Expert Review of Gastroenterology & Hepatology最新文献

Introduction: Bariatric surgical interventions such as laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), One-Anastomosis Gastric Bypass (OAGB) and Laparoscopic Adjustable Gastric Banding (LAGB) have proven to be effective in long-term management of obesity. These procedures result in changes in anatomy and in motor and secretory function of the gastrointestinal (GI) tract.

Areas covered: This review covers the changes in gastrointestinal motility and their consequences observed after the various types of bariatric surgery. A systematic literature search on motility disorders of esophagus, stomach, small and large bowel until August 2025 was performed (PubMed).

Expert opinion: Esophageal motility: a higher prevalence of dysphagia and post-obesity surgery esophageal dysfunction (POSED) is seen after bariatric surgery due to gastric restriction (intragastric high-pressure zone, esophageal outflow obstruction). Gastroesophageal reflux disease (GERD) is already common in people with obesity and may significantly increase after bariatric surgery depending on the type of procedure (LSG, not RYGB). Gastrointestinal motility: bariatric surgery results in significant acceleration of gastric emptying and of small intestinal transit (LSG > RYGB) with delay in colonic transit. Clinical considerations relevant for preoperative work-up, selection of bariatric procedure-type and postoperative follow-up of GI-motility disorders induced by bariatric surgery have been provided.

Background: Human albumin (HA) infusion may be effective for improving hypervolemic hyponatremia in cirrhosis. However, it remains unclear about whether HA dosage can influence its efficacy.

Methods: Overall, 288 cirrhotic patients with ascites and hypervolemic hyponatremia were retrospectively included and divided into high-dosage (>80 g) and low-dosage (≤80 g) HA groups during the period from the first hyponatremia diagnosis to the last HA infusion. Multivariate logistic regression analyses were performed to explore the impact of HA dosage on hyponatremia and serum albumin (ALB) level, and evaluate the impact of improvement of ALB on hyponatremia. Subgroup analyses were performed according to the baseline serum ALB level.

Results: High-dosage HA was independently associated with normalization of hyponatremia (OR = 1.919, p = 0.040) and improvement of ALB (OR = 3.001, p < 0.001). The effect of high-dosage HA on normalization of hyponatremia (OR = 2.108, p = 0.028) and improvement of ALB (OR = 2.926, p = 0.001) remained significant in patients with a baseline ALB level of <30 g/L. Improvement of ALB was independently associated with normalization of hyponatremia (OR = 2.108, p = 0.014). The effect remained significant in patients with a baseline ALB level of <30 g/L (OR = 2.228, p = 0.019).

Conclusions: High-dosage HA should be superior to low-dosage HA for correcting hypervolemic hyponatremia in cirrhosis, especially in those with a baseline ALB level of <30 g/L, probably due to its significant benefit in the improvement of ALB.

Introduction: Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is one of the few cancers with a 5-year survival below 25%, largely driven by frequent late-stage diagnoses. Historically, viral etiologies have been the leading causes of HCC; however, the rising prevalence of metabolic risk factors including obesity and diabetes, in parallel with increasing alcohol misuse, has resulted in increasing proportions of HCC due to non-viral etiologies.

Areas covered: This review summarizes HCC prevention, including established approaches such as hepatitis B vaccination and antiviral therapies, as well as emerging strategies tailored to non-viral etiologies. The review also discusses existing surveillance modalities and highlights emerging strategies including blood-based biomarkers, imaging modalities, and artificial intelligence (AI) models.

Expert opinion: Traditional prevention strategies face challenges with the shifting liver disease patterns. Emerging approaches, including lifestyle modifications and pharmacological therapies, show promise but require further evaluation in contemporary populations. Advances in surveillance may help overcome underutilization, improve early-HCC detection, and increase curative treatment receipt.

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions of pancreatic ductal adenocarcinoma, and clinical markers of increased risk of extra-pancreatic malignancies (EPMs). However, the true burden, organ-specific risks, and optimal screening strategies for EPMs in this population remain unclear.

Areas covered: This review summarizes current evidence on the association between IPMNs and EPMs, focusing on colorectal, gastric, breast, lung, and renal cancers. Geographic and ethnic differences in cancer distribution are examined, with gastric cancer predominating in East Asian populations and breast or renal cancer more common in Western cohorts. Potential mechanisms linking IPMNs to systemic carcinogenic susceptibility are discussed. A structured literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases for studies published up to June 2025.

Expert opinion: Twenty-three studies (n = 9899 IPMN patients) revealed a consistently increased risk of colorectal cancer (SIRs 1.5-3.0), followed by gastric, breast, lung, and renal cancers. Gastric cancer was notably overrepresented in East Asian cohorts, while breast and renal cancers were more frequent in Western populations. Screening colonoscopy at IPMN diagnosis and upper endoscopy in East Asians are strongly supported. Broader, risk-adapted EPM surveillance integrating genetic and demographic factors is warranted.

Introduction: Autoimmune gastritis (AIG) is traditionally classified as an organ-specific autoimmune disease; however, emerging evidence highlights its immunological overlap with systemic autoimmunity, warranting a reevaluation of its pathophysiological framework.

Areas covered: This review delineates the immunopathogenic basis of AIG, with particular emphasis on the breakdown of central and peripheral tolerance, the predominance of autoreactive CD4⁺ T-cell subsets, and the contributions of Th1 and Th17 cytokine profiles. The role of humoral immunity, including autoantibodies as potential biomarkers, is critically appraised. Literature was selected through a targeted search of PubMed and Scopus, prioritizing mechanistic studies, translational research, and recent therapeutic advances, covering the period from January 2000 to March 2025.

