCLUSION: YTA exhibited potential anti-colitis activity by modulating metabolomic profiles and the gut microbiota, suggesting its potential as a complementary and alternative therapy in phytomedicine.", "provenance": [ { "field": "population", "quote": "DSS-induced colitis mice" }, { "field": "intervention", "quote": "Three graded doses of YTA were introduced to DSS-induced colitis mice for 7 days to evaluate the anti-colitis effect." }, { "field": "comparator", "quote": "DSS-induced colitis mice" }, { "field": "primaryOutcome", "quote": "YTA alleviated weight loss, diarrhea, and hematochezia in colitis mice, reducing inflammation and oxidative stress while restoring intestinal barrier impairment." }, { "field": "result", "quote": "YTA alleviated weight loss, diarrhea, and hematochezia in colitis mice, reducing inflammation and oxidative stress while restoring intestinal barrier impairment." } ] }, { "id": "pmid:41474906", "pmid": "41474906", "doi": null, "nctId": null, "pmcid": null, "title": "Frequency of Synchronous Polyp in Colorectal Carcinoma and Clinicopathological Profile: a Cross Sectional Analytical Study in Dhaka Medical College Hospital", "firstAuthor": "Appolo", "multipleAuthors": true, "journal": "Mymensingh Med J", "year": 2026, "design": "case-series", "n": 60, "nField": "reported", "population": "patients diagnosed with colorectal cancer at a hospital", "intervention": "none - this was an observational study describing symptoms and polyps, not a treatplanned intervention", "comparator": "colorectal cancer patients with synchronous polyps versus those without polyps", "primaryOutcome": "how often colorectal cancer patients also had polyps, and their clinical features", "result": "61.7% of colorectal cancer patients had rectal bleeding as a symptom, and 18.3% also had a synchronous polyp", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, single-hospital descriptive study of cancer patients, not a study designed to find the cause of rectal bleeding in the general population.", "directness": "indirect", "limitations": "Small sample size (60 patients), single hospital, and histopathology of the polyp was not done in over a third of synchronous polyp cases.", "followUp": "", "plainFinding": "Bleeding is a common colon cancer symptom.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41474906/", "sourceText": "The object of the study was to characterize the demographic profile, clinical features and frequency of synchronous polyp in patients with colorectal cancer. This was a hospital based cross sectional analytical study among sixty colorectal cancer patients who met the selection criteria and attended in Gastroenterology, Surgery, Medicine and Radiotherapy departments of Dhaka Medical College Hospital from November 2016 to October 2017. Patient's demographic profile, clinical features, presence of synchronous polyp and histopathology of both tumour and polyp were noted. Site distributions of colorectal cancer and polyp were also noted. Comparison of clinical, demographic and pathological characteristics between synchronous polyp group and non-polyp group of colorectal cancer patients were done. Mean age was 42.40±1.64 years (range 16-75 years) and majority (38.3%) were less than 30 years. Forty-one were males (68.3%) and 19 were females (31.7%). Most frequent clinical presentations were altered bowel habit (81.7%), weight loss (78.3%), tenesmus (76.7%) and per rectal bleeding (61.7%). Significant observations (p<0.05) in left sided tumour was per rectal bleeding and blood mixed stool, where as in right sided tumour it was cramping discomfort in lower abdomen, and anaemia. Most frequent site of colorectal cancer was rectum (56.7%), followed by caecum (11.7%), ascending colon (8.3%) and transverse colon (8.3%). Left sided colorectal cancer was 66.7% and right sided was 33.3%. Histopathology showed 98.3% adenocarcinoma, and only 1.7% squamous cell carcinoma. Out of 60 cases, 11(18.3%) had synchronous polyp. Most common site of the synchronous polyp was rectum (54.5%) followed by sigmoid colon (18.2%) and transverse colon (9.1%). 18.2% patients had synchronous polyp at multiple sites. Histopathology of the synchronous polyp showed two (18.2%) tubular adenoma, another two (18.2%) tubulovillous adenoma, three (27.3%) villous adenoma and in four (36.4%) patients' histopathology of polyp was not done. Analysis of Clinical, demographic and pathological characteristics between synchronous polyp group and non-polyp group of colorectal cancer patients were unremarkable. Symptoms suggestive of colorectal cancer in young adults should not be overlooked. Synchronous polyp should be searched preoperatively in colorectal cancers. If present they should be resected for biopsy to reduce the risk of metachronous colorectal cancer.", "provenance": [ { "field": "population", "quote": "sixty colorectal cancer patients who met the selection criteria and attended in Gastroenterology, Surgery, Medicine and Radiotherapy departments of Dhaka Medical College Hospital" }, { "field": "n", "quote": "sixty colorectal cancer patients" }, { "field": "primaryOutcome", "quote": "to characterize the demographic profile, clinical features and frequency of synchronous polyp in patients with colorectal cancer" }, { "field": "result", "quote": "Most frequent clinical presentations were altered bowel habit (81.7%), weight loss (78.3%), tenesmus (76.7%) and per rectal bleeding (61.7%)" }, { "field": "result", "quote": "Out of 60 cases, 11(18.3%) had synchronous polyp" }, { "field": "comparator", "quote": "Comparison of clinical, demographic and pathological characteristics between synchronous polyp group and non-polyp group of colorectal cancer patients were done" }, { "field": "intervention", "quote": "This was a hospital based cross sectional analytical study" } ] }, { "id": "pmid:41473479", "pmid": "41473479", "doi": "10.1016/j.idcr.2025.e02445", "nctId": null, "pmcid": "PMC12747243", "title": "Fulminant disseminated human parvovirus B19 infection: Case report", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "IDCases", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "A 35-year-old man with multi-organ illness and rectal bleeding", "intervention": "Supportive care and intravenous immunoglobulin for disseminated parvovirus B19 infection", "comparator": "None (single case, no comparison group)", "primaryOutcome": "Recovery of organ function and resolution of rectal bleeding/lesions", "result": "After four weeks of treatment, kidney, liver, and lung function recovered and the rectal lesions resolved", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this treatment works for anyone else or explain most causes of rectal bleeding.", "directness": "indirect", "limitations": "Single case report of a rare, severe infection; findings may not generalize to typical causes of bright red rectal bleeding.", "followUp": "32 days to improvement (illness Day 32 confirmation, improved after four weeks of care)", "plainFinding": "Rare severe viral infection, not typical cause", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41473479/", "sourceText": "BACKGROUND: Fulminant, disseminated Human parvovirus B19 (HPV B19) infection is uncommon and can be fatal if unrecognized. CASE PRESENTATION: A 35-year-old man developed abrupt confusion on the second day of incarceration. He was admitted to intensive care with acute kidney, liver injury, coagulopathy, thrombocytopenia, and persistent hematochezia. The etiology remained unclear until next-generation sequencing detected HPV B19 DNA in blood, cerebrospinal fluid (CSF), bronchoalveolar lavage fluid, and ascitic fluid. On illness Day 32, B19 infection was confirmed by quantitative PCR from blood, CSF, and a rectal biopsy. Despite negative B19-specific IgM, the patient improved after four weeks of supportive care and two courses of intravenous immunoglobulin, with recovery of renal, hepatic, and respiratory function and resolution of rectal lesions. CONCLUSIONS: Disseminated HPV B19 infection should be considered in unexplained multiorgan dysfunction, even in the absence of rash or IgM seroconversion. Early PCR-based testing of blood and affected tissues can be diagnostic.", "provenance": [ { "field": "n", "quote": "A 35-year-old man developed abrupt confusion on the second day of