Current Gastroenterology Reports最新文献

Purpose of review: Endoscopic resection (ER) has transformed the management of early gastrointestinal (GI) malignancies by offering curative treatment with low morbidity and organ preservation. Traditionally restricted to mucosal disease with negligible risk of lymph node metastasis (LNM), recent advances in technique and risk stratification have prompted a re-evaluation of ER indications for esophageal, gastric, and colorectal cancers. This review summarizes the oncologic rationale, current evidence, and emerging technologies supporting the safe expansion of ER indications across GI malignancies.

Recent finding: s: Refined histopathologic criteria, enhanced en-bloc resection through endoscopic submucosal dissection, and the introduction of endoscopic full-thickness resection have expanded curative resection to select early GI malignancies previously considered surgical. Clinical outcomes from large series demonstrate comparable long-term survival to surgery when rigorous selection and surveillance criteria are applied, while minimizing morbidity. Molecular biomarkers, artificial intelligence (AI)-based predictive models, and sentinel node mapping are promising tools to further improve risk assessment for occult LNM. Expansion of ER indications for early GI cancers is feasible and increasingly practiced in expert centers with outcomes approximating those of surgical resection. Ongoing integration of precision diagnostics, molecular profiling, and AI-driven risk models promises to further refine patient selection. However, widespread adoption should proceed within structured, evidence-based frameworks to prevent undertreatment of potentially curable disease and maintain oncologic integrity.

Purpose of review: This systematic review sought to thoroughly investigate the relationship between Inflammatory Bowel Disease (IBD) and Immunoglobulin A Vasculitis (IgAV), pinpointing both factors that increase risk and those that provide protection, laying the groundwork for future studies on specific treatments approaches to enhance the wellbeing of patients with IgAV and / or IBD.

Recent findings: There is a new and quickly expanding body of literature on this subject, indicating a rising interest in it. Recent research has sought to investigate the connection between newly emerged viruses, such as COVID-19, or medications like Anti-Tumor Necrosis Factor Alpha (anti-TNF-α), and the development, progression, and treatment approaches of IgAV in IBD patients, and vice versa. Certain recent research is centered on a particular age groups or the condition of the initial illness. IgAV has been observed for numerous years following the diagnosis of IBD, displaying manifestations in the skin, joints, kidneys, and gastrointestinal tract. IBD encompassing Crohn's disease and ulcerative colitis, and IgAV share immunological overlaps via dysregulated IgA production, genetic loci like HLA-DQA1/DQB1, and environmental triggers such as infections amid gut dysbiosis. IgAV often emerges as an IBD sequela or anti-TNF-α therapy complication, with TNF blockade potentially disrupting B-cell maturation, fostering Gd-IgA1 complexes, and neutrophil-driven inflammation. (31) studies encompassing (83) patients with co-occurring IBD and IgAV, predominantly males (60.2%) and younger individuals with confirmed dual diagnoses (95.2%). Compared to UC, more severe CD phenotypes and extended disease duration correlate with increased IgAV risk. Anti-TNF inhibitors appear to substantially contribute to IgAV onset in IBD patients. Most affected individuals develop IBD initially, followed by IgAV, whereas only a minority experience IBD subsequent to IgAV diagnosis. Ceasing anti-TNF-α therapy post-IgAV diagnosis may lead to IgAV resolution but could also trigger disease recurrence. The study's limited sample size has hindered the researchers from reaching conclusions via a meta-analysis. Additionally, the criteria utilized for IBD diagnosis have displayed inconsistency across all studies. Patients with IBD are at higher risk of developing IgAV, thus a high level of suspicion and prompt diagnostic assessment are crucial. To date, there have been no previous systematic reviews or meta-analyses highlighting a link between IgAV and IBD. Therefore, this systematic review is a pivotal endeavor to elucidate the complex relationship between these conditions, shaping future research in this area.

Purpose of review: This review summarizes the history and current landscape of fecal microbiota transplantation (FMT), with an emphasis on use of the therapy for Clostridioides difficile infection (CDI), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS). We clarify indications, evidence, and current recommendations for FMT-highlighting major advances and minor setbacks that have led to the state of FMT in 2025.