Expert opinion: AIG represents a paradigm of localized autoimmunity with systemic immunological features, including cytokine dysregulation and epitope spreading. Although serologic markers are valuable for screening, their prognostic utility remains limited. Therapeutic approaches currently focus on complication prevention rather than immune modulation. Future research should prioritize the identification of predictive biomarkers of disease progression and the development of targeted immunotherapies aimed at restoring immune tolerance and preserving gastric mucosal integrity.

Introduction: Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, often affects individuals during their peak reproductive years. Female patients with IBD face unique challenges across the reproductive years, from fertility and conception to delivery and lactation. Despite increasing awareness, knowledge gaps remain regarding optimal management during pregnancy and postpartum. This review outlines these challenges and provides a practical, evidence-based approach across reproductive stages.

Areas covered: This review summarizes care for IBD in reproductive years, including preconception counseling, pregnancy management, delivery planning, surgical, and perianal disease considerations, postpartum care, breastfeeding, and infant vaccination after biologic exposure.

Expert opinion: Managing IBD from preconception through the postpartum period requires early planning, multidisciplinary coordination, and patient-centered care. Disease remission is the strongest predictor of maternal and fetal outcomes. Most IBD therapies, including biologics, are safe in pregnancy and lactation and should continue, except small molecules, which remain contraindicated due to teratogenic risk or limited safety data. Rotavirus and other vaccinations can generally be administered on schedule in infants exposed to biologics in utero. A proactive, treat-to-target strategy throughout pregnancy, combined with close postpartum monitoring, can prevent disease flares and support optimal outcomes for both mother and child.

Introduction: Metabolic-associated steatotic liver disease (MASLD) represents a prevalent and multifaceted systemic condition, characterized by its intricate interplay of obesity, type 2 diabetes, and various metabolic perturbations. Given its complexity, MASLD necessitates a comprehensive multidisciplinary strategy for both prevention and management.

Areas covered: Each of the experts who contributed to this review has made an in-depth review of the literature within their field of knowledge using PubMed. This review covers nutrition, physical activity and exercise, type 2 diabetes mellitus, cardiovascular risk factors, psychological approach, and clinical care by hepatologists in MASLD patients.

Expert opinion: Adherence to the Mediterranean diet and engagement in exercise have been shown to ameliorate and potentially reverse MASLD. The hepatologist plays a pivotal role in diagnosis, assessment of liver comorbidities, and disease staging, emphasizing lifestyle modification and tailored therapy. Nutritionists are vital in dietary interventions, while specialists in sports medicine are essential for overcoming sedentary lifestyles, requiring fitness evaluations to customize exercise prescriptions. Psychological support addresses social and adherence challenges, enhancing patient management. Additionally, metabolic medicine experts are crucial for managing associated comorbidities, including cardiovascular risk factors and type 2 diabetes.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are approved for diabetes, obesity, and metabolic liver disease, but are also used off-label for other conditions. Adverse events associated with GLP-1RAs have become evident with their increased use.

Areas covered: This review characterizes GLP-1 physiology and GLP-1RA effects on gastrointestinal (GI) function and symptoms. A comprehensive literature search was conducted accessing PubMed and EMBASE databases from July 1987 through August 2025. Effects of GLP-1RAs on parameters of dysfunctional GI transit and motility and symptoms potentially associated with these impairments are highlighted. The additional impact of GLP-1RA induced gastric food retention on the risk for pulmonary aspiration during anesthesia is a focus of concern. Extraintestinal complications including biliary tract disease and pancreatitis are discussed. Management of GLP-1RA adverse events is reviewed including adjustment of dosing protocols, dietary modifications, and pharmacotherapy to target GI symptoms, however these recommendations lack evidence-based support. New GLP-1RAs are in testing, many with action on other incretin pathways, but these may have adverse consequences similar to existing agents.

Expert opinion: Prospective investigations of multicenter databases are advocated to transform management approaches of these GLP-1RA induced GI functional consequences and adverse symptoms from empiric treatments to more evidence-based protocols.

Introduction: Carcinoid syndrome (CS) is a complex condition caused by the systemic release of bioactive substances from neuroendocrine neoplasms (NENs), particularly small bowel tumors (sbNENs). Its symptoms-flushing, abdominal pain, and diarrhea-often resemble irritable bowel syndrome (IBS), resulting in misdiagnosis and delayed therapy.

Areas covered: This review examines the pathophysiology of CS, especially serotonin overproduction and its effects on gut motility and secretion. The overlap between CS and IBS is analyzed, with emphasis on diagnostic pitfalls and warning signs. Distinctive features include "dry" flushing without sweating, typical of CS, versus "wet" or emotional flushing in IBS or anxiety. Poor response to standard IBS treatments and symptom exacerbation after specific foods or alcohol may also indicate CS. The utility of biomarkers such as 5-HIAA and imaging modalities including intestinal ultrasound and 68 Ga-DOTATATE PET/CT is discussed. A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library for English-language studies published between January 2000 and March 2024.

Expert opinion: Early recognition of subtle differences and red-flag symptoms, combined with appropriate use of biomarkers and imaging, can minimize misdiagnosis. Timely identification of CS may improve patient outcomes by enabling earlier and more effective interventions.