incarceration." }, { "field": "population", "quote": "A 35-year-old man developed abrupt confusion on the second day of incarceration." }, { "field": "intervention", "quote": "the patient improved after four weeks of supportive care and two courses of intravenous immunoglobulin" }, { "field": "comparator", "quote": "CASE PRESENTATION" }, { "field": "primaryOutcome", "quote": "with recovery of renal, hepatic, and respiratory function and resolution of rectal lesions" }, { "field": "result", "quote": "the patient improved after four weeks of supportive care and two courses of intravenous immunoglobulin, with recovery of renal, hepatic, and respiratory function and resolution of rectal lesions" } ] }, { "id": "pmid:41432114", "pmid": "41432114", "doi": "10.1080/09537104.2025.2601056", "nctId": null, "pmcid": null, "title": "Immune thrombocytopenia triggered by dostarlimab in a patient with endometrial carcinoma: first reported case", "firstAuthor": "Fernández-Sánchez", "multipleAuthors": true, "journal": "Platelets", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 55-year-old woman with relapsed endometrial carcinoma treated with the immunotherapy drug dostarlimab", "intervention": "treatment of severe low platelet count (immune thrombocytopenia) with corticosteroids, immunoglobulin, and later romiplostim", "comparator": "", "primaryOutcome": "recovery of platelet count and resolution of bleeding", "result": "the patient had a partial response to steroids and immunoglobulin, with full platelet recovery only after adding romiplostim", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this applies to other people with rectal bleeding.", "directness": "indirect", "limitations": "single case report with no comparison group, describing a rare drug side effect in a cancer patient, not a general explanation for rectal bleeding", "followUp": "", "plainFinding": "Rare drug-caused bleeding disorder, not relevant here.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41432114/", "sourceText": "Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for various malignancies, but they are associated with a range of immunerelated adverse events, including rare hematological complications. Immune thrombocytopenia (ITP) has been reported with other antiPD1 agents such as nivolumab and pembrolizumab, but to date, no cases have been described with dostarlimab. We report the first case of ITP in a patient receiving dostarlimab for relapsed endometrial carcinoma. A 55yearold woman developed severe thrombocytopenia (3 × 109/L) accompanied by rectal bleeding, resulting in a lifethreatening condition. Secondary causes were excluded, and bone marrow findings supported a diagnosis of ITP. Initial treatment with highdose corticosteroids and intravenous immunoglobulin achieved only a partial response, while sustained platelet recovery was obtained with the addition of romiplostim. The patient remained on dostarlimab following hematological recovery without further episodes of ITP. This case highlights a potentially lifethreatening adverse effect of a widely used immunotherapy and underscores the importance of early recognition and timely escalation of treatment in ICIinduced ITP.", "provenance": [ { "field": "population", "quote": "We report the first case of ITP in a patient receiving dostarlimab for relapsed endometrial carcinoma." }, { "field": "n", "quote": "A 55yearold woman developed severe thrombocytopenia (3 × 109/L) accompanied by rectal bleeding, resulting in a lifethreatening condition." }, { "field": "intervention", "quote": "Initial treatment with highdose corticosteroids and intravenous immunoglobulin achieved only a partial response, while sustained platelet recovery was obtained with the addition of romiplostim." }, { "field": "primaryOutcome", "quote": "sustained platelet recovery was obtained with the addition of romiplostim" }, { "field": "result", "quote": "Initial treatment with highdose corticosteroids and intravenous immunoglobulin achieved only a partial response, while sustained platelet recovery was obtained with the addition of romiplostim." } ] }, { "id": "pmid:41429902", "pmid": "41429902", "doi": "10.1038/s41598-025-33056-w", "nctId": null, "pmcid": "PMC12749976", "title": "Pharmacodynamics of direct oral anticoagulants associated with post-endoscopic delayed mucosal resection bleeding of colorectal neoplasms", "firstAuthor": "Murata", "multipleAuthors": true, "journal": "Sci Rep", "year": 2025, "design": "prospective-cohort", "n": null, "nField": "not-reported", "population": "people taking direct oral anticoagulants who had endoscopic removal (EMR) of colon polyps", "intervention": "direct oral anticoagulant (DOAC) use with measured blood drug levels and anti-factor Xa activity", "comparator": "patients with lower anticoagulant drug levels/activity", "primaryOutcome": "bleeding after the colon polyp removal procedure", "result": "high anticoagulant activity was linked to a much higher chance of bleeding after the procedure", "resultDirection": "harm", "quality": "low", "qualityWhy": "it is a small multicenter observational study with a very wide confidence interval around the risk estimate, so the result is uncertain.", "directness": "indirect", "limitations": "wide confidence interval (95% CI: 1.081-137.922), observational design, specific to patients on anticoagulants undergoing a bowel procedure", "followUp": "", "plainFinding": "Higher blood thinner levels raise bleeding risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41429902/", "sourceText": "Anticoagulant effects of direct oral anticoagulants (DOACs) are influenced by their plasma levels and anti-factor Xa (FXa) activity. Delayed bleeding is a major adverse event associated with endoscopic mucosal resection (EMR) of colorectal neoplasms. However, the association between post-EMR bleeding and pharmacodynamics in patients taking DOAC remains unknown. This study investigated the association between pharmacological risk factors and delayed bleeding in patients receiving DOAC. This multicenter prospective trial in Japan evaluated the incidence of post-EMR delayed bleeding in DOAC users between April 2018 and May 2022 and determined the association of post-EMR delayed bleeding with plasma levels and FXa activity. The incidence of post-EMR delayed bleeding was 10.5% (95% confidence interval [CI]: 5.3%-18.0%). There were large individual differences in plasma levels and FXa activity for each DOAC. At the trough and Tmax, plasma DOAC levels and plasma level/dose ratios were significantly correlated with FXa activity. Multivariate analysis showed that high anticoagulant ability was a risk factor for post-EMR delayed bleeding (adjusted OR, 12.211; 95% CI: 1.081-137.922, p = 0.043). DOAC users with high anticoagulant activity may be at higher risk of post-EMR delayed bleeding from colorectal neoplasms.", "provenance": [ { "field": "population", "quote": "patients receiving DOAC" }, { "field": "intervention", "quote": "Anticoagulant effects of direct oral anticoagulants (DOACs) are influenced by their plasma levels and anti-factor Xa (FXa) activity." }, { "field": "comparator", "quote": "high anticoagulant ability was a risk factor for post-EMR delayed bleeding" }, { "field": "primaryOutcome", "quote": "Delayed bleeding is a major adverse event associated with endoscopic mucosal resection (EMR) of colorectal neoplasms." }, { "field": "result", "quote": "Multivariate analysis showed that high anticoagulant ability was a risk factor for post-EMR delayed bleeding (adjusted OR, 12.211; 95% CI: 1.081-137.922, p = 0.043)." } ] }, { "id": "pmid:41404227", "pmid": "41404227", "doi": "10.7759/cureus.96875", "nctId": null, "pmcid": "PMC12703109", "title": "Left Internal Iliac Artery Aneurysm Presenting With Nephrostomy-Site and Rectal Bleeding From an Arterio-Ureteral Fistula in a Patient With Rectovesical Fistula After Colorectal Cancer Therapy: A Report of a Rare Case", "firstAuthor": "Abdullah", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "75-year-old man with history of colorectal cancer treated with surgery and pelvic radiotherapy, with rectovesical fistula and bilateral nephrostomies", "intervention": "Endovascular coil embolization of an internal iliac artery aneurysm causing an arterio-ureteral fistula", "comparator": "None (single case before and after