Expert Review of Gastroenterology & Hepatology最新文献

Introduction: Lower gastrointestinal (GI) defects, including leaks, perforations, and fistulas, pose significant challenges for diagnosis and management. These conditions are associated with high morbidity and mortality rates, necessitating effective treatment strategies to restore GI continuity and improve patient outcomes.

Areas covered: This special report examines current evidence and future perspectives on the endoscopic management of lower GI defects. A literature search was conducted in PubMed, Google Scholar, and Scopus for studies published up to July 2025 that focused on the endoscopic management of lower GI defects. It provides an overview of various endoscopic techniques, including clips, endosuturing, stents, endoscopic internal drainage, endoscopic vacuum therapy, and emerging regenerative approaches, and their underlying advantages and limitations. The need for more standardized and larger studies to establish guidelines has been addressed.

Expert opinion: Endoscopy is increasingly being recognized as a therapeutic option for lower GI defects, offering less invasive alternatives to traditional surgery. The challenges in developing standardized protocols are due to diverse clinical scenarios and limited prospective data. Future advancements are expected in technologies and personalization of treatments. A multidisciplinary approach is essential to achieve optimal outcomes in this complex field.

Introduction: Inflammatory Bowel Diseases (IBD) are chronic immune-mediated disorders diagnosed in both adult and pediatric populations. In recent years, there has been a significant global increase in pediatric-onset IBD, not only in Western countries but also in newly industrialized regions. Age of onset plays a crucial role in disease behavior and prognosis, with pediatric onset often associated with a more extensive and aggressive disease. As a systemic inflammatory condition, IBD can involve multiple organ systems beyond the gastrointestinal tract, thus resulting in extraintestinal manifestations (EIMs) of variable severity. These manifestations (musculoskeletal, dermatological, oral, ocular, and hepatobiliary) may significantly impact patients' quality of life, sometimes even more than intestinal symptoms. To support this review, a PubMed search was conducted using the terms inflammatory bowel disease, Crohn's disease, ulcerative colitis, pediatric inflammatory bowel disease, extraintestinal manifestations, focusing on the most relevant papers with no time restrictions.

Areas covered: This review aims to provide a comprehensive revision and comparison of the presentation, course, and management of EIMs in pediatric- versus adult-onset IBD.

Expert opinion: A deeper understanding of EIMs in different age groups is essential for timely diagnosis and holistic care, ultimately improving the overall quality of clinical management of patients with IBD.

Introduction: The relationship between chronic atrophic gastritis and dyspeptic symptoms has been suggested since the early 20th century, however, current evidence is scarce and no study has sistematically assessed this link.

Areas covered: We conducted a narrative review to assess the association between chronic atrophic gastritis (either corpus-restricted or multifocal) and dyspeptic symptoms based on the available evidence. A literature search was conducted on PubMed up to February 2025, using the SANRA scale. About 30% of patients with corpus atrophic gastritis report dyspeptic symptoms, while the prevalence of dyspepsia in patients with corpus atrophic gastritis was about 8%. Other issues addressed were: the pathogenetic mechanisms involved in dyspeptic symptoms generation, the topographic assessment of gastric atrophy, the characterization of dyspeptic symptoms and the paucity of available medical treatment.

Expert opinion: In the coming years, more rigorous studies should be conducted to achieve a deeper understanding of the association between corpus atrophic gastritis and dyspeptic symptoms, to better elucidate the pathogenetic mechanisms underlying this link, and to evaluate possible treatment options.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum of conditions from simple steatosis to advanced fibrosis that may represent the cradle for hepatocellular carcinoma. Thus, an accurate assessment of fibrosis is critical for patient management. Noninvasive tools, including serum biomarkers and imaging techniques, have emerged as practical alternatives to liver biopsy, which presents limitations for invasiveness, cost, and sampling variability.

Areas covered: In this review, we examined references from relevant articles on PubMed, to investigate the most used noninvasive scores, focusing on their specific applications in various pathological conditions, including those beyond the liver. The application of these tools is particularly vital in challenging subpopulations, where conventional metabolic risk factors may be absent, or to target new therapeutical approaches. Sex-specific differences in hormonal and metabolic profiles, however, influence fibrosis progression and the interpretation of noninvasive tools, necessitating further refinement to optimize their clinical utility.

Expert opinion: Despite these complexities, integrating noninvasive scores with imaging techniques has proven effective in stratifying risk, guiding treatment decisions, and improving long-term outcomes. As research continues to enhance these tools, their routine use in clinical practice represents a cornerstone for the early detection, monitoring, and personalized management of MASLD with sex-specific cutoffs.

Introduction: Ulcerative colitis is a chronic inflammatory condition of the colon driven by aberrant immune activation. Although advanced medical therapies form the cornerstone of ulcerative colitis management, unmet needs include failure to induce and sustain remission in a substantial proportion of patients and in managing acute severe ulcerative colitis. We review new treatment strategies that might improve patient outcomes in the management of moderate-to-severe ulcerative colitis.

Areas covered: A literature search was conducted using the PubMed database, including studies published from inception to October 2024, selected for their relevance. Recognizing current limitations, this article reviews strategies to improve treatment outcomes in ulcerative colitis using advanced therapies. These approaches include early treatment initiation, dose optimization, positioning newer agents as first-line therapies, combination therapy, targeting novel therapeutic endpoints, and the management of acute severe ulcerative colitis.

Expert opinion: The strategies discussed may contribute to establishing new standards of care aimed at achieving long-term remission and enhancing patient outcomes. Personalized therapy, which tailors treatment based on individual disease characteristics and risk factors, is anticipated to become a critical aspect of delivering more effective care in the future.

Introduction: Acute liver failure (ALF) is a rare syndrome characterized by acute severe liver dysfunction and hepatic encephalopathy. The etiology of ALF varies according to age and geographical distribution and hence management depends on the etiology and clinical condition.

Areas covered: While high-income-countries (HIC) most often see acetaminophen (APAP) and drug-induced liver injury (DILI) as causes of ALF, low-middle-income countries (LMIC) face a higher burden of viral hepatitis (particularly hepatitis A and E virus) and herbal/traditional/toxin medicine-related ALF transplant-free survival from ALF continues to improve with corresponding reduced rates of intracranial hypertension and cerebral edema particularly in APAP-ALF.

Expert opinion: In this review, we will provide an update on the epidemiology and management of ALF with a particular focus on the differences in worldwide populations.

Introduction: Advancements in therapeutic endoscopy have expanded the management of gastrointestinal (GI) diseases. Procedures such as endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR) frequently result in iatrogenic GI defects requiring secure closure to prevent complications like bleeding and perforation. While through-the-scope clips (TTSCs) are effective for small defects, larger or full-thickness defects necessitate alternative closure techniques.

Areas covered: This review discusses the endoscopic closure devices, including TTSCs, over-the-scope clips (OTSCs), and endoscopic suturing systems. A structured literature search was conducted using PubMed and Embase, focusing on device efficacy, retention rates, and safety outcomes. Novel closure devices and robotic-assisted techniques are also discussed.

Expert opinion: The choice of closure technique depends on defect size, location, and tissue characteristics. TTSCs are suitable for small mucosal defects, while OTSCs and suturing devices enable robust closure for full thickness defects. While endoscopic suturing offers high closure strength, technical expertise is required. In near future, robotic-assisted endoscopy may enhance precision and efficiency of resection as well as closure of post-resection defects. Further research should focus on refining closure techniques and optimizing device selection to improve clinical outcomes.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide and a major cause of morbidity and mortality. Portal hypertension (pHTN), previously thought to occur only with cirrhosis, is now recognized in MASLD even before advanced fibrosis, due to endothelial dysfunction and increased portal pressure. This underscores the need for early, noninvasive detection and treatment.

Areas covered: This review examines the pathophysiological mechanisms leading to pHTN in MASLD, highlighting the role of vascular remodeling and endothelial dysfunction in portal pressure elevation. Although hepatic venous pressure gradient remains the gold standard for diagnosis, its invasive nature requires alternative strategies. This article discusses emerging noninvasive techniques, including imaging modalities and circulating biomarkers reflecting intrahepatic resistance, liver injury, and inflammation, that may improve early detection and risk stratification of pHTN in MASLD. A comprehensive literature search was performed in PubMed and Embase for studies published between January 2000 and June 2025.

Expert opinion: Given the increasing burden of MASLD, noninvasive assessment of pHTN is essential. The combination of imaging and biomarkers could improve diagnosis and guide treatment. Future research should validate these tools and develop targeted therapies to prevent pHTN progression and improve outcomes.

Introduction: Food insecurity, the household-level socio-economic condition of having limited or uncertain ability to acquire adequate and safe food, has affected 13.8 million households in the United States in 2020 and is a cofactor in the onset and worsening of metabolic dysfunction-associated steatotic liver disease (MASLD).

Areas covered: To illustrate the epidemiological evidence linking MASLD with food insecurity, and the potential pathobiological mechanisms underlying their association we searched the PubMed, Web of Science, and Scopus database from inception to April 2025 for relevant keywords pertaining to the topic. Finally, we discuss promising areas of future research in this field.

Expert opinion: Research on food insecurity contributes to the establishment of the biopsychosocial disease model in the MASLD field. Understanding the broader sociocultural factors influencing food choices, which may disproportionately affect certain vulnerable populations, can help shift the focus from individual responsibility to a more comprehensive approach to addressing obesity-related metabolic dysfunction. Future studies should focus on quantifying descriptors of food insecurity more effectively. Additionally, further research is necessary to determine whether and to what extent global cultural advancements and specific education in food security can prevent and reverse the negative outcomes of food insecurity-associated MASLD.

Introduction: Historically, irritable bowel syndrome (IBS) has been classified as a functional disorder, diagnosed through symptom-based criteria and managed by a uniform algorithm. However, current research suggests IBS may represent a group of disorders, each with an organic basis, such as post-infectious changes to the intestinal tract, inflammation, and immune activation, gut-brain axis dysfunction, bile acid dysregulation, or gut microbiome irregularities.

Areas covered: This literature review examines the historical classification of IBS, the revisions/changes in diagnostic criteria over time, and innovative research into potential causes of the disease. Key advances including bile acid profiling, stool microbiome analysis, mast cell markers, and breath testing are explored. Additionally, emerging treatments targeting these mechanisms are reviewed. These include microbiome-directed therapies, including antibiotics, probiotics, anti-inflammatory agents, and bile acid modulators. The literature search included peer-reviewed studies, clinical trials, and meta-analyses from major medical databases.

Expert opinion: Although existing symptom-based diagnostic criteria for IBS have been useful, they have contributed to a situation whereby current treatments address symptoms, not the underlying causes. Approaching IBS as a constellation of diseases with individual organic bases will allow the development of more precisely targeted and effective treatments.