Current Gastroenterology Reports最新文献

Purpose of review: Achalasia is characterized by impaired lower esophageal sphincter (LES) relaxation, while Barrett's esophagus (BE) is typically associated with gastroesophageal reflux disease (GERD) which can occur with excess LES relaxation. This article will provide an overview of the diagnostic challenges, surveillance strategies, and management approaches in the coexistence of these two conditions.

Recent findings: Data on outcomes and management of concurrent BE and achalasia are limited. Most commonly, GERD and subsequent BE may occur after therapies for achalasia directed at increasing LES relaxation, and recent papers have focused on GERD and BE outcomes after achalasia therapies. The coexistence of BE and achalasia represents a challenging clinical scenario that requires consideration of the pathophysiology, diagnostic approach, and management strategies for both conditions.

Metabolic dysfunction-associated steatohepatitis with significant fibrosis is the aggressive form of steatotic liver disease that can progress to cirrhosis and its complications. Resmetirom is a liver-directed thyroid hormone receptor beta agonist that recently received accelerated approval by the FDA based on the results of the MAESTRO trial that demonstrated reasonable safety and efficacy in achieving both MASH resolution and fibrosis regression based on histological assessment. In this review, we discuss the resmetirom clinical development program, the use of noninvasive tests to select and monitor patients for treatment, and different aspects of the utility of resmetirom in the real world.

Purpose of review: The goal of this review is to provide practical guidance for gastroenterologists regarding diagnosis and management of inflammatory bowel disease associated spondyloarthritis.

Recent findings: While there is limited data regarding optimal management approaches, we summarize available screening tools along with classification and consensus criteria that can be deployed in this setting and offer guidance regarding patient symptoms, physical exam findings, laboratory data, and imaging strategies that may facilitate diagnosis. In addition, we outline various therapeutic options available while highlighting deficits in the currently available literature. Inflammatory bowel disease associated spondyloarthritis is common but remains poorly understood. Ongoing research to establish a clear diagnostic pathway and reproducible treatment targets is essential to better identify and treat this patient population.

PURPOSE OF REVIEW: Gastroesophageal reflux disease is prevalent and has a complex pathophysiology. Though medications are first line, a significant proportion of patients are refractory to this treatment and require anti-reflux surgery (ARS). Though surgery has proven safe and effective, most patients and referring providers are reluctant. Anti-Reflux Mucosectomy (ARMS) provides a less invasive alternative treatment option. This review aims to report our experience with ARMS, discuss other technical variations used, and future directions. Recent Findings In our experience, we note improvement in dysphagia with the modified butterfly-shaped mucosal resection, leading to shorter length of stay, quicker recovery, and equivalent QOL outcomes compared to ARS. We note similar efficacy and safety profiles for anti-reflux mucosal ablation, anti-reflux mucosectomy with cap-assisted mucosal resection, peroral endoscopic cardial constriction, and resection and plication. ARMS and its variations show safety and efficacy as alternative non-invasive treatment options for appropriately selected patients with refractory GERD.

Purpose of review: Dysbiosis can disrupt intestinal barrier integrity and impact the immune and nervous systems, playing a significant role in developing disorders of gut-brain interaction (DGBI). This review aims to provide a comprehensive understanding of dysbiosis and its role in DGBI while examining the latest advancements in fecal microbiota transplantation (FMT). It also highlights key challenges in the field and outlines critical directions for future research to optimize FMT strategies, ultimately improving patient outcomes in this evolving treatment area.

Recent findings: In DGBI, dysbiosis triggers immune responses, increases gut permeability, and disrupts nervous system signaling, with contributing factors including diet, antibiotics, stress, and infections. Individuals with DGBI exhibit distinct microbial imbalances, such as an increased Firmicutes-to-Bacteroidetes ratio and reduced beneficial bacteria. FMT has shown mixed results, with factors like patient selection, treatment protocols, and microbiome diversity influencing outcomes. While FMT can improve symptoms in refractory irritable bowel syndrome (IBS), effects may fade over time, requiring repeat treatments. Future FMT approaches should focus on targeted microbial interventions, considering the role of archaea, fungi, and microbial metabolites, while prioritizing optimal donor selection and large-scale trials for long-term efficacy. Despite the promising findings, FMT has not yet been widely endorsed in clinical guidelines due to the variability and heterogeneity of the data available. While much of the research has focused on IBS, studies have also explored the impact of FMT on other conditions such as functional diarrhea, functional constipation, and functional dyspepsia, which all exhibit altered microbial profiles.