treatment)", "primaryOutcome": "Resolution of bleeding from nephrostomy and rectum", "result": "Bleeding completely stopped after embolization and stayed resolved at one month follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show what causes bleeding in general or how well this treatment works in others.", "directness": "indirect", "limitations": "Single case report; describes a rare vascular abnormality (artery aneurysm and fistula) rather than common causes of bright red rectal bleeding seen with routine wiping.", "followUp": "one month", "plainFinding": "Rare blood vessel cause, fixed by procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41404227/", "sourceText": "Internal iliac artery aneurysms (IIAAs) are rare vascular abnormalities, while arterio-ureteral fistulas (AUFs) are uncommon but potentially fatal causes of hematuria. Both conditions are typically associated with prior pelvic surgery, radiotherapy, or long-term ureteric stenting. We describe the case of a 75-year-old man with a history of colorectal carcinoma managed with surgery and adjuvant pelvic radiotherapy, complicated by a rectovesical fistula and bilateral nephrostomies for obstructive uropathy. The patient presented with intermittent bleeding from the left nephrostomy and per rectum. A CT angiography demonstrated a left internal iliac artery aneurysm arising from the anterior division, in proximity to the distal left ureteric stent, raising suspicion of an arterio‑ureteral fistula. Endovascular coil embolization of the aneurysm was performed, resulting in complete resolution of bleeding. Follow-up CT angiography performed one month after the procedure confirmed complete exclusion of the aneurysm and absence of recurrent bleeding. This case illustrates a rare presentation of an internal iliac artery aneurysm with an arterio-ureteral fistula in the setting of a rectovesical fistula after colorectal cancer treatment, emphasizing the importance of early recognition and prompt endovascular management in complex post-oncologic pelvic bleeding.", "provenance": [ { "field": "n", "quote": "a 75-year-old man with a history of colorectal carcinoma" }, { "field": "population", "quote": "a 75-year-old man with a history of colorectal carcinoma managed with surgery and adjuvant pelvic radiotherapy, complicated by a rectovesical fistula and bilateral nephrostomies for obstructive uropathy" }, { "field": "intervention", "quote": "Endovascular coil embolization of the aneurysm was performed, resulting in complete resolution of bleeding." }, { "field": "comparator", "quote": "We describe the case of a 75-year-old man" }, { "field": "primaryOutcome", "quote": "The patient presented with intermittent bleeding from the left nephrostomy and per rectum." }, { "field": "result", "quote": "Follow-up CT angiography performed one month after the procedure confirmed complete exclusion of the aneurysm and absence of recurrent bleeding." }, { "field": "followUp", "quote": "Follow-up CT angiography performed one month after the procedure" } ] }, { "id": "pmid:41401088", "pmid": "41401088", "doi": null, "nctId": null, "pmcid": null, "title": "The Use of the Fecal Immunochemical Test in the Acute-Care Hospital Setting", "firstAuthor": "Román-Colón", "multipleAuthors": true, "journal": "P R Health Sci J", "year": 2025, "design": "retrospective", "n": 1354, "nField": "reported", "population": "Patients in the emergency department or admitted to a VA hospital who had a fecal immunochemical test (FIT) done", "intervention": "Fecal immunochemical test (FIT) ordered for reasons other than routine colon cancer screening", "comparator": "FIT-positive versus FIT-negative results", "primaryOutcome": "Clinical impact of FIT results, including symptoms, follow-up consultations, and endoscopic procedures", "result": "Positive FIT results were linked to rectal bleeding, weakness, and diarrhea, and often led to extra consultations and endoscopic procedures, while none of the tests had been ordered for proper screening", "resultDirection": "harm", "quality": "low", "qualityWhy": "This was a single-center retrospective chart review without a control group, so it can show associations but not prove cause or effect.", "directness": "indirect", "limitations": "Retrospective design, single VA hospital, mostly older male patients, and no standardized indication for why tests were ordered.", "followUp": "", "plainFinding": "Misused stool test, not bleeding explanation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41401088/", "sourceText": "OBJECTIVE: The fecal immunochemical test (FIT) is indicated for colon cancer screening in asymptomatic average-risk patients. However, the inclusion of orders for non-indication-based FITs in medical records has led to increased inappropriate use in emergency department (ED) and inpatient settings. This study aimed to evaluate the clinical impact of FIT results when the test is used for purposes other than routine screening. METHODS: We conducted a single-center, retrospective chart review using electronic medical records, analyzing patients who underwent the FIT in the ED or while admitted to the VA Hospital from September 2013 through December 2016. The collected data included demographics; clinical symptoms and signs; medications; and information on digital rectal examinations, gastroenterology consultations, and endoscopic procedures. RESULTS: Of the 1,354 patients included, most were men. Among FIT-positive patients, the mean age was 73.7 years. The majority of FITs were done in the ED. Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea. Anticoagulants were associated with positive FIT results. Patients with positive tests often received gastroenterology consultations and were more likely to undergo endoscopic procedures. CONCLUSION: None of the evaluated FITs were used for screening, confirming that they had been ordered inappropriately. This indiscriminate use can lead to unnecessary interventions and prolonged hospitalizations. Additionally, negative tests may lead to underestimate worrisome symptoms or features that require further investigation. In conclusion, our study does not support the indiscriminate use of the FIT in inpatient or ED settings.", "provenance": [ { "field": "n", "quote": "Of the 1,354 patients included, most were men." }, { "field": "population", "quote": "analyzing patients who underwent the FIT in the ED or while admitted to the VA Hospital from September 2013 through December 2016" }, { "field": "intervention", "quote": "the inclusion of orders for non-indication-based FITs in medical records has led to increased inappropriate use in emergency department (ED) and inpatient settings" }, { "field": "comparator", "quote": "Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea." }, { "field": "primaryOutcome", "quote": "This study aimed to evaluate the clinical impact of FIT results when the test is used for purposes other than routine screening." }, { "field": "result", "quote": "Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea. Anticoagulants were associated with positive FIT results. Patients with positive tests often received gastroenterology consultations and were more likely to undergo endoscopic procedures." } ] }, { "id": "pmid:41399193", "pmid": "41399193", "doi": "10.1111/pai.70264", "nctId": null, "pmcid": "PMC12706178", "title": "Diagnosis and Management of Food Protein-Induced Allergic Proctocolitis in the pediatric age: A position paper from the Italian Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Italian Society for Pediatric Allergy and Immunology", "firstAuthor": "Coppola", "multipleAuthors": true, "journal": "Pediatr Allergy Immunol", "year": 2025, "design": "guideline", "n": null, "nField": "not-reported", "population": "infants and young children with suspected food-allergy-related rectal bleeding", "intervention": "structured diagnostic approach using clinical history, elimination diet, and oral food challenge", "comparator": "", "primaryOutcome": "accurate diagnosis and management of food protein-induced allergic proctocolitis", "result": "the panel recommends a structured approach combining clinical history, elimination diet response, and food challenge to improve diagnosis and avoid overtesting and unnecessary diets", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an