Expert Review of Gastroenterology & Hepatology最新文献

Introduction: Colonoscopy is widely accepted as the gold standard modality for colorectal cancer (CRC) screening and polyp surveillance. Colonoscopy has been shown to decrease the incidence and mortality of CRC and is the ground truth test to which new and alternative CRC screening modalities are compared. In the U.S., more than 15 million colonoscopies are performed yearly for CRC screening, and the procedure is accepted as safe and effective. However, there are important limitations of colonoscopy for CRC screening that remain unresolved and continue to limit the maximal usefulness of this procedure.

Areas covered: This article will highlight some of the recognized limitations of colonoscopy for CRC screening, including high costs, access and compliance barriers, preparation difficulties, complications, and performance variability.

Expert opinion: Colonoscopy is the gold-standard test for CRC screening but is subject to significant limitations. There have been important efforts directed toward mitigating the limitations of colonoscopy for CRC screening, and these efforts have the potential to expand and enhance the use of colonoscopy as a CRC screening test in the future.

Introduction: Chronic intestinal failure (CIF) is a rare condition characterized by inadequate intestinal absorption requiring long-term parenteral nutrition (PN). Given etiological shifts and expanding therapeutic options, we provide an updated review covering CIF definitions, epidemiology and multidisciplinary management in adults, based on recently published studies (2012-2025).

Areas covered: We conducted a scoping review of recent literature, registry data and guideline recommendations to summarize contemporary trends in CIF.Short bowel syndrome remains the leading cause of CIF, though the etiological profile has shifted toward surgical complications and active malignancy. Advances in the multidisciplinary and multimodal management with safer PN formulations, chyme reinfusion therapy, and disease-modifying pharmacotherapies such as glucagon-like peptide-2 analogues have transformed outcomes, while intestinal transplantation is reserved for selected cases. Preventing complications and focusing on quality of life (QoL) are central to long-term management.

Expert opinion: CIF prevalence continues to rise worldwide, though accurate data remain inconsistent. As patient complexity rises, long-term outcomes increasingly depend on complication prevention and centralized, multidisciplinary care delivered by expert centers. In the next five years, the convergence of pharmacological, surgical, digital and organizational innovations will enhance enteral autonomy, reduce PN-related complications and improve patients' QoL, providing a more equitable and effective model of CIF care worldwide.

Introduction: Recent advances in physiology and technology have led to the identification of additional parameters that have the potential to enhance diagnostic accuracy and inform the management of Gastroesophageal reflux disease (GERD). Whilst traditional pH monitoring and acid exposure time (AET) remain central to diagnosis, recent advances have introduced novel physiological markers that improve diagnostic accuracy, especially in cases where results are inconclusive.

Areas covered: This review summarizes recent advances in predicting abnormal acid reflux. Novel physiologic indices include baseline impedance as markers of mucosal integrity, and the post-reflux swallow-induced peristaltic wave (PSPW) as a measure of chemical clearance. High resolution esophageal manometry (HRM) provides indirect evidence through EGJ contractile integral (EGJ-CI), multiple rapid swallows, and straight leg raise testing. Finally, artificial intelligence (AI) offers powerful methods to automate reflux event detection, PSPW calculation, and endoscopic classification, reducing interobserver variability and supporting precision diagnosis.

Expert opinion: While AET remains central, novel physiologic metrics and AI integration substantially enhance prediction of abnormal acid reflux, particularly in patients with borderline findings. The standardization of thresholds and validation in large multicentre studies is required for the establishment of these tools in clinical practice.

Introduction: Per-oral endoscopic myotomy (POEM) is a minimally-invasive, effective treatment option in patients with non-spastic and spastic achalasia, and is continuously evolving toward a personalized, tailored approach for patients.

Areas covered: This article reviews the procedural aspects of POEM, its efficacy in the treatment of non-spastic and spastic achalasia, adverse events, and how it compares to other first-line therapies including pneumatic dilation and laparoscopic Heller myotomy with partial fundoplication. It also describes the evolution of tailored therapy in patients, including short-tailored myotomy in non-spastic achalasia and manometry-directed myotomy in spastic achalasia. This review is based on data from randomized controlled trials, systematic reviews, meta-analyses, and comparative studies from PubMed over the past 20 years, and primarily over the past 5-10 years.

Expert opinion: POEM has continuously moved toward personalized medicine, offering tailored therapy to a patient's specific phenotype. Delivering effective therapy while minimizing the major disadvantages of POEM (e.g. gastroesophageal reflux, esophagitis, and blown-out myotomy) would be a milestone in achalasia therapy. A movement toward a short-tailored myotomy in non-spastic achalasia and manometry-directed therapy for spastic achalasia may provide these answers.

Introduction: Intestinal disorders such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and colorectal cancer (CRC) are rising in prevalence worldwide. Despite medical advances, many patients experience persistent symptoms and impaired quality of life (QoL), highlighting the need for integrative, non-pharmacological approaches.

Areas covered: This review explores the physiological and clinical impact of yoga therapy in intestinal disorders, examining its effects on neural, intestinal, and microbial pathways. A structured literature search was conducted in PubMed for studies published from database inception to August 2025, to identify relevant clinical trials and meta-analyses across IBS, IBD, and CRC. Evidence suggests yoga improves symptom control, stress resilience, QoL, and may exert anti-inflammatory and neuromodulatory effects.

