Expert Review of Gastroenterology & Hepatology最新文献

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: 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: 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: 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.

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.

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: 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).