Current Gastroenterology Reports最新文献

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.

Purpose of review: To review and assess current design approaches in endoscopic mucosal resection (EMR) trials, identify areas where traditional methodologies may limit relevance or generalizability, and propose a forward-looking framework that incorporates methodological innovations aligned with clinical and stakeholder priorities.

Recent findings: Despite major procedural advances in EMR, trial design has evolved more slowly - employing binary endpoints, limited patient and clinician input, and enrollment models often led by high-volume proceduralists. Critical design innovations, such as ordinal recurrence classifications, composite outcomes ranked by clinical severity, and proceduralist-aware statistical models can help to overcome these limitations. Introducing methodology such as generalized pairwise comparisons yielding a win ratio, while useful for analyzing hierarchical composite endpoints (HCEs), represent just one facet of a broader strategy. Drawing from innovations in cardiovascular and other procedural disciplines, this review highlights how diverse design elements can be adapted to the EMR space. Improving EMR trials demands a shift in trial architecture. By combining stakeholder-informed outcome hierarchies, advanced analytic methods, and strategies to mitigate operator bias, a modern framework capable of producing more meaningful, reproducible, and generalizable evidence is possible. This evolution in design reflects a necessary progression for procedural trials and sets the stage for a new standard in colorectal polyp resection research.

Purpose of review: Traditional abdominal ultrasound for monitoring inflammatory bowel disease is known as Intestinal ultrasound (IUS). This is a non-invasive, point-of-care imaging tool that is utilized to visualize the bowel wall and its layers. IUS was initially used for assessment of small bowel Crohn's disease (CD) but has now proven to be just as accurate for colonic disease.

Recent findings: IUS can detect disease activity in both ulcerative colitis (UC) and colonic CD with high sensitivity and specificity when compared to colonoscopy. The sonographic parameter of bowel wall thickness (BWT) is key for detecting disease activity. The ease and reproducibility of IUS allows for rapid assessment of treatment response in both outpatient and inpatient settings with changes seen as early as 48 h after initiating appropriate treatment. IUS has proven to be useful in special populations, including pregnancy and pediatrics, where traditional methods of monitoring are less feasible or of higher risk. IUS is a useful tool for objective assessment of colonic disease activity in colonic UC or CD.

Purpose of review: This review examines the debated association between cholecystectomy and colorectal cancer risk. The goal is to evaluate biological mechanisms, epidemiological evidence, and related risk factors to better understand this potential association.

Recent findings: Cholecystectomy may increase CRC risk through altered bile acid metabolism and gut microbiota changes, particularly in the right colon. Epidemiological studies, however, yield mixed outcomes: some show a heightened CRC risk following surgery, especially in women and for proximal colon cancers, while others find no notable link or even a lower risk compared to individuals with untreated gallstones. No clear consensus exists on the cholecystectomy-CRC link. Biological evidence hints at a possible connection, yet epidemiological findings are inconsistent, calling for more prospective research to resolve this uncertainty. Until conclusive answers emerge, high-risk patients' post-cholecystectomy may benefit from enhanced CRC screening and lifestyle adjustments, influencing future clinical and research directions.

Purpose of review: Eosinophilic colitis (EoC) has an increasing association with inflammatory bowel disease (IBD), and there is a paucity of data on the natural history of EoC. Here, we provide a comprehensive overview of EoC and critically evaluate the evidence supporting its potential association with, or evolution into IBD.

Recent findings: Experts currently classify EoC as one of the eosinophilic gastrointestinal disorders (EGID) beyond eosinophilic esophagitis (EoE). Transcriptomic analyses have demonstrated a distinct molecular signature for EoC. However, recent studies suggest that a subset of patients with EoC may progress to develop IBD. The key predictive factors include high eosinophilic density on colonic biopsy and poor response or relapse following standard therapy. Emerging evidence suggests that EoC may precede or overlap with IBD. The lack of standardized diagnostic criteria and limited longitudinal data hinder firm conclusions and warrant future prospective multicenter studies. Available current literature suggests that clinicians should be vigilant with persistent or severe symptomatic patients despite standard treatment to evaluate for IBD.

Purpose of review: This review summarizes current landscape of colonoscopy quality metrics, with an emphasis on priority intraprocedural indicators. We aim to clarify the rationale, evidence, and practical implementation of both traditional and recently introduced metrics-highlighting which measures are most relevant for improving patient outcomes in 2025.

Recent findings: The 2024 ACG/ASGE guidelines reaffirmed the core quality indicators of adenoma detection rate (ADR), cecal intubation rate (CIR), bowel preparation adequacy, and guideline-based surveillance interval assignment. The guidelines also introduced new metrics such as sessile serrated lesion detection rate (SSLDR), adenomas per colonoscopy (APC), extended withdrawal time, and a distinct ADR benchmark for colonoscopies following positive fecal screening. Altogether, these updates reflect a shift toward more granular, detection-focused metrics. The traditional quality indicators remain the cornerstone of high colonoscopy quality due to their feasibility in most clinical settings and established correlation with reducing post-colonoscopy colorectal cancer rates (PCCRC). New detection-based metrics, particularly SSLDR and APC, have independent impacts on lowering PCCRC, but unique challenges in becoming widely adopted. We advocate for endoscopists to establish a strong foundation of traditional colonoscopy quality metrics while working towards establishing systems to monitor novel quality metrics like SSLDR and APC. Quality measurement, whether automated or manually tracked, remains the key to delivering high-quality, cancer-preventing colonoscopy.

Purpose of review: Brain-gut behavior therapies (BGBTs) comprise of several behavioral and psychological therapies such as cognitive-behavioral therapy or gut-directed hypnotherapy that are effective at improving symptom management and quality of life for patients with a range of neurogastroenterology and motility disorders. This review highlights recent advances in BGBT approaches, including novel delivery methods to improve access to care.

Recent findings: Traditional BGBT approaches have evolved to more effectively target GI-specific psychological processes, with exposure techniques and mindfulness-based skills emerging as important elements of treatment. BGBTs are also being delivered in new ways, including digital formats, to expand access to care. Digital therapeutics show promise; however, feasibility of these tools in clinical practice remains unclear. BGBTs continue to evolve to address the complex needs of patients with Disorders of Gut-Brain Interaction (DGBI) and are being applied more broadly to treat the full spectrum of DGBI conditions. Novel delivery methods show promise; however, further research is needed to identify real-world effectiveness of digital treatments and to identify patients most likely to benefit.

Purpose of review: This review article aims to summarize the safety and efficacy of medical therapies in elderly inflammatory bowel disease (IBD) patients contextualizing the therapies within the framework of polypharmacy, comorbidities and frailty.

Recent findings: Anti-TNF therapies are the most extensively studied advanced therapy in elderly IBD patients. Based on most published studies, elderly IBD patients on anti-TNF therapy versus no advanced therapy demonstrate decreased treatment persistence that could be attributed to both diminished clinical response and increased adverse events. Caution should be used when considering Janus Kinase inhibitors in the elderly given the risk of infection and the possible increased risk of thrombosis. The majority of literature on the medical management of elderly IBD patients revolves around retrospective and observational studies. Further prospective research is required in the areas of disease pathophysiology, comparative effectiveness of therapies and frailty to better inform clinical practice. Multidisciplinary care models can best position elderly IBD patients to obtain optimal outcomes.

Purpose of review: This review explores the evolving role of neoadjuvant therapy (NAT) in the management of gastrointestinal (GI) malignancies, emphasizing its impact on surgical resectability, tumor downstaging, and survival outcomes. It examines how NAT is reshaping traditional surgical approaches across GI cancers.

Recent findings: Recent evidence highlights the integration of chemotherapy, radiotherapy, immunotherapy, and targeted therapies in NAT protocols for esophageal, gastric, colorectal, pancreatic, and hepatobiliary cancers. Studies report improved R0 resection rates, reduced lymph node positivity, and enhanced eligibility for organ-preserving procedures. Precision medicine and artificial intelligence are emerging as tools to refine patient selection and predict therapeutic responses. NAT has transformed GI cancer care from a surgery-first model to a multimodal, biology-driven approach. While its benefits are substantial, challenges persist in toxicity management and treatment optimization. Future research should focus on refining protocols, enhancing predictive models, and advancing personalized therapeutic strategies to maximize patient outcomes.