Expert Review of Gastroenterology & Hepatology最新文献

Introduction: The degree of fibrosis is the most significant indicator of clinical prognosis in chronic liver disease (CLD). While liver biopsy remains the gold standard for assessing liver disease activity and fibrosis, its invasive nature, potential complications, and high cost have spurred the development of alternative diagnostic methods. This has led to significant interest in noninvasive, cost-effective, and easily replicable techniques for evaluating liver fibrosis. Among these noninvasive tests, vibration-controlled transient elastography (VCTE) has emerged as the most extensively researched and validated imaging-based method for staging liver fibrosis.

Areas covered: A selective literature search was conducted across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on VCTE. Randomized controlled trials, meta-analyses, systematic reviews, evidence-based clinical practice guidelines and selected expert consensus statements and narrative reviews were included.Given its increasing use, clinicians must know common pitfalls in VCTE applications when evaluating CLD. This review aims to outline these potential errors and provide evidence-based guidelines to help clinicians avoid them, thereby improving the accuracy and utility of VCTE in clinical practice.

Expert opinion: The future of VCTE involves improved accuracy, accessibility, and integration, leading to earlier detection and personalized management of CLD.

Introduction: Asymptomatic bile duct stones are increasingly diagnosed by imaging studies. Guidelines recommend endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of bile duct stones, but evidence regarding short- and long-term outcomes of asymptomatic bile duct stones remains inadequate.

Area covered: This review summarized evidence about clinical outcomes and technical tips of ERCP for asymptomatic bile duct stones through a literature search of PubMed until March 2025. Long-term outcomes including cholangitis, cholecystitis, biliary pancreatitis, and spontaneous passage of bile duct stones among patients who selected the wait-and-see strategy were also summarized. According to the recent evidence of short- and long-term outcomes, we discussed the pros and cons of each treatment option and proposed a treatment strategy for asymptomatic bile duct stones.

Expert opinion: Despite guideline recommendations for endoscopic removal, ERCP for asymptomatic bile duct stones is associated with a high incidence of post-ERCP pancreatitis (PEP) and clinicians need to mitigate the risk of PEP by including administration of non-steroidal anti-inflammatory drugs, prophylactic pancreatic stent, or peri-procedural aggressive hydration. Considering the probability of spontaneous stone passage, the wait-and-see strategy might be a treatment option.

Introduction: Adipose-derived mesenchymal stem cells (ADMSCs) are being increasingly explored in regenerative medicine because of their accessibility and potent immunomodulatory properties. Their application is gaining traction in gastroenterology, where inflammation and tissue degeneration are central to disease progression.

Areas covered: This review aims to provide an in-depth overview of the biological mechanisms, therapeutic effects, and clinical applications of ADMSCs, focusing on gastrointestinal disorders. We conducted a narrative literature review of relevant studies in PubMed, Google Scholar, and Scopus, covering key findings from gastroenterology, cardiology, neurology, orthopedics, and plastic surgery (editor comment#4b). Original studies evaluating ADMSCs use in gastroenterology and related medical fields were included. Data were organized to illustrate the cellular pathways, cytokine profiles, and paracrine signaling mechanisms through which ADMSCs exert therapeutic effects. ADMSCs consistently reduced inflammation, enhanced tissue repair, and modulated immune responses.

Expert opinion: In gastroenterology, ADMSCs have demonstrated potential in the treatment of inflammatory bowel disease and liver disorders by promoting mucosal healing and limiting fibrosis. They hold significant promise because of their robust immunomodulatory and regenerative properties. Future studies should focus on refining the isolation methods, validating therapeutic protocols, and establishing safety and efficacy through controlled trials to bring ADMSCs into clinical practice.

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality in patients with cirrhosis and carries a substantial public health burden. Primary liver cancer is the sixth most common cancer worldwide. Despite guideline recommendations for HCC surveillance, pooled surveillance rates are around 18%. Further, racial, ethnic, and socioeconomic disparities exist. Along the HCC care continuum, care gaps exist from access to care, to surveillance, and ultimately in linkage to treatment.

Areas covered: A literature search was performed utilizing PubMed to review peer-reviewed articles published from 2000 to present. Key landmark studies are reviewed highlighting the care gaps in cirrhosis management, HCC surveillance, and treatment. These studies underscore the complex interplay of systems, provider, and patient level factors that influence care gaps experienced by patients with HCC.

Expert opinion: Despite low adherence to HCC surveillance and care gaps, there are several opportunities to ensure equitable access to care while achieving personalized, precision medicine. Future efforts will need to focus on multi-disciplinary care while ensuring that providers are knowledgeable and able to provider culturally competent care.

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.