expert consensus guideline based on a literature review rather than new patient data, so it cannot show whether treatments actually work.", "directness": "indirect", "limitations": "abstract does not describe original study data, sample size, or outcome statistics; it is a consensus recommendation document.", "followUp": "", "plainFinding": "Guidance on diagnosing allergy-related rectal bleeding in infants", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41399193/", "sourceText": "BACKGROUND: Food protein-induced allergic proctocolitis (FPIAP) is one of the most common phenotypes of food allergy in the first years of life. Several clinical aspects of FPIAP remain largely undefined, with a negative impact on its management. To bridge these gaps, a dedicated joint working group (WG) from the Italian Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP) was launched to provide practical evidence-based suggestions for the best diagnostic approach and management of this condition in pediatric age. METHODS: This position paper was developed by a multidisciplinary panel of experts in the pediatric food allergy field from SIGENP and SIAIP. A structured literature review was conducted, and consensus was achieved through the Delphi process. Key topics include anamnestic factors, clinical presentation, diagnostic criteria, differential diagnosis, the role of laboratory and endoscopic investigations, dietary management, reintroduction strategies, and long-term outcomes. RESULTS: The panel proposes a structured diagnostic approach emphasizing the role of a focused clinical history, response to the elimination diet, and recurrence of symptoms during the oral food challenge. Best strategies for the elimination diet in different clinical settings and for the appropriate use of diagnostic tools were also addressed. The paper underscores the importance of avoiding overdiagnosis and unnecessary diagnostic procedures and dietary restrictions, which can impact management, nutritional status, and quality of life. CONCLUSION: This position paper provides practical, evidence-based recommendations for the diagnosis and management of FPIAP in infants. The guidance aims to reduce diagnostic errors and delays and to promote appropriate, non-invasive, and family-centered care.", "provenance": [ { "field": "population", "quote": "Food protein-induced allergic proctocolitis (FPIAP) is one of the most common phenotypes of food allergy in the first years of life." }, { "field": "intervention", "quote": "The panel proposes a structured diagnostic approach emphasizing the role of a focused clinical history, response to the elimination diet, and recurrence of symptoms during the oral food challenge." }, { "field": "primaryOutcome", "quote": "provide practical evidence-based suggestions for the best diagnostic approach and management of this condition in pediatric age" }, { "field": "result", "quote": "This position paper provides practical, evidence-based recommendations for the diagnosis and management of FPIAP in infants." } ] }, { "id": "pmid:41390368", "pmid": "41390368", "doi": "10.1186/s12876-025-04550-2", "nctId": null, "pmcid": "PMC12821880", "title": "Behavioral changes and delayed colorectal cancer diagnosis during COVID-19: a real-world survey analysis", "firstAuthor": "Fujino", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2025, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients who had surgery for colorectal cancer during the COVID-19 pandemic", "intervention": "delaying or cancelling medical visits and screenings because of the pandemic", "comparator": "patients who did not delay their visits or screenings", "primaryOutcome": "whether pandemic-related delays in care were linked to more advanced cancer stage and symptoms like rectal bleeding", "result": "patients who delayed care were more likely to be women and tended to have more advanced cancer stage; rectal bleeding as a symptom became more common later in the study period", "resultDirection": "harm", "quality": "low", "qualityWhy": "small survey-based study with only 83 patients and some results only reaching borderline significance, so it can't strongly prove a cause-effect link.", "directness": "indirect", "limitations": "small sample size, retrospective data collection combined with a survey, and some associations (like stage severity) did not reach statistical significance (P = 0.062).", "followUp": "", "plainFinding": "Delayed care linked to worse cancer stage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41390368/", "sourceText": "BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly altered healthcare systems and patient behavior worldwide, resulting in a significant decrease in hospital visits and delays in diagnosis and treatment. Thus, we aimed to investigate behavioral changes in patients undergoing colorectal cancer surgery during the pandemic, identify vulnerable populations, and determine the impact of such changes on cancer progression. METHODS: We conducted a comprehensive survey of patients who underwent colorectal cancer surgery at Osaka University Hospital and Minoh City Hospital between January 2021 and June 2023. Participants were asked about their clinical symptoms, regular and additional medical visits, and screenings. Behavioral changes were defined as pandemic-related postponements or cancellations of additional screenings and regular medical visits. Clinical and pathological data were collected retrospectively from medical records. RESULTS: Among the 98 patients who completed the survey, 83 met the inclusion criteria (43 males, average age 70 years). Behavioral changes due to the pandemic were observed in 8.4% of patients. Clinical symptoms, particularly rectal bleeding, were more common in the latter part of the study period (P = 0.014). Women were more likely to change their behavior (P = 0.038), and the disease stage tended to be more advanced in patients who changed their behavior (P = 0.062). CONCLUSIONS: The COVID-19 pandemic led to significant behavioral changes, resulting in delayed medical consultations and more advanced cancer diagnoses. These findings highlight the need for robust public health strategies to promote regular medical checkups and timely screening, especially among vulnerable groups, during global health crises.", "provenance": [ { "field": "population", "quote": "patients who underwent colorectal cancer surgery at Osaka University Hospital and Minoh City Hospital between January 2021 and June 2023" }, { "field": "n", "quote": "83 met the inclusion criteria" }, { "field": "intervention", "quote": "Behavioral changes were defined as pandemic-related postponements or cancellations of additional screenings and regular medical visits." }, { "field": "comparator", "quote": "Behavioral changes due to the pandemic were observed in 8.4% of patients." }, { "field": "primaryOutcome", "quote": "identify vulnerable populations, and determine the impact of such changes on cancer progression" }, { "field": "result", "quote": "Clinical symptoms, particularly rectal bleeding, were more common in the latter part of the study period (P = 0.014). Women were more likely to change their behavior (P = 0.038), and the disease stage tended to be more advanced in patients who changed their behavior (P = 0.062)." } ] }, { "id": "pmid:41384824", "pmid": "41384824", "doi": "10.1158/1940-6207.CAPR-25-0232", "nctId": null, "pmcid": null, "title": "Uncovering the Red Flags: A Cross-Sectional Retrospective Case-Control Study on Predictors of Early-Onset Colorectal Cancer in a Multistate Community Health System", "firstAuthor": "Castro", "multipleAuthors": true, "journal": "Cancer Prev Res (Phila)", "year": 2026, "design": "case-control", "n": 2052, "nField": "reported", "population": "adults aged 20 to 49 diagnosed with early-onset colorectal cancer, matched to similar patients without the cancer", "intervention": "having rectal bleeding as a symptom", "comparator": "patients without early-onset colorectal cancer", "primaryOutcome": "odds of being diagnosed with early-onset colorectal cancer", "result": "rectal bleeding, along with other symptoms, was linked to significantly higher odds of early-onset colorectal cancer", "resultDirection": "harm", "quality": "moderate", "qualityWhy": "It's a large, carefully matched study using medical records, but being retrospective and observational means it can show a link, not prove that bleeding causes or predicts cancer in any one person.", "directness": "direct", "limitations": "Abstract does not explicitly discuss limitations; retrospective design based on medical record data from one multistate health system.", "followUp": "", "plainFinding": "Bleeding linked to higher cancer odds.