Phil Smith

Back for a time limited period only.

🔁🖨️ REPOST | ORIGINAL RESEARCH — PSVD outcomes 🩺 Porto-sinusoidal vascular disorder (PSVD) is often framed as “non-cirrhotic” — but long-term risk isn’t trivial. This UK quaternary-centre study reports: 📉 ~60% estimated 10-year survival ⚠️ ~30% risk of new-onset decompensation 🧮 Plus a nomogram to help clinicians stratify risk in practice. 📄 Paper: fg.bmj.com/content/early/… #Hepatology #PortalHypertension #PSVD #RiskStratification #FrontlineGastroenterology @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy @basl_events @heppharm @livernursing @LiverAHPs @Liver4Lifeuk @f4liverresearch @IQILS_Liver @LiverTrust @EASLedu @EASLnews @BritSocGastro @BavenoCoop @BCLC_group @ILCAnews @APASLnews @liverfellow @UKCPAGastro

@Gut_BMJ @FrontGastro_BMJ

We hope you enjoy this April 2026 issue of Gut (bit.ly/4lAuQgZ), bringing together cutting-edge research spanning hepatology, gastrointestinal cancer, microbiome science and endoscopic innovation. This month’s issue highlights how advances in technology, translational science and clinical practice are reshaping how we understand and manage digestive disease. This issue also features an Editor’s Choice paper by Huo et al., highlighted on the #GUTFrontCover and discussed in the next #GUTPodcast (available via bit.ly/3PLy2dL). The #GUTFrontCover is a photo of the Watchtower of the Forbidden City at sunset, Beijing, China, in honour of being the Editor’s choice paper and the great collaborative work by Huo et al. reporting the long-term prognosis of lean MASLD with evidence from three population-based prospective cohorts. Highlights from this issue include: Huo et al. present “Long-term prognosis of lean MASLD: evidence from three population-based prospective cohorts” via bit.ly/4cWOsKe (Original research, Hepatology section; Editor’s Choice). Lean MASLD is often considered lower risk—but this large prospective analysis challenges that assumption. The authors show that individuals without obesity still face significant long-term liver-related and cardiovascular risk. This important work reinforces the need to move beyond BMI when assessing risk and will be highly relevant for everyday clinical practice. Sheng et al. present “Spatial profiling of patient-matched HER2 positive gastric cancer reveals resistance mechanisms to targeted therapy” via bit.ly/4dsscb5 (Original research, GI cancer section). Why do targeted therapies stop working? Using spatial transcriptomics, this study reveals how tumour heterogeneity, immune escape and metabolic shifts drive resistance in HER2-positive gastric cancer. A must-read for anyone interested in precision oncology and treatment optimisation. Grancher et al. present “Does a long time to colonoscopy after a positive faecal immunochemical test result have a deleterious impact on colorectal cancer outcomes? A nationwide cohort study” via bit.ly/4rK6OSm (Original research, GI cancer section). Timing matters. This nationwide study shows that delays to colonoscopy after a positive screening test are associated with worse cancer outcomes. The findings provide strong real-world evidence to support faster diagnostic pathways in colorectal cancer screening programmes. Gupta et al. present “Oncological impact of universal endoscopic submucosal dissection for large Barrett’s cancers” via bit.ly/4rF59x8 (Original research, Endoscopy section). Can we safely push endoscopic therapy further? This study demonstrates that broader use of endoscopic submucosal dissection can achieve excellent oncological outcomes in large Barrett’s neoplasia—potentially reducing the need for surgery. Pal et al. present “Can transperineal ultrasound replace endoscopic ultrasound in staging distal ulcerative colitis?” via bit.ly/4btuCnm (Endoscopy news). A less invasive future? This study explores whether transperineal ultrasound could replace endoscopic ultrasound for staging distal ulcerative colitis, showing promising agreement between techniques and opening the door to more patient-friendly assessment. Nigam et al. present “Acute upper gastrointestinal bleeding in the UK: 2022 audit update” via bit.ly/4rZHQP7 (Original research, GI bleeding section). National audit data continue to show encouraging improvements in outcomes for acute upper GI bleeding. Reductions in mortality and rebleeding reflect better organisation of care, earlier intervention and wider uptake of evidence-based practice. Castells-Nobau et al. present “Gut microbial modulation of 3-hydroxyanthranilic acid and dopaminergic signalling influences attention in obesity” via bit.ly/4bmfucM (Original research, Gut microbiota section). The gut–brain axis in action. This fascinating study links microbial metabolism to dopaminergic signalling and attention, providing mechanistic insight into how the microbiome may influence behaviour in obesity. Liu et al. present “iPSC-induced multilineage liver organoids, small intestinal organoids and brain organoids sustain bit.ly/4buH3z9 (Original research, Hepatology section). A major step forward for translational research, this study shows that human organoid systems can support replication of multiple hepatitis E virus genotypes—offering a powerful new platform for studying infection and testing therapies. Cui et al. present “Spatial transcriptomics defines the molecular progression, invasion and immune landscape of IPMN and IPMN-derived pancreatic cancer” via bit.ly/41awwEC (Original research, Pancreas section). How does pancreatic cancer evolve? By mapping molecular and immune changes across disease progression, this study provides valuable insight into tumour development and highlights potential opportunities for earlier intervention. Zhou et al. present “Combination therapies for metabolic dysfunction-associated steatohepatitis: challenges and opportunities” via bit.ly/3PMfE4v (Recent advances in clinical practice). As single therapies fall short, combination approaches are gaining momentum in MASH. This review explores the rationale, challenges and future direction of multi-targeted treatment strategies. Leung et al. present “Asian Pacific Association of Gastroenterology task force recommendations on surveillance for Helicobacter pylori associated gastric premalignant conditions” via bit.ly/4bthNuF (Guideline section). This comprehensive guideline provides clear, practical recommendations for surveillance of gastric premalignant conditions, supporting risk-based approaches to improve early cancer detection. Damianos et al. present “Coeliac disease and the intestinal barrier: mechanisms of disruption and strategies for restoration” via bit.ly/4rCdPEN (Recent advances in basic science). Barrier dysfunction is central to coeliac disease. This review brings together current understanding of underlying mechanisms and explores emerging therapeutic strategies aimed at restoring intestinal integrity. In summary… From redefining risk in liver disease to uncovering mechanisms of cancer resistance and harnessing the microbiome–brain axis, this issue showcases the breadth of modern gastroenterology. Across all sections, a common theme emerges: a shift towards earlier detection, deeper mechanistic insight, and more personalised, less invasive care.

Our state of the art review on upper GI bleeding - showcasing some of the key advances over the last 5 years 💡 📸: fg.bmj.com/content/early/…

🔎📌 | Repeat OGD after severe oesophagitis/oesophageal ulcer — are we over-scoping? Big cohort (n=771) suggests follow-up yield is very low: 🎯 Cancer at follow-up: 0.40% (NNS 250) 🧩 Cancer/dysplasia at follow-up: 0.81% (NNS 123) Most cancer/dysplasia was picked up at index endoscopy (83.8%)—risk higher when suspicious features or Barrett’s are present. 🔎📌 📄 Read: fg.bmj.com/content/early/… #Endoscopy #UpperGI #Oesophagus #GastroTwitter #QualityImprovement @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @WorldGastroOrg @ulstergastro @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy

Thank you to @FrontGastro_BMJ and @PhilSmithIsBack for granting free open access for the next month 🆓🥳

🔁🎙️ REPOST | Checkpoint inhibitor colitis — a gastroenterologist’s perspective 🛡️ If you’re seeing more patients on immunotherapy, this is essential listening. Practical, frontline insights on recognition, work-up, severity assessment, and when to escalate (including MDT coordination with oncology). 🧠🩺 🎧 Listen: fgbmj.podbean.com/e/checkpoint-i… podcasts.apple.com/gb/podcast/che… open.spotify.com/episode/12Atrl… #Immunotherapy #ICIcolitis #OncoGI #Endoscopy #PatientSafety #GastroTwitter @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy

🔁🖨️ REPOST | “But bread causes my symptoms” 🍞🤔 Wheat reactions aren’t one entity — and this FG review lays out the clinical scenarios we all see in clinic: ⚛️ Coeliac disease (gluten-driven immune response) 🌾 Wheat allergy (IgE-mediated) 🔄 Non-coeliac gluten/wheat sensitivity (often overlaps with IBS, no clear biomarkers → diagnosis by exclusion + challenge) 📌 Take-home: a stepwise, practical approach helps you avoid mislabelling patients — and target the right pathway. 🧭🩺 x.com/FrontGastro_BM… @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy @ESPENorg @SENPE_ @ASPEN_nutrition @BAPENUK @HHCNeuroGI @esnm_eu @RomeGastroPsych @IFFGD @ANMSociety @RomeFoundation

@medicalmodelbri Unbelievable this is still going on - will have been signed off by a senior doctor(s)

New band 7/8a job ad for a PA to: ‘contribute to pt care where relevant and exercise a high level of professional judgement. This will include taking medical histories, undertaking physical examinations, diagnosing and explaining conditions during consultations.’

@JonnyBlackwell Really sorry this has happened to you Jonny. You are ace and will be missed on here - we need the good people to outnumber the less so good. Take care, Phil

I’m signing off Twitter for the foreseeable future. The last year has been exhausting & often unpleasant. I hate conflict but circumstances required me to speak truth. To all those who wished me a painful death I wish you only peace. Thanks to all who supported me! You’re ace!

🔁 REPOST ⭐💉🧠 S/C IFX — a real-world experience📄 Worth a read: a retrospective observational cohort (≈101 adult patients) looking at subcutaneous infliximab in routine practice—practical insights for teams considering switching/optimising anti-TNF delivery. 👇 x.com/FrontGastro_BM… #IBD #Infliximab #Biologics #GastroTwitter #FrontlineGastroenterology @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy

🚨🧠 Neurogastro made practical — 60 minutes that’ll change how you run clinic. The #FGGlobal Webinar is back (instalment #4) and it’s all about how to diagnose, consult and treat gut–brain axis disorders you see every week. 🗓️ Thursday 26 March 2026 ⏰ 19:00–20:00 (GMT) 🎤 Expert panel: 👨‍⚕️ Dr Calum Moulton • 👨‍⚕️ Prof Alex Ford • 👨‍⚕️ Dr Chris Black • 👨‍⚕️ Prof Daniel Keszthelyi @alex_ford12399 @IBS_Maastricht @DrCJBlack ✅ Free to join — register here: bsg.org.uk/events/fggloba… #Neurogastroenterology #DGBI #IBS #FunctionalDyspepsia #Gastroparesis #GastroTwitter #MedEd @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @pancreatitis_nl @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy @ESPENorg @SENPE_ @ASPEN_nutrition @BAPENUK @HHCNeuroGI @esnm_eu @RomeGastroPsych @IFFGD @ANMSociety @RomeFoundation

🔁 REPOST 🦠🩺💊 Should we treat more people with chronic hepatitis B—earlier? This FG study models what happens if UK services adopt expanded treatment criteria aligned with newer international guidance. 📉 Better outcomes + lower costs in all expanded scenarios 🏥 Fewer cases progressing to cirrhosis + fewer HCC events 🧠 A strong prompt for UK centres to audit local practice and ensure pathways are up to date Read: fg.bmj.com/content/early/… #HepB #Hepatology #HealthEconomics #LiverCancer #FrontlineGastroenterology @DrJMKennedy @basl_events @heppharm @livernursing @LiverAHPs @Liver4Lifeuk @f4liverresearch @IQILS_Liver @LiverTrust @EASLedu @EASLnews @BritSocGastro @BavenoCoop @BCLC_group @ILCAnews @APASLnews @liverfellow @my_ueg @UKCPAGastro @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @drkeithsiau @ebtapper @DrLChina @acv69cardenas @GeriKeane @jamesbmaurice @ClinicLiver

🔁📢 REPOST | #FGGlobal Webinar — Neurogastroenterology: what clinicians need to know 🧠 Want a practical, clinic-ready update on common neurogastro problems? IBS • functional dyspepsia • gastroparesis (& more) 🎤 Dr Calum Moulton • Prof Alex Ford • Dr Chris Black • Prof Daniel Keszthelyi 🗓️ Thu 26 March 2026 ⏰ 7pm GMT 📝 Register (free) 👉 bsg.org.uk/events/fggloba… #Neurogastroenterology #GastroTwitter #MedEd #FGGlobal @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @WorldGastroOrg @ulstergastro @SEEDendoscopia @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy @HHCNeuroGI @esnm_eu @RomeGastroPsych @IFFGD @ANMSociety @RomeFoundation

⚠️🚨🖨️ REPOST | Perianal Crohn’s disease (pCD)! 🖨️🚨⚠️ A must-read Frontline Gastroenterology review giving a clear, 2026-ready overview of what gastroenterologists need to know about pCD—from assessment and MDT pathways to medical + surgical strategy. 🔍 👏 Huge thanks to Dr Eathar Shakweh and co-authors @eathar_s @easan_anand @theohpelly @philtozer1 @drailsahart @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BSGtrainees @WorldGastroOrg @ulstergastro @SEEDendoscopia @EASLedu @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @amergastroassn @BritSocGastro @ASGEendoscopy

🎙️✨ #FGPodcast (Pt 3/3) — finale is live! 🧑‍⚕️📚 Prof Alexander Ford @alex_ford12399 wraps the series with practical, no-fluff lessons on building a sustainable academic career in gastroenterology: 🧭 focus on questions that matter • 🗂️ protect your time • 🤝 mentors + collaborators • 📈 impact over “impact factor” • 🧠 avoid burnout 🎧 Listen now: ▶️ Apple: podcasts.apple.com/us/podcast/the… ▶️ Spotify: open.spotify.com/episode/3pqLij… ▶️ Web: fgbmj.podbean.com/e/the-life-of-… #GastroTwitter #AcademicMedicine #MedEd @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @BASLedu @BSGtrainees @WorldGastroOrg @ulstergastro @SEEDendoscopia @AmCollegeGastro @Aegastro @SAGES_updates @WAGE_media @my_UEG @amergastroassn @NASPGHAN @UHSEndoscopy @ESGE_news @BritSocGastro @ASGEendoscopy @bmj_latest @RomeFoundation @esnm_eu

🔥🔥🔥 FAST-TRACK TO JAK! 🔥🔥🔥 If you haven’t seen this December #OriginalResearch in Frontline Gastroenterology, it’s worth a look 👇 fg.bmj.com/content/early/… From a tertiary #IBD centre 🏥 @StMarksHospital: upadacitinib in a small, high-risk cohort of moderate–severe UC with prior IFX exposure was associated with: 📌 91.7% colectomy-free survival at week 12 📉 meaningful clinical + biochemical improvement 🧪✅ Real-world experience focused specifically on this challenging population—and timely supportive evidence alongside ACESO 🇬🇧🔬 (UK multi-centre RCT evaluating upadacitinib in ASUC). 👏 Thanks to Dr Magdalini and the team @KamperidisNik @ravmis81 @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @JonnyBlackwell @alenkabrooks @DCharabaty @jennie_clough @rachelcooney7 @DisneyBen @bealoquebea @jklimdi @wingyanjoyce @jonathansegal85 #UlcerativeColitis 🧻 #AcuteSevereUC 🚨 #ASUC #Upadacitinib 💊 #JAKinhibitor #RescueTherapy 🛟 #TargetedTherapy 🎯 #GastroTwitter #IBDCommunity

ATTENTION ALL THERAPEUTIC EUSists With the current issues with Axios stents please see our article on behalf of the BSG therapeutic EUS GROUP. We cover most common but also more niche uses with alternatives discussed. @helpatologist @MitraVikramjit @manuknayar @DouglasAdlerMD

@alex_ford12399 @FrontGastro_BMJ @dr_aditi_kumar @FrontGastro_BMJ @Gut_BMJ @BritSocGastro @BSGTrainees

The final part of my podcast about academic gastroenterology for @FrontGastro_BMJ with @PhilSmithIsBack and @dr_aditi_kumar is now on the FG website. fgbmj.podbean.com/e/the-life-of-… Happy listening!

Probably my favourite part in the #FGPodcast trilogy with @alex_ford12399 and @dr_aditi_kumar Do listen to it and the excellent advice Alex provides @FrontGastro_BMJ @Gut_BMJ @BritSocGastro @BSGTrainees