Purpose of review: This review summarizes the current understanding of the physiologic influence of GLP-1 RAs on gastrointestinal motility, highlights key clinical implications of these effects, and defines areas for future investigation.

Recent findings: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have revolutionized the treatment of diabetes and obesity and are increasingly being identified as promising therapies for a wide range of conditions. GLP-1 RAs mimic naturally occurring GLP-1, an enterohormone produced in response to oral intake that regulates glucose metabolism and promotes weight loss. While GLP-1 RAs target a wide range of organ systems, their impacts on gastrointestinal motility are widely regarded as a major mechanism by which they exert their metabolic effects. However, the drugs' alterations in gut motility may account for many of their commonly reported adverse effects including nausea, vomiting, early satiety, dyspepsia, and bowel habit changes. GLP-1 RAs alter gastrointestinal motility at all levels of the GI tract, with delayed gastric emptying being the most well characterized. The effects of GLP-1 RAs on gastrointestinal motility have important clinical implications, including possible increased periprocedural aspiration risk and potential challenges with medication adherence and tolerability.

Purpose of review: Postpartum anorectal and pelvic floor disorders (PFD) are common, though under-recognized. There is limited knowledge regarding their diagnosis, treatment, and prevention. Here we provide a critical review of this topic and highlight knowledge gaps and treatment options for these problems.

Recent findings: Recent advances include dynamic 3D and 4D ultrasound of the pelvic floor to reveal pathology, anal sphincter defects, and pelvic organ prolapse. Treatments for fecal incontinence include anal inserts, vaginal inserts, translumbosacral neuromodulation therapy (not yet studied postpartum), and increasing data for safety of sacral nerve stimulators in pregnancy. Exercise, pelvic floor muscle training, and use of special devices show mixed results. Postpartum anorectal and pelvic floor disorders include fecal and/or flatus incontinence, constipation, hemorrhoids, pelvic organ prolapse, and urinary incontinence. Many patients present years later, and most suffer in silence. Early recognition, appropriate treatment, and preventative measures could mitigate these problems.

Purpose of review: With endoscopic advances water/saline have been widely adopted as alternatives for CO2 insufflation in endoscopy and its use has been advocated in wide array of endoscopic procedures, both diagnostic and therapeutic. This review aims to highlight the applications and advantages of underwater endoscopy in comparison to conventional techniques.

Recent findings: Underwater endoscopy was initially described with water insertion and water exchange techniques to aid difficult insertions during colonoscopy. Its application has now expanded to U-EMR, U-ESD as well as underwater third space endoscopy, where in many scenarios it has been shown to be superior to conventional endoscopy. Underwater endoscopy offers a new dimension in gastrointestinal endoscopic procedures with various advantages over conventional techniques, rapidly making it the preferred approach for various procedures which could otherwise be challenging.

Purpose of review: Perianal fistulizing Crohn's disease (PFCD) is a severe and debilitating phenotype of Crohn's disease that presents significant clinical and therapeutic challenges. This review aims to outline a practical approach to classification and management, emphasizing the utility of the TOpClass system.

Recent findings: The TOpClass classification incorporates clinical and anatomic characteristics to assess severity, treatment options, and patient-clinician goals. Post-hoc analyses from clinical trials for the Janus kinase inhibitor Upadacitinib and emerging data on IL-23 receptor antagonists suggest potential roles beyond anti-TNFs, while the broader use of mesenchymal stem cell therapy remains limited due to inconsistent efficacy. Fistula conditioning with curettage and internal opening closure-an underutilized technique-alongside adjunctive therapies such as hyperbaric oxygen therapy (HBOT), has shown promise in promoting wound healing in select patients. The TOpClass classification, by integrating patient-centered factors and multidisciplinary management, offers a comprehensive and adaptable framework for PFCD, addressing key gaps in treatment planning, standardization, and research. The classification will enable tailored, evidence-based care across the disease spectrum.