Current Gastroenterology Reports最新文献

Purpose of review: The purpose of this review is to summarize key features of the epidemiology of pancreatic cystic lesions (PCLs), highlight the most common PCLs encountered in clinical practice, review relevant guideline recommendations, and briefly introduce innovative new diagnostic and therapeutic technologies in the field, particularly as they relate to the care of elderly patients.

Recent findings: While CT and MRI are mainstays of diagnostic studies for PCLs, endoscopic ultrasound with fine-needle aspiration and cyst fluid analysis can considerably improve the accuracy of presurgical diagnosis. Surgical interventions remain associated with considerable morbidity. While surveillance of certain lesions is appropriate, surveillance is associated with considerable monetary costs and can cause undue anxiety for patients. There remains uncertainty regarding the optimal management strategy of PCLs given the lack of high-quality evidence to guide recommendations. Management decisions for PCLs, be it for surveillance, surgical resection, or invasive diagnostics, should be highly personalized and based on the unique risk-benefit analysis for a given lesion. Especially in elderly populations, physicians should have informed conversations with patients regarding the likelihood of a given PCL meaningfully affecting quality-of-life or life-expectancy.

Purpose of review: The purpose of this review is to provide gastroenterologists a basic understanding of what anal squamous intraepithelial lesions (ASILs) are, how they develop, who are the high-risk populations, who and how to screen, and management of these lesions.

Recent findings: Human papilloma virus (HPV) infection is the most common cause of squamous cell carcinoma of the anus. Anal intraepithelial neoplasia is a precursor to the development of anal squamous cell carcinoma, and screening can lead to early detection and cure. Despite the availability of HPV vaccination for primary prevention, the mortality from squamous cell carcinoma of the anus continues to rise. ASILs are precursor lesions to anal cancer, and with proper detection and treatment, the risk of anal cancer progression can be lessened. We discuss the screening and surveillance of these lesions, and their further management when high-grade dysplasia or cancer develops.

Purpose of review: This review provides an update on the management of Helicobacter pylori (H. pylori) infection in children and adolescents, incorporating newly available data and highlighting how it differs from adults. It explores emerging diagnostic tools and evolving therapeutic approaches to improve eradication rates.

Recent findings: Pediatric data confirm that antimicrobial resistance rates are rising, mirroring trends in the adult population. Novel molecular methods to assess H. pylori antimicrobial susceptibility demonstrate good correlation with culture and are less dependent on transport conditions, timing, and laboratory expertise. These assays, already studied in adults, show promise in pediatric populations, particularly in patients with upper gastrointestinal bleeding, and may eventually extend to stool-based applications. Recent large studies in both high- and low-incidence populations confirm that H. pylori eradication reduces gastric cancer risk in adults, while emerging pediatric studies report on the prevalence and natural history of premalignant lesions. New therapeutic strategies include antibiotic and acid suppression dose optimization, and incorporation of new agents such as potassium-competitive acid blockers. Advances in molecular diagnostics and acid-suppressive therapies have the potential to significantly improve H. pylori eradication in children. While guideline endorsement is pending, these innovations may reduce reliance on repeated empiric therapies and increase the likelihood of successful, tailored treatment.

Purpose of the review: Review the efficacy and safety of IL2319 inhibitors in the management of IBD.

Recent findings: Risankizumab, mirikizumab, and guselkumab have been found to be efficacious and safe in the management of IBD. IL23p19 inhibitors have been found to be successful in the management of IBD. The new class of biologics adds to the growing armamentarium of medical options and could additionally prove beneficial as dual therapy.

Purpose of review: This review reframes enteral nutrition in critically ill patients as a targeted therapy rather than simple support. It asks whether Mediterranean-style, bioactive-rich formulas containing omega-3 fatty acids, polyphenols, and glutamine can modulate key pathways in sepsis, endothelial dysfunction, and fibrotic remodeling, and whether ICU feeding should be personalized by disease severity, immune profile, and genetic factors.

Recent findings: Recent evidence shows these bioactive agents have potent anti-inflammatory, antioxidant, and nutrigenomic effects. They influence cytokine signaling, oxidative stress, and endothelial-to-mesenchymal transition, offering molecular targets for attenuating organ injury. Personalized, metabolism-guided enteral nutrition enriched with Mediterranean bioactive foods may improve tolerance, reduce organ dysfunction, and enhance recovery by directly modulating pathological gene programs. Integrating nutrigenomics into ICU care could transform feeding practices. The review calls for clinical trials to validate these approaches and establish evidence-based guidelines linking diet composition to genetic responses and patient outcomes.

Purpose of review: This review examines various colon-targeted drug delivery systems (CTDDS) and their implications for the treatment of colonic disorders.