Recent findings: After decades of steady progress, the U.S. Food and Drug Administration (FDA) approved the first FMT-based therapies: fecal microbiota, live-jslm and fecal microbiota spores, live-brpk-in 2022 and 2023, respectively. The 2024 American Gastroenterological Association (AGA) Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases made specific recommendations for conventional FMT and these FDA-approved therapies for multiple CDI presentations, as well as for IBD and IBS. Conventional FMT remains an option for CDI; however, OpenBiome's halt of shipped, frozen FMT preparations on December 31, 2024, has made access more challenging in 2025. Although first reported almost seventy years ago, extensive efforts over the last two decades have placed FMT in routine algorithms for many patients with CDI. While understanding of the intestinal microbiome's role in other gastrointestinal conditions is expanding, and FMT may modulate these pathways, additional evidence is needed before FMT becomes routine outside CDI.

Purpose of review: Gastroesophageal Reflux Disease (GERD) is a condition, which is frequently encountered by gastroenterologists, otorhinolaryngologists, surgeons and general physicians and requires a multidisciplinary treatment when there is a high symptom burden in patients. Besides lower oesophageal sphincter (LES) dysfunction there are several other risk factors that contribute to the development and symptoms (worsening) of GERD. While these lifestyle modifications and pharmacological therapies, particularly proton pump inhibitors (PPIs), are first-line treatments, a subset of patients requires surgical intervention due to refractory symptoms or complications. This review traces the evolution of anti-reflux surgery, examining its historical milestones, advancements, and future prospects.

Recent findings: This review discusses the epidemiology of GERD, its pathophysiology, but also the development of Anti-Reflux Surgery (ARS). We will discuss the available evidence regarding different ARS procedures and will focus on individualised treatment for patients with GERD. In the treatment of patients with GERD we have to take into account that it might be challenging to personalise treatment and therefore optimise results. In this instance special considerations need to be taken for patients with GERD and obesity, patients with Barretts oesophagus, patients after bariatric and metabolic surgery (BMS) and patients with oesophageal motility disorders.

Purpose of review: Acute severe ulcerative colitis (ASUC) remains a high-risk condition with suboptimal clinical outcomes despite advancements in diagnostics, prognostication, and therapies. This review synthesizes recent evidence to address critical gaps in care, focusing on optimizing medical strategies to reduce colectomy rates and improve patient outcomes.

Recent findings: Recent studies have identified novel biomarkers and predictive models for stratifying patients as high-risk for colectomy. Several emerging therapeutic strategies to optimize care have also been explored. Intensified infliximab dosing has not consistently shown improved clinical outcomes across all patients with ASUC, though it may benefit a subset of patients with unfavorable pharmacokinetics. Furthermore, Janus kinase inhibitors have shown promise in reducing colectomy rates, offering a potential alternative for select patients; however, supporting evidence remains preliminary. Despite these advancements, colectomy remains exceedingly common but continues to serve as a critical intervention to reduce complications and mortality. This underscores the therapeutic efficacy ceiling that still exists in our current approach to ASUC in 2025. Modern ASUC management prioritizes rapid risk stratification (using clinical, endoscopic, and biomarker data) and patient-tailored advanced therapy selection. Future strategies should focus on conducting rigorous trials of emerging agents in comparison to our current protocols, while integrating real-time, personalized, and dynamic prognostic tools to reduce heterogeneity in treatment response.

Purpose of review: The health benefits of food are being increasingly recognized. Exposing children and parents to culinary medicine enables them to make healthy food choices with potential for long term health improvement. Here we review pediatric literature on culinary medicine, share results of a recent practice survey, and review strategies for program development and implementation including training opportunities.

Recent findings: There is growing evidence of interest in culinary medicine in pediatrics. A pediatric culinary medicine practice survey directed to current practitioners in the USA showed great variability. Common challenges associated with the practice included sustained funding, program management needs and getting the message out to the right audience. Based on survey responses and current literature, we generated educational resources and practice recommendations to further knowledge on pediatric culinary medicine practice. Several opportunities exist for practitioners to further the field of pediatric culinary medicine by engaging in additional clinical practices, research, education, and advocacy.

Purpose of review: Building a successful third space endoscopy program (TSE) requires alignment across multiple domains. The strategy should be consistent with the needs of the hospital and community at large. We hope to outline clinical questions and strategies for successfully building a TSE in a community hospital setting.

