Expert Review of Gastroenterology & Hepatology最新文献

Introduction: Occult B infection (OBI) represents a mild form of hepatitis B characterized by low-level HBV-DNA in the absence of positive serum HBsAg. OBI is associated with liver disease and HBV transmissibility, although to a lesser extent than overt (HBsAg+) chronic hepatitis B.

Areas covered: Residual HBV replication in the liver of OBI patients has been associated with i) increased risk for cirrhosis and/or liver cancer, ii) HBV transmission to recipients of organs or hemoderivates, iii) overt HBV reactivation under immunosuppression, and iv) extrahepatic manifestations.We searched PubMed with the keywords "occult hepatitis B," "occult B infection" or "OBI.'

Expert opinion: The WHO has called for reducing 90% new HBV infections and 65% HBV-related mortality by 2030. The persistence of low-level virus replication in persons who cleared serum HBsAg is challenging. OBI misdiagnosis has emerged as a major obstacle for global HBV elimination. Efforts for unveiling OBI carriers are warranted, increasing clinical suspicion and expanding testing. New diagnostic tools, including more sensitive HBsAg and HBV-DNA tests and novel HBV-RNA and HBcrAg assays, may help unveil OBI carriers. Furthermore, point-of-care HBV-DNA assays will allow testing larger populations for OBI. New antivirals should target this form of hidden hepatitis B.

Introduction: Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) represent an increasing global health challenge for modern medicine. Europe and Asia have responded with region-specific guidelines -respectively, European Association for the Study of the Liver (EASL)-European Association for the Study of Diabetes (EASD)-European Association for the Study of Obesity (EASO) for MASLD and Asian Pacific Association for the Study of the Liver (APASL) for MAFLD- that reflect different epidemiology, clinical priorities and healthcare systems.

Areas covered: We compare the two guidelines on the basis of three main points: 1) definitions and diagnostic strategies, 2) treatment and in particular lifestyle and pharmacological options, and 3) surveillance approaches.

Expert opinion: Both guidelines agree on the central role of lifestyle management and early diagnosis. However, there are several differences in diagnosis, pharmacotherapy, and surveillance. The European approach supports targeted fibrosis assessment using fibrosis-4 and transient elastography. On the other hand, the Asian-Pacific framework provides broader coverage, including special populations. What our analysis suggests is a harmonization, to be reached via global consensus, that balances precision medicine with inclusivity and that supports collaborative, cross-regional research that focuses on closing the gaps of current knowledge.

Background: Colorectal cancer (CRC) is a leading cause of global cancer-related mortality and morbidity, with rising incidence in Sub-Saharan African countries over the past decade. This study aims to determine the prevalence, and describe location, as well as histopathology of polyps in patients undergoing colonoscopy in Ghana. The prevalence and polyp characteristics provide additional data and have implications for developing locally relevant screening guidelines.

Research design and methods: Retrospective chart review of patients ≥18 years who completed a colonoscopy at the anonymized from 1 January 2021 to 31 December 2023.

Results: 510 patients were included in the analysis. The mean age was 54.8 (±0.7 SD); 62% were males. Abnormal findings included hemorrhoids (47.1%), polyps (30.0%), diverticular disease (10.2%), and colonic mass (2.4%). Overall adenoma detection rate (ADR) was 26.1%. Histopathology showed 30.8% tubular adenoma, 30.1% hyperplastic polyps, and 16.0% tubulovillous adenoma. The highest burden of polyps was in the 60- to 80-year-old age group. The prevalence of CRC was 2.2% in our study.

Conclusions: CRC prevalence rates remain relatively low in Sub-Saharan Africa. Access to screening is limited, and the numbers may be underestimated. A cost-effective screening strategy to improve early detection and outcomes is needed.

Introduction: Liver cancer, particularly hepatocellular carcinoma (HCC), is a leading cause of cancer-related mortality worldwide. Traditional imaging techniques including CT and MRI provide valuable anatomical data but often overlook the liver's functional heterogeneity, which is crucial for accurate diagnosis and personalized treatment.

Areas covered: This review explores advancements in functional imaging modalities, including contrast-enhanced ultrasound (CEUS), diffusion-weighted imaging (DWI), dynamic contrast-enhanced MRI (DCE-MRI), and PET/CT, which provide detailed insights into tumor biology and treatment response in HCC. CEUS enables real-time assessment of hepatic microvascular perfusion with excellent temporal resolution and without ionizing radiation. DCE-MRI and perfusion CT permit time-resolved quantification of perfusion kinetics and vascular permeability, offering surrogate biomarkers of tumor angiogenesis and treatment response. PET/CT, through tracers captures regional variations in metabolism, reflecting tumor viability and functional reserve.

Expert opinion: Collectively, these modalities advance precision imaging by linking physiological and metabolic information to morphologic findings, thereby improving diagnostic accuracy, risk stratification, and therapy monitoring in hepatocellular carcinoma.

Introduction: The diagnostic management of biliary strictures remains a complex clinical challenge requiring evidence-based guidance. Multiple societies, including the European Society of Gastrointestinal Endoscopy (ESGE), American College of Gastroenterology (ACG), and American Society for Gastrointestinal Endoscopy (ASGE), have recently published guidelines with both consensus and divergence.