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41384824/", "sourceText": "UNLABELLED: The increasing prevalence and aggressive, potentially fatal, nature of early-onset colorectal cancer (EOCRC) makes it critical to identify risk factors that can facilitate earlier screening and detection. With electronic medical record data, we compared adults ages 20 to 49 years diagnosed with EOCRC (2017-2023) to control patients without EOCRC who were 1:2 exact-matched based on age and sex. We extracted data on patients' sociodemographics, comorbidities, hereditary syndromes, family history, symptoms, specialty visits, and medications within 12 to 24 months prior to or on their diagnostic visit. Using a model-building approach, we analyzed data with univariate then multivariate logistic regressions to predict the odds of EOCRC diagnosis. We constructed three models using high-risk background characteristics as predictors (baseline and high-risk) and exclusion criteria (sporadic), respectively. Our final analysis included 684 EOCRC cases and 1,368 controls. The mean age was 42 years, with 53% male, 72% White, and 72% non-Hispanic/Latino. Across all models, several predictors were significantly associated with higher EOCRC odds, including alcohol use history, higher number of comorbidities, abdominal pain, rectal bleeding, constipation, iron deficiency anemia, and prescriptions for metformin, non-steroidal anti-inflammatory drugs (NSAID), and multivitamins. Significant predictors of lower EOCRC odds were employment and Medicare/Medicaid insurance. By concurrently including symptoms, medical history, and sociodemographic characteristics, we constructed and validated well-fitting models with good discrimination that replicated and extended prior case-control research. To facilitate earlier screening and detection, these EOCRC risk factors can be used to identify patients who would benefit from screening earlier than 45 years of age. PREVENTION RELEVANCE: There is a need for risk stratification models that simultaneously consider symptoms, medical history, and sociodemographic characteristics. This study identified a set of risk factors that can be used to recommend early screening to symptomatic and asymptomatic patients below the age of 45, even among those without high-risk familial background.", "provenance": [ { "field": "n", "quote": "684 EOCRC cases and 1,368 controls" }, { "field": "population", "quote": "compared adults ages 20 to 49 years diagnosed with EOCRC (2017-2023) to control patients without EOCRC who were 1:2 exact-matched based on age and sex" }, { "field": "intervention", "quote": "rectal bleeding" }, { "field": "comparator", "quote": "control patients without EOCRC" }, { "field": "primaryOutcome", "quote": "to predict the odds of EOCRC diagnosis" }, { "field": "result", "quote": "several predictors were significantly associated with higher EOCRC odds, including alcohol use history, higher number of comorbidities, abdominal pain, rectal bleeding, constipation, iron deficiency anemia, and prescriptions for metformin, non-steroidal anti-inflammatory drugs (NSAID), and multivitamins" } ] }, { "id": "pmid:41344811", "pmid": "41344811", "doi": "10.3399/BJGP.2025.0619", "nctId": null, "pmcid": "PMC13060685", "title": "Variations in the investigation of colorectal cancer-related symptoms in Australian primary care: a retrospective cohort study", "firstAuthor": "Lei", "multipleAuthors": true, "journal": "Br J Gen Pract", "year": 2026, "design": "retrospective", "n": 70107, "nField": "reported", "population": "adults aged 40 and older seen in primary care with symptoms that can signal colorectal cancer, including rectal bleeding", "intervention": "being investigated with colonoscopy or referred to a specialist after reporting these symptoms", "comparator": "receiving no investigation, or only medication, for the same symptoms", "primaryOutcome": "how often patients got diagnostic tests, imaging, colonoscopy, or specialist referral for their symptoms", "result": "Colonoscopy or specialist referral happened for about two-thirds of patients with rectal bleeding, while many patients with other symptoms like constipation or diarrhoea got no testing at all", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It is a retrospective records study of testing patterns, not a trial testing a treatment, so it cannot say what causes bleeding or what treatment works.", "directness": "indirect", "limitations": "Retrospective design, only 0.5% of patients were actually diagnosed with colorectal cancer, and the study looks at testing patterns rather than diagnoses or causes of bleeding.", "followUp": "12 months", "plainFinding": "Doesn't explain why bleeding happens.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41344811/", "sourceText": "BACKGROUND: Colorectal cancer-related symptoms are commonly seen in primary care. Understanding variations in symptom management is crucial for timely care. AIM: To examine diagnostic testing patterns for gastrointestinal symptoms associated with colorectal cancer in primary care. DESIGN AND SETTING: Retrospective cohort study using linked primary care data from patients aged ≥40 years presenting with colorectal cancer-related symptoms between 2008 and 2022. METHOD: The proportion of patients receiving diagnostic actions was assessed, including medications, pathology, imaging, colonoscopy, or specialist referral. Differences in testing by socioeconomic status and subsequent colorectal cancer diagnosis were examined. RESULTS: Among 70 107 patients, 378 (0.5%) were diagnosed with colorectal cancer within 12 months. Abdominal pain (32%; n = 28 455/90 059) and diarrhoea (21%; n = 19 071/90 059) were the most frequent presentations. No investigation or treatment occurred in 20% (change in bowel habit; n = 226/1106) to 50% (constipation; n = 6028/12 128; and diarrhoea; n = 7069/14 122) of patients. Medication-only management was highest for diarrhoea (11%; n = 1547/14 122) and constipation (23%; n = 2847/12 128). Blood or imaging tests were most frequent for abdominal pain (36%; n = 7572/20 956) and abdominal mass (41%; n = 294/718). Colonoscopy or specialist referral was highest for rectal bleeding (67%; n = 4536/6772) and change in bowel habit (60%; n = 662/1106). Investigation likelihood increased with multiple symptoms or repeat visits (odds ratio [OR] 3.40, 95% confidence interval [CI] = 3.16 to 3.65, P<0.001). Patients aged ≥80 years were significantly less likely to be investigated or referred (OR 0.53, 95% CI = 0.50 to 0.55, P<0.001), and those from more advantaged areas were more likely to be investigated (OR 1.45, 95% CI = 1.38 to 1.53, P<0.001). CONCLUSION: Substantial variation in investigating colorectal cancer-related symptoms may contribute to inequities in diagnostic outcomes.", "provenance": [ { "field": "n", "quote": "Among 70 107 patients, 378 (0.5%) were diagnosed with colorectal cancer within 12 months." }, { "field": "population", "quote": "patients aged ≥40 years presenting with colorectal cancer-related symptoms between 2008 and 2022" }, { "field": "intervention", "quote": "Colonoscopy or specialist referral was highest for rectal bleeding (67%; n = 4536/6772)" }, { "field": "comparator", "quote": "No investigation or treatment occurred in 20% (change in bowel habit; n = 226/1106) to 50% (constipation; n = 6028/12 128; and diarrhoea; n = 7069/14 122) of patients." }, { "field": "primaryOutcome", "quote": "The proportion of patients receiving diagnostic actions was assessed, including medications, pathology, imaging, colonoscopy, or specialist referral." }, { "field": "result", "quote": "Colonoscopy or specialist referral was highest for rectal bleeding (67%; n = 4536/6772) and change in bowel habit (60%; n = 662/1106)." } ] }, { "id": "pmid:41335039", "pmid": "41335039", "doi": "10.1177/10962964251403444", "nctId": null, "pmcid": null, "title": "Fatal Toxic Shock Syndrome