Recent findings: Recent studies have demonstrated substantial advancements in CTDDS by the development of pH-dependent, enzyme-responsive, and time-controlled formulations designed for enhancing site-specific delivery and reducing systemic adverse effects. Advanced methodologies, such as ligand or receptor-mediated targeting and multifunctional systems that incorporate various triggering mechanisms, are demonstrating encouraging outcomes in improving therapeutic efficacy. Furthermore, innovative methods like pressure, osmotic-controlled systems, and 3D printing technologies are also being explored for their ability to ensure precise drug release in the colonic region. CTDDS enables localized, controlled therapy, which has the potential to enhance colonic disease outcomes. Integrating the knowledge of the colon's physiology with new delivery technologies may help future research and facilitate the development of more effective treatments.

Purpose of review: ESD adoption in Western countries has been limited by longer procedure times, higher complication rates, and a steeper learning curve than in Eastern centers. This review examines the rationale for traction in Western practice, compares outcomes of traction-assisted versus conventional ESD, and outlines best practices for common techniques.

Recent findings: Traction methods such as clip-with-line, clip-and-snare, internal elastic devices, double-scope, and novel single-operator tools function as a "third hand" to improve submucosal visualization and dissection. Meta-analyses show that traction shortens procedure time (~20 minutes), increases R0 resection rates, and may reduce perforation risk-benefits most evident in the esophagus and colon. Western data are emerging: an expert U.S. center found no major differences with selective use, whereas Japanese RCTs and European guidelines support routine traction in defined settings. Traction addresses key challenges in Western ESD. Mastery of multiple methods allows tailored use, shortens the learning curve, and improves efficiency and safety.

Purpose of review: Since its introduction in 2010, peroral endoscopic myotomy (POEM) has reshaped the management of esophageal motility disorders. Originally designed for achalasia, it has expanded into a versatile therapeutic option for a range of esophageal conditions. This review summarizes current evidence on the role of esophageal POEM (E-POEM) across diverse pathologies.

Recent findings: Emerging data suggest favorable outcomes of E-POEM for non-achalasia disorders, including spastic esophageal disorders, esophagogastric junction outflow obstruction (EGJOO), diverticular disease, revisional therapy, and other rare indications. However, the evidence remains limited, and careful patient selection is essential before offering treatment. E-POEM has progressed from a procedure for classical achalasia to a promising approach for complex and refractory esophageal conditions. Its broader application may be beneficial when performed in appropriately selected patients under expert hands.

Purpose of review: Complicated Crohn's disease in the small bowel is often associated with structural complications, particularly strictures. Endoscopy plays a key role in the diagnosis, disease monitoring, and therapy of small bowel CD. This article will provide state-of-the-art endoscopic treatment modalities for small bowel complications in CD.

Recent findings: Endoscopic therapy for small bowel disease can be delivered through upper endoscopy, push enteroscopy, ileocolonoscopy, device-assisted enteroscopy, intraoperative enteroscopy, and ileoscopy. In addition to persistent medical therapy, endoscopic treatment is performed using bare- or drug-coated balloon dilation, electrocision, and mechanical stricturectomy. Isolated ileocecal valve CD with associated stricture and adjacent fistulas comprises a unique phenotype of CD, mimicking the clinical presentation and disease course of achalasia at the gastroesophageal junction. Ileocecal valve CD can be treated with stricturectomy and fistulotomy. Endoscopy also has a major role in the treatment of surgery-associated anastomotic complications (such as stricture, bleeding, and leaks). Endoscopic treatment should be attempted in patients with short (<4-5) small bowel strictures on top of medical therapy. Isolated ileocecal valve CD represents a unique phenotype of CD consisting of inflammation, stricture, and fistula at and around the valve, which is amenable for endoscopic therapy.

Purpose of review: This review summarizes the current understanding of portal hypertensive colopathy (PHC), highlights the clinical and endoscopic presentation, treatment options to be considered and areas for future investigation.

Recent findings: Portal hypertensive colopathy (PHC) is an underrecognized consequence of portal hypertension in cirrhosis. It frequently presents with subtle gastrointestinal symptoms, such as iron deficiency anemia or intermittent rectal bleeding, and is often misattributed to more common etiologies like hemorrhoids or diverticular disease. PHC is a diagnosis made endoscopically and is characterized by erythema of the colonic mucosa, vascular lesions and colon varices. Management focuses on portal pressure reduction, endoscopic colon therapies and intra-vascular procedures. Due to a lack diagnostic criteria, the true prevalence of PHC is unknown but has been reported to be up to 71% among cirrhotic patients. The management of acute bleeding from PHC is based on case reports, case series and expert opinion. PHC should be considered in all cirrhotic patients with unexplained lower GI bleeding or chronic anemia. A high index of suspicion is required in order to make a timely and accurate diagnosis.