Expert opinion: Yoga therapy presents a low-risk, potentially cost-effective adjunct to conventional care, with applicability across diverse gastrointestinal conditions. Future integration into clinical practice will depend on overcoming barriers such as protocol variability, lack of clinician awareness, and limited reimbursement. Advancements in biomarker research, digital therapeutics, and personalized treatment models will shape the field. In the next decades, yoga therapy may become a standard, personalized component of integrative care in gastroenterology.

Introduction: Multiparametric intestinal ultrasound (MPUS) has emerged as a valuable, noninvasive tool for the diagnosis, monitoring, and phenotyping of inflammatory bowel diseases (IBD), offering real-time assessment of bowel wall structure, vascularity, and stiffness.

Areas covered: This review discusses the latest advancements in intestinal ultrasound, including contrast-enhanced ultrasound (CEUS), elastography, and ultrasound microvascular imaging (UMI). These techniques enhance the characterization of inflammation and fibrosis, help differentiate between inflammatory and fibrotic strictures, detect complications such as abscesses or phlegmons, and monitor therapeutic response. The narrative is based on a comprehensive analysis of recent literature identified through a PubMed search conducted up to September 2025. with a focus on clinical applicability, technical methodology, and current evidence supporting each modality.

Expert opinion: MPUS represents a transformative evolution in IBD imaging, particularly in point-of-care and longitudinal disease management. Despite its strong potential, widespread adoption is limited by technical variability, operator dependency, and lack of standardization. Future integration into clinical practice will require multicenter validation, standardized protocols, and training programs. The development of AI-assisted tools and targeted CEUS may soon elevate MPUS from a structural to a functional and molecular imaging modality, opening the door to personalized, precision-based IBD care.

Introduction: Reliable biomarkers for monitoring inflammatory bowel disease (IBD) remain an unmet clinical need, particularly in patients receiving biologic therapies where C-reactive protein (CRP) responses may be attenuated. Leucine-rich alpha-2 glycoprotein (LRG) is a novel acute-phase reactant regulated by multiple cytokines, potentially less dependent on interleukin-6 than CRP.

Areas covered: This narrative review synthesizes recent Japanese real-world data and emerging international literature on LRG, outlining its biological characteristics, early clinical applications, and evidence in ulcerative colitis and Crohn's disease. Key topics include correlations with clinical, endoscopic, and histologic activity; proposed cutoff values; comparisons with conventional biomarkers; diagnostic performance in small bowel disease; and its role in therapeutic monitoring, including postoperative assessment.

Expert opinion: LRG shows strong correlations with mucosal and transmural inflammation across IBD phenotypes, retains sensitivity in biologic-treated patients or those with normal CRP, and predicts treatment response. Its rapid turnaround and noninvasive nature make it well suited to treat-to-target strategies. However, most evidence originates from Japan, limiting generalizability until confirmed in large, multicenter international cohorts. Broader adoption will require assay standardization, validation across diverse populations, and integration into composite indices to optimize individualized care. If validated globally, LRG could transform precision monitoring and enhance outcomes in clinical practice.

Introduction: Cirrhosis is associated with significant risk of comorbidity and early mortality. Cardiopulmonary exercise testing has the advantage of allowing cardiac, pulmonary and muscle function assessment and could have a better prognosis value than the usual assessment of cardiorespiratory function often evaluated at rest in patients with cirrhosis.

Methods: We reviewed electronic databases (PubMed, Scopus, Embase, Google Scholar) for relevant literature running up to April 2024.

Results: This review gathers the data from 3029 patients with cirrhosis from 62 studies. Patients with cirrhosis had lower cardiorespiratory fitness (CRF) than age-matched healthy subjects and reference values were meta-analyzed. VO2Peak (mL.min-1.kg-1) and anaerobic threshold (mL.min-1.kg-1) were significantly lower in Child-Pugh C compared to A (p = 0.009) and B (p < 0.001). Supervised exercise proved effective for improving VO2Peak (p < 0.001) before and after transplantation (p < 0.001), but not when conducted in a home-based setting (p = 0.569). Liver transplantation initially (at three months) results in a minor decrease in CRF, but over time (at 12 months) leads to an improvement in CRF.

Conclusion: This meta-analysis provides reference values for CRF in patients with cirrhosis and shows the benefits of supervised physical exercise before and after liver transplantation. CRF could help clinicians to prioritize patients on the LT waiting list.

Introduction: Inflammatory bowel disease (IBD) commonly affects young women and frequently overlaps with peak reproductive years. Despite this overlap, there remains limited data on the safety and efficacy of IBD treatments during pregnancy and lactation, and many gastroenterology trainees report limited exposure to managing pregnant patients with IBD. Optimal management of IBD in pregnancy ideally starts before conception, with a goal of at least 3 months of steroid-free remission. The preconception period is critical for patient education and therapeutic optimization for patients with IBD. Optimized management during pregnancy and lactation is necessary to prevent adverse maternal and fetal outcomes.

Areas covered: In this review, we discuss latest evidence on the safety and efficacy of available IBD therapies during conception, pregnancy, and lactation. Medications discussed include 5-aminosalicylates, biologic therapies, calcineurin inhibitors, Janus kinase inhibitors, corticosteroids, immunomodulators, and sphingosine 1-phosphate receptor modulators.

Expert opinion: While most IBD therapies can be safely continued during pregnancy and lactation. Patient education during the preconception period is critical for maintenance of remission during pregnancy and postpartum. Evidence-based research and representation of pregnant patients with IBD in future studies are necessary to address existing knowledge gaps to optimize maternal and neonatal outcomes.