Resulting from Clostridium sordellii Bacteremia after Perforation of a Low Rectal Cancer", "firstAuthor": "Fesmire", "multipleAuthors": true, "journal": "Surg Infect (Larchmt)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "60-year-old woman with a perforated low rectal cancer and fistula between rectum and vagina", "intervention": "none (describes natural disease course and emergency surgery)", "comparator": "none", "primaryOutcome": "survival after infection with Clostridium sordellii bacteria in the blood", "result": "She developed severe sepsis and organ failure and died despite surgery to divert stool and drain infection", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show what causes bleeding in general or how common this is.", "directness": "indirect", "limitations": "Only one patient; this is an extremely rare and severe cancer-related infection, not a typical cause of bleeding when wiping.", "followUp": "", "plainFinding": "Rare fatal infection from rectal cancer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41335039/", "sourceText": "BACKGROUND: Clostridium sordellii infections are rare and highly lethal. They are most associated with medical abortions and other genitourinary procedures. We report a fatal case of C. sordellii bacteremia from a perforated low rectal cancer with rectovaginal fistula. CASE PRESENTATION: A 60-year-old female presented with 10 days of abdominal pain, loose stools, and hematochezia. She developed rapidly progressive septic shock. Imaging identified a perforated rectal mass, pneumovagina, and a large pelvic abscess. She underwent fecal diversion and drainage of the pelvic abscess. Despite this intervention, she had refractory septic shock with multisystem organ failure resulting in death. Blood cultures grew C. sordellii post-mortem. CONCLUSION: C. sordellii infections are often fatal if not treated immediately. Clinicians must have a high index of suspicion in rectal cancer with associated gynecological involvement.", "provenance": [ { "field": "population", "quote": "A 60-year-old female presented with 10 days of abdominal pain, loose stools, and hematochezia." }, { "field": "intervention", "quote": "She underwent fecal diversion and drainage of the pelvic abscess." }, { "field": "comparator", "quote": "Despite this intervention, she had refractory septic shock with multisystem organ failure resulting in death." }, { "field": "primaryOutcome", "quote": "Blood cultures grew C. sordellii post-mortem." }, { "field": "result", "quote": "Despite this intervention, she had refractory septic shock with multisystem organ failure resulting in death." }, { "field": "n", "quote": "A 60-year-old female presented" } ] }, { "id": "pmid:41331150", "pmid": "41331150", "doi": "10.1007/s00384-025-05019-0", "nctId": null, "pmcid": "PMC12672606", "title": "Longitudinal assessment of quality of life and symptom burden in locally advanced rectal cancer patients receiving IMRT-based preoperative radiotherapy: A prospective cohort study", "firstAuthor": "Truelsen", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "prospective-cohort", "n": 123, "nField": "reported", "population": "people with locally advanced rectal cancer having radiotherapy before surgery", "intervention": "preoperative radiotherapy (IMRT-based, either short-course or long-course chemoradiotherapy)", "comparator": "symptoms tracked over time within the same patients (no separate control group)", "primaryOutcome": "quality of life and treatment-related side effects, including bowel symptoms like rectal bleeding", "result": "Rectal bleeding and diarrhoea, which occurred during treatment, got better over the following year; other symptoms like fatigue and urinary problems worsened slightly, while overall quality of life was largely preserved at 1 year", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it followed a reasonable number of patients over time with standard symptom scales, but there was no comparison group and patients all had cancer radiotherapy, not everyday rectal bleeding.", "directness": "indirect", "limitations": "No control group for comparison; findings apply to radiotherapy-induced symptoms in cancer patients, not to rectal bleeding from common causes like hemorrhoids.", "followUp": "1-year follow-up", "plainFinding": "Radiotherapy-related rectal bleeding improved within a year", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41331150/", "sourceText": "PURPOSE: Preoperative radiotherapy (pRT) for rectal cancer (RC) reduces local recurrence rates. However, treatment-induced side effects may compromise patient-reported quality of life (QoL). This study aimed to report longitudinal QoL and physician-assessed toxicity in RC patients receiving preoperative intensity modulated radiotherapy (IMRT). METHODS: This prospective cohort study included 123 RC patients treated with short-course (SCRT) or long-course chemoradiotherapy (LCRT). Patient-reported outcomes (PRO) were assessed using the EORTC QLQ-C30 and CR29 questionnaires at pretreatment, end of treatment, preoperatively, and at 1-year follow-up. Physician-reported toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE). Longitudinal changes in PROs were analysed using mixed-effects regression modelling. CTCAE grades were reported as frequencies, and symptom transitions illustrated using Sankey diagrams. RESULTS: For EORTC C30 items, pRT-induced transient declines were observed for Global Health, physical, role and social functioning, fatigue, and pain, with scores recovering at preoperative assessment, except for persistent worsening for fatigue. At 1-year, Global Health remained stable; emotional functioning improved; fatigue and social functioning showed minor persistent worsening. Bowel and bladder symptoms peaked during pRT and gradually resolved or improved at 1Y. CTCAE grades were predominantly mild; diarrhoea and rectal bleeding improved over time, while urinary dysfunction and fatigue increased modestly. Sankey plots illustrate symptom transitions. Discrepancies were noted between physician- and patient-reported outcomes. CONCLUSION: IMRT-based pRT was associated with largely preserved QoL at 1Y. Reported trajectories of PRO and CTCAE scores provide complementary insights to support physician-patient communication, with differences underlining the importance of integrating both perspectives.", "provenance": [ { "field": "n", "quote": "This prospective cohort study included 123 RC patients treated with short-course (SCRT) or long-course chemoradiotherapy (LCRT)." }, { "field": "population", "quote": "RC patients receiving preoperative intensity modulated radiotherapy (IMRT)" }, { "field": "intervention", "quote": "preoperative radiotherapy (pRT) for rectal cancer (RC)" }, { "field": "comparator", "quote": "Patient-reported outcomes (PRO) were assessed using the EORTC QLQ-C30 and CR29 questionnaires at pretreatment, end of treatment, preoperatively, and at 1-year follow-up." }, { "field": "primaryOutcome", "quote": "This study aimed to report longitudinal QoL and physician-assessed toxicity in RC patients receiving preoperative intensity modulated radiotherapy (IMRT)." }, { "field": "result", "quote": "CTCAE grades were predominantly mild; diarrhoea and rectal bleeding improved over time, while urinary dysfunction and fatigue increased modestly." }, { "field": "followUp", "quote": "at pretreatment, end of treatment, preoperatively, and at 1-year follow-up" } ] }, { "id": "pmid:41293339", "pmid": "41293339", "doi": "10.7759/cureus.95311", "nctId": null, "pmcid": "PMC12641384", "title": "A Rare Cause of Upper Gastrointestinal Bleeding: Superior Mesenteric Artery Aneurysm", "firstAuthor": "Sinou", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "an 87-year-old woman with severe abdominal pain who later had rectal bleeding, vomiting blood, and blood in her stool", "intervention": "endovascular coil embolization of a bleeding artery aneurysm (superior mesenteric artery)", "comparator": "no direct comparison treatment was used in this patient; the abstract mentions other options like open surgery or endoscopic treatment exist", "primaryOutcome": "whether bleeding stopped and the patient's blood pressure/circulation stabilized", "result": "the bleeding stopped and the patient's circulation fully stabilized after the procedure, with no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether the treatment works better than alternatives.", "directness": "indirect", "limitations": "single case report; findings cannot be generalized; the cause of bleeding (a rare artery aneurysm) is very different from common causes of bright red blood when wiping.", "followUp": "", "plainFinding": "Rare artery aneurysm bleeding, successfully treated.