Areas covered: A comparative analysis of the ESGE, ACG, and ASGE guidelines reveals shared principles, such as the role of MRI/MRCP in initial evaluation (moderate quality evidence), limited utility of tumor markers alone (low to very low quality evidence), and preference for metal stents in palliation (moderate quality evidence). Key differences arise in tissue acquisition for perihilar strictures, with ACG/ASGE discouraging EUS-guided sampling in surgical candidates (low-quality evidence), while ESGE conditionally supports its use in non-resectable cases candidates (low-quality evidence). The ASGE provides conditional recommendations on bilateral stenting for malignant hilar obstruction, not emphasized in other guidelines.

Expert opinion: Although founded on similar evidence, guideline variations reflect differing risk tolerance and resource considerations. Clinicians must recognize these nuances to tailor management. Future research should clarify EUS seeding risk, evaluate cost-effectiveness, and inform harmonized guideline updates.

Introduction: Investigative work in pediatric liver disease is rapidly growing. Despite noninvasive methods in place for several years, the medical liver biopsy is still a critical step for diagnosing and treating pediatric patients. We provide a narrative review focusing on indications, procedures, and histopathology of pediatric liver biopsy.

Areas covered: We searched the PubMed, Scopus, and Cochrane databases for articles on pediatric liver biopsy, discussing the clinical implications of several procedures and their associated costs. We also complemented our search by digging into the gray literature (e.g., reports, abstracts, textbooks, and Google Scholar) for similar items. The search for articles was conducted between 1 January 2022, and 31 July 2025.

Expert opinion: Pediatric liver biopsy is not limited to data gathered following formalin-fixation and paraffin-embedded liver tissue. It includes frozen tissue-based special stains, such as the oil red-O stain for lipids; a specimen devoted to ultrastructural analysis using a transmission electron microscope; and a flash-frozen tissue specimen used for future transcriptomics and genomic studies (e.g., single-nucleotide polymorphisms).

Introduction: Primary biliary cholangitis (PBC) is a rare, chronic autoimmune cholestatic liver disease causing progressive destruction of intrahepatic bile ducts. Predominantly affecting women aged 35 to 70, PBC may remain asymptomatic for years before symptoms such as pruritus, fatigue, or sicca symptoms manifest. If untreated, PBC can progress to cirrhosis, liver failure and need for transplantation, significantly impacting life expectancy.

Areas covered: Ursodeoxycholic acid (UDCA) remains the only approved first-line therapy. The recent withdrawal of obeticholic acid (OCA) from the European market, the only available second-line agent since 2016, highlighting the need for alternative options. The recent European Medicine Agency (EMA) approval of new peroxisome proliferator-activated receptor (PPAR) agonists is promising for patients with suboptimal response to UDCA. A literature review was conducted to map the patient journey and examine current treatments.

Expert opinion: A panel of Italian expert hepatologists was involved to explore unmet needs along the patient journey and define clinical priorities. Focus areas included response monitoring, treatment evaluation timing, symptoms management - particularly pruritus and fatigue - and care of comorbid and high-risk patients. Many patients live with indolent disease, but some may require a more structured pathway, where emerging treatments can be an important turning point.

Background: First-degree family history of gastric cancer is a risk factor for gastric cancer and precancerous conditions, but only a few studies exist regarding the endoscopic follow-up of these patients. This study investigates endoscopic and histological findings over a 15-year period in patients with first-degree relatives of gastric cancer intestinal type who underwent follow-up upper gastrointestinal endoscopies.

Research design and methods: We conducted a retrospective real-world observational study involving patients who underwent at least two upper gastrointestinal endoscopies between 2008 and 2023 at Sant'Andrea Hospital, Rome. The study analyzed histological findings, dividing participants into four subgroups based on their baseline conditions [H. pylori infection, gastric atrophy, intestinal metaplasia, dysplasia].

Results: One hundred and six patients were included, only 13% were indicated for follow-up endoscopy according to the MAPS guidelines. An additional 13% of patients developed precancerous conditions, most of whom were H. pylori positive at the index examination, with an odds ratio risk of 6.778 (p = 0.004).

Conclusions: Performing routinely virtual chromoendoscopy during the index endoscopy in these patients could improve the detection of precancerous conditions. Special attention should be given to H. pylori-positive patients due to their increased risk of developing precancerous conditions, for whom follow-up endoscopies may be beneficial.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder in children and is increasingly recognized as a multisystem condition. Among its extrahepatic manifestations, gastrointestinal (GI) comorbidities significantly influence disease progression and long-term outcomes. A deeper understanding of the liver - gut pathophysiological interplay is essential for developing integrated, multidisciplinary management strategies.

Areas covered: This narrative review summarizes current evidence on hepatic and GI comorbidities in pediatric MASLD. A comprehensive literature search was conducted across PubMed, EMBASE, and Google Scholar to identify relevant studies published to date. Beyond disease progression, the review highlights the wide spectrum of GI comorbidities, potential malignancy risks, and emerging pathophysiological insights that may inform the development of targeted therapeutic strategies.

Expert opinion: MASLD is a significant early-life risk factor for various GI comorbidities, highlighting the need for thorough GI assessment in pediatric MASLD management. Early detection, prevention, and comprehensive management are essential to reduce long-term complications and slow disease progression. Developing pediatric-specific guidelines and validated noninvasive biomarkers is crucial to enable standardized screening, risk stratification, and monitoring. Continued research - especially incorporating omics technologies - is vital for improving risk prediction, enabling earlier diagnosis, and advancing personalized therapies, ultimately enhancing outcomes and reducing disease burden.