Recent findings: The field of third space endoscopy has advanced beyond traditional ESD and POEM to include derivatives of POEM and submucosal tunneling techniques including submucosal tunneling endoscopic resection (STER). There is a sparsity of data about third space endoscopy in American community hospitals. Focusing on proper training through mentorship, industry sponsored courses, appropriate indications can allow for a successful implementation of TSE program within a community hospital. Future research should focus on outcomes in TSE outside of academic institutions.

Purpose of review: Food protein-induced allergic proctocolitis (FPIAP) is a frequent cause of rectal bleeding in otherwise healthy infants. Although benign and self-limited, wide variation in diagnostic and management practices often leads to overdiagnosis, unnecessary dietary restriction, and disruption of breastfeeding. This review summarizes contemporary evidence to guide a pragmatic, challenge-anchored approach to diagnosis and management.

Recent findings: Diagnosis of FPIAP remains clinical, based on symptom resolution after elimination and recurrence upon reintroduction of the trigger food; however, confirmatory challenges are seldom performed. Fecal calprotectin and other proposed biomarkers-such as eosinophil-derived neurotoxin, zonulin, and microbiome signatures-show poor reliability in infants and are not ready for clinical use. Management should prioritize the least restrictive diet - maternal dairy elimination for breastfed infants and extensively hydrolyzed formulas for formula-fed infants - only in challenge-proven FPIAP. Growing data support earlier reintroduction once colitis resolves, and early introduction of other allergens may reduce future IgE-mediated allergy risk. A standardized, challenge-confirmed framework minimizes over-restriction and supports continued breastfeeding. Future priorities include validation of non-invasive biomarkers and trials comparing timing and strategies for safe dietary reintroduction in FPIAP.

Purpose of review: Follicular lymphoma (FL) is the most common indolent B-cell lymphoma, yet primary gastrointestinal FL (GI-FL) remains poorly defined, and treatment of relapsed/refractory cases is controversial. This review aims to critically evaluate the role of CD19-directed chimeric antigen receptor (CAR) T-cell therapy in nodal and GI-FL, highlighting key clinical trials and the unique biological considerations of GI involvement.

Recent findings: Pivotal trials such as ZUMA-5, ELARA, and TRANSCEND FL have demonstrated high overall and complete response rates with durable progression-free survival in patients with relapsed/refractory FL. Liso-cel in particular has shown a favourable efficacy-toxicity balance, including in patients with transformed disease or progression within 24 months (POD24). However, data specific to GI-FL are scarce, and emerging evidence suggests that its microenvironment, immune checkpoint expression, and mutational profile may influence CAR-T responses differently from nodal FL. CD19 CAR-T therapy represents a major therapeutic advance for relapsed/refractory FL and holds promise for patients with advanced or high-risk GI-FL. Nonetheless, the rarity of GI-FL, limited dedicated clinical data, and challenges such as treatment-related toxicities, costs, and accessibility warrant further prospective studies. Integrating biomarker-based patient selection and GI-FL-specific trial designs will be crucial to optimise the application of CAR-T therapy in this distinct subtype.

Purpose of review: Rectal prolapse in the pediatric population presents a clinical challenge with wide variability in etiology, presentation, work-up and management. In this article, we reviewed the evidence supporting various medical and surgical treatment options as well as the recent trends amongst pediatric surgeons.

Recent findings: Medical therapy is highly effective in most patients, with bowel management programs being particularly successful. Nonetheless, medically refractory disease, often seen in older children and in children with behavioral/psychiatric disorders, can be challenging. Sclerotherapy with ethanol or 5% phenol can be effective local treatments. 15% hypertonic saline, 50% dextrose, and Deflux are additional safe alternatives. Perianal procedures and perineal procedures are less invasive surgical options, but transabdominal rectopexy appears to be the favored treatment for disease refractory to local treatment. Transabdominal rectopexy with sigmoidectomy, the recommended operation in the adult population for patients with prolapse and constipation, appears only to be preferred in the pediatric population for postoperative recurrences.

Recent findings: While outcomes of medical treatment for pediatric rectal prolapse are excellent, sclerotherapy and transabdominal rectopexy are effective options for refractory disease preferred by most pediatric surgeons.