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41293339/", "sourceText": "Superior mesenteric artery (SMA) aneurysms are a rare cause of gastrointestinal (GI) bleeding that is usually underdiagnosed. These conditions can lead to severe complications, making prompt treatment essential. We report a case of a 87-year-old female patient admitted for intense pain in the abdominal area. After a 24-hour hospital stay, she had an episode of hematochezia, hematemesis, and intense epigastric pain. Upper GI endoscopy revealed a foreign body in the duodenum, which was removed. The bleeding and the hemodynamic instability were persistent even after the removal of the foreign body. A CT angiography revealed an aneurysm in the SMA with active contrast extravasation. The patient underwent endovascular treatment with coil embolization, achieving complete hemodynamic stabilization without complications. GI bleeding from an aneurysm in the SMA is an unusual but critical entity with high mortality (40-60%); thus, rupture of the SMA aneurysm should always be considered in the differential diagnosis in cases with persistent GI bleeding. Regarding the hemodynamic stability of the patient or the patient's overall clinical condition, the available treatment options include endoscopic interventions or open surgery. Endovascular treatment offers a safe and effective alternative to open surgery, with favorable outcomes. Prompt diagnosis and, most of the time, endovascular embolization are crucial for successful management of SMA aneurysm-related upper GI bleeding.", "provenance": [ { "field": "population", "quote": "a case of a 87-year-old female patient admitted for intense pain in the abdominal area" }, { "field": "intervention", "quote": "The patient underwent endovascular treatment with coil embolization" }, { "field": "comparator", "quote": "the available treatment options include endoscopic interventions or open surgery" }, { "field": "primaryOutcome", "quote": "achieving complete hemodynamic stabilization without complications" }, { "field": "result", "quote": "achieving complete hemodynamic stabilization without complications" }, { "field": "n", "quote": "a case of a 87-year-old female patient" } ] }, { "id": "pmid:41282523", "pmid": "41282523", "doi": "10.5223/pghn.2025.28.6.343", "nctId": null, "pmcid": "PMC12636102", "title": "Solitary Rectal Ulcer Syndrome: Clinical, Endoscopic, and Histopathological Findings in 40 Bangladeshi Children", "firstAuthor": "Nahid", "multipleAuthors": true, "journal": "Pediatr Gastroenterol Hepatol Nutr", "year": 2025, "design": "case-series", "n": 40, "nField": "reported", "population": "children under 18 with rectal bleeding, in Bangladesh", "intervention": "none - researchers examined symptoms, colonoscopy, and tissue findings", "comparator": "none", "primaryOutcome": "clinical, endoscopic, and tissue findings in children with solitary rectal ulcer syndrome", "result": "most children had straining during bowel movements, constipation, and a single rectal ulcer seen on colonoscopy, with tissue changes called fibromuscular obliteration and crypt distortion", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive case series with no comparison group, so it cannot tell you how common this cause is or whether anything helps it.", "directness": "indirect", "limitations": "single center, children only, no control group, and this covers only one specific diagnosis (solitary rectal ulcer syndrome) among many possible causes of rectal bleeding.", "followUp": "", "plainFinding": "Straining, constipation linked to rectal ulcers in kids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41282523/", "sourceText": "PURPOSE: Solitary rectal ulcer syndrome (SRUS) is a benign disease of unknown etiology. This study aimed to evaluate the clinical, endoscopic, and histopathological findings of SRUS in Bangladeshi children. METHODS: This prospective observational study was conducted at the Department of Pediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, between January 2021 and December 2022. A total of 260 children aged <18 years with rectal bleeding were admitted for a full evaluation, including detailed history taking and colonoscopy. Among them, 40 met the inclusion criteria for SRUS. The collected data contained clinical characteristics and macroscopic and microscopic findings, expressed as numbers and percentages. RESULTS: The mean age of the group was 13.07±2.14 years; male patients comprised 57.5% and female patients 42.5%. Among the 40 children who presented with rectal bleeding, the most common symptoms were straining during defecation (85.0%), followed by constipation (82.5%), sensation of incomplete evacuation (72.5%), mucus passage per rectum (70.0%), tenesmus (57.5%), abdominal pain (45.0%), manual digital evacuation (42.5%), perianal discomfort (37.5%), and diarrhea (22.5%). Colonoscopy revealed that most lesions were located in the rectum (97.6%) and ulcerative (65.9%). The mean distance of the lesions from the anal verge; 6.04±0.91 cm. Histologically, most lesions showed fibromuscular obliteration (95.0%) and crypt distortion (85.0%). CONCLUSION: Among the 40 children with SRUS who presented with rectal bleeding, straining during defecation was the most common symptom. Single ulcerative lesions in the rectum were the most frequent colonoscopic findings, and the majority showed fibromuscular obliteration and crypt distortion.", "provenance": [ { "field": "n", "quote": "Among them, 40 met the inclusion criteria for SRUS." }, { "field": "population", "quote": "A total of 260 children aged <18 years with rectal bleeding were admitted for a full evaluation" }, { "field": "intervention", "quote": "The collected data contained clinical characteristics and macroscopic and microscopic findings" }, { "field": "comparator", "quote": "This study aimed to evaluate the clinical, endoscopic, and histopathological findings of SRUS in Bangladeshi children." }, { "field": "primaryOutcome", "quote": "This study aimed to evaluate the clinical, endoscopic, and histopathological findings of SRUS in Bangladeshi children." }, { "field": "result", "quote": "straining during defecation (85.0%), followed by constipation (82.5%)" }, { "field": "result", "quote": "Colonoscopy revealed that most lesions were located in the rectum (97.6%) and ulcerative (65.9%)" }, { "field": "result", "quote": "Histologically, most lesions showed fibromuscular obliteration (95.0%) and crypt distortion (85.0%)." } ] }, { "id": "pmid:41262021", "pmid": "41262021", "doi": "10.53738/REVMED.2025.21.940.48029", "nctId": null, "pmcid": null, "title": "[Hematochezia : when should we worry ?]", "firstAuthor": "Roth", "multipleAuthors": true, "journal": "Rev Med Suisse", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hematochezia (bright red blood when wiping), including young people", "intervention": "a proposed diagnostic algorithm using anoscopy as the first examination", "comparator": "current approach that does not distinguish between rectosigmoidoscopy and colonoscopy", "primaryOutcome": "how to properly diagnose the cause of hematochezia", "result": "The abstract proposes a diagnostic algorithm rather than reporting a tested result", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative discussion proposing a diagnostic approach, not a study that tested outcomes in patients.", "directness": "direct", "limitations": "No patient numbers, no comparative data, and no outcomes are reported; it is an opinion/algorithm proposal rather than a controlled study.", "followUp": "", "plainFinding": "Proposes exam order, no outcome data", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41262021/", "sourceText": "Hematochezia is a common symptom, which could reveal benign pathologies as well as malign. It should therefore be considered properly, and explained in the best possible ways. It could be falsely reassuring when it happened in young people, for the proportion of malign causes is relatively low in this population. It could also once a while hide a serious condition, which should be recognized and treated as soon as possible. The gastroenterology societies do not differentiate rectosigmoidoscopy and colonoscopy, in the process of diagnostic of an hematochezia. We suggest an algorithm of diagnostic, which could use an anuscopy as first line examination, eventually completed by a colonoscopy depending on the results of the first examination as well as the evolution under treatment.", "provenance": [ { "field": "population", "quote": "It could be falsely reassuring when it happened in young people, for the proportion of malign causes is relatively low in this population." }, { "field": "intervention", "quote": "We suggest an algorithm of diagnostic, which could use an anuscopy as first line examination, eventually completed by a colonoscopy depending on the results of the first examination as well as the evolution under treatment." }, { "field": "comparator", "quote": "The gastroenterology societies do not differentiate rectosigmoidoscopy and colonoscopy, in the process of diagnostic of an hematochezia." }, { "field": "primaryOutcome", "quote": "Hematochezia is a common symptom, which could reveal benign pathologies as well as malign." }, { "field": "result", "quote": "We suggest an algorithm of diagnostic, which could use an anuscopy as first line examination, eventually completed by a colonoscopy depending on the results of the first examination as well as the evolution under treatment." } ] }, { "id": "pmid:41257278", "pmid": "41257278", "doi": "10.3748/wjg.v31.i41.112794", "nctId": null, "pmcid": "PMC12620867", "title": "Uncommon causes of acute small intestinal bleeding-invasive mole: A case report and review of literature", "firstAuthor": "Yu", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 22-year-old woman with bloody stool and a pregnancy hormone that was high even though she wasn't pregnant", "intervention": "not applicable (diagnostic case report, not a treatment study)", "comparator": "", "primaryOutcome": "finding the cause of gastrointestinal bleeding", "result": "bleeding was caused by a rare tumor (invasive mole) that had spread to the small intestine", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show what causes bright red blood in general or how common this is", "directness": "indirect", "limitations": "only one patient; this is an extremely rare cause of bleeding and not relevant to typical bright red blood on wiping, which is usually from hemorrhoids or anal fissures", "followUp": "", "plainFinding": "Rare tumor caused bleeding in one woman.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41257278/", "sourceText": "BACKGROUND: Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare. Most reported cases of metastatic invasive mole are diagnosed after surgery, and lack rich illustrations, which leads to insufficient understanding by clinicians, misdiagnosis, and unnecessary surgeries. CASE SUMMARY: A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin. The transvaginal gynecological ultrasound ruled out pregnancy. Upper gastrointestinal endoscopy and colonoscopy were performed, but no bleeding focus was detected. The contrast-enhanced computed tomography was unremarkable. The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots. Therefore, oral single-balloon enteroscopy was performed, and two connected protuberant lesions were detected, with blood clot traces and local ulceration. The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor. The patient underwent surgical resection of the diseased jejunum. Intraoperative endoscopy was performed, and the findings were the same as those of the small intestine endoscopy. The postoperative pathology confirmed the preoperative diagnosis of invasive mole. CONCLUSION: In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding, metastatic trophoblastic neoplasia should be considered.", "provenance": [ { "field": "population", "quote": "A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin." }, { "field": "n", "quote": "A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin." }, { "field": "primaryOutcome", "quote": "Upper gastrointestinal endoscopy and colonoscopy were performed, but no bleeding focus was detected." }, { "field": "result", "quote": "The postoperative pathology confirmed the preoperative diagnosis of invasive mole." }, { "field": "intervention", "quote": "The patient underwent surgical resection of the diseased jejunum." } ] } ], "faqs": [ { "q": "When I wipe my bum I feel a lump — what is it?", "a": "This is most often a hemorrhoid, a swollen vein around the anus, which can bleed bright red when you wipe. A review of anorectal symptoms found that a lump plus bright red bleeding fits this pattern, but ongoing pain, a lump that changes, or weight loss are reasons to get it looked at rather than assume." }, { "q": "Is bright red blood on toilet paper always from hemorrhoids?", "a": "No. It's the most common cause described in the evidence, but studies also found that reporting rectal bleeding was linked to a higher chance of finding a pre-cancerous growth or early bowel cancer, particularly in adults under 50. The pattern of the blood and any other symptoms matter." }, { "q": "What should I do instead of just assuming it's hemorrhoids?", "a": "Mention it to a doctor, especially if it's new, keeps happening, or you're under 50 — studies found that bleeding in this group was linked to meaningfully higher odds of a serious growth, and that people often delay seeking help by a month or more. A doctor can examine you or arrange a simple stool test rather than you guessing." }, { "q": "Can rectal bleeding be a sign of bowel cancer in young people?", "a": "Yes, it can. Studies of adults under 50 found rectal bleeding was linked to more than double the odds of an advanced pre-cancerous growth, and to higher odds of early-onset bowel cancer diagnosis, even though the absolute number of people with cancer among those who bleed stayed low." }, { "q": "What tests can find out what's actually causing the bleeding?", "a": "A simple stool blood test (FIT) can help show who is at low risk and may not need further tests, while a direct examination such as anoscopy or colonoscopy can look inside and find the exact cause. A review proposed starting with a basic anal exam before moving to more invasive tests." } ], "searchedAs": [ "why does my bum bleed when i wipe", "bright red blood when i wipe my butt", "red blood when i wipe my bum", "why's my bum bleeding when i wipe", "when i wipe my bum i feel a lump" ], "patientTakeaway": "Most bright red blood on the toilet paper comes from hemorrhoids or a small tear near the anus, and this often settles with more fibre, more water, and not straining. But the research also found this bleeding is linked to a higher chance of a serious cause like a growing polyp or bowel cancer, especially in people under 50 — so get it checked by a doctor rather than assuming, particularly if it keeps happening, you notice a change in bowel habits, or you lose weight without trying.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Gastrointestinal Hemorrhage\"[Mesh] OR hematochezia[tiab] OR \"rectal bleeding\"[tiab] OR (blood[tiab] AND wiping[tiab]) OR (blood[tiab] AND toilet[tiab] AND paper[tiab])) AND (\"Hemorrhoids\"[Mesh] OR \"Fissure in Ano\"[Mesh] OR \"Colorectal Neoplasms\"[Mesh] OR etiology[tiab] OR causes[tiab] OR differential[tiab])" }, "pubmedQueryTranslation": "(\"Gastrointestinal Hemorrhage\"[MeSH Terms] OR \"hematochezia\"[Title/Abstract] OR \"rectal bleeding\"[Title/Abstract] OR (\"blood\"[Title/Abstract] AND \"wiping\"[Title/Abstract]) OR (\"blood\"[Title/Abstract] AND \"toilet\"[Title/Abstract] AND \"paper\"[Title/Abstract])) AND (\"Hemorrhoids\"[MeSH Terms] OR \"Fissure in Ano\"[MeSH Terms] OR \"Colorectal Neoplasms\"[MeSH Terms] OR \"etiology\"[Title/Abstract] OR \"causes\"[Title/Abstract] OR \"differential\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Why does my bum bleed when I wipe?", "description": "Research on bright red blood when wiping: usually hemorrhoids, but some studies link it to higher bowel cancer risk, especially under 50." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }