Expert Review of Gastroenterology & Hepatology最新文献

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.

Introduction: Oropharyngeal dysphagia (OD) is a common but underdiagnosed condition associated with serious complications such as malnutrition, aspiration pneumonia, and increased mortality. Spontaneous swallowing frequency (SSF) has recently emerged as a potential noninvasive biomarker for dysphagia screening.

Areas covered: This narrative review explores the current state of knowledge on SSF in both healthy individuals and patients with OD, including stroke, Parkinson's disease, head and neck cancer, and cerebral palsy. The review discusses the physiological and neurological bases of SSF, summarizes the available measurement techniques (such as acoustic, electromiography, accelerometry), and examines its diagnostic and therapeutic implications. The literature search was conducted in PubMed, Scopus, and Web of Science, without publication date restrictions; studies included were published between 1965 and 2023. Literature was selected based on relevance, novelty, and methodological robustness, focusing on recent clinical studies and technical advances.

Expert opinion: SSF holds promise as a clinical tool to assess brainstem function and detect dysphagia, particularly when integrated with AI-based systems. However, standardization of methods and large-scale validation are essential for its widespread implementation. In the future, SSF may complement existing assessments, enabling earlier and more precise management of OD.

Introduction: Metabolic dysfunction associated steatotic liver disease (MASLD) is prevalent among patients with type 2 diabetes mellitus (T2DM) and is a growing cause of morbidity and mortality in Western countries. MASLD contributes to serious complications in individuals with T2DM, such as hepatocellular carcinoma, variceal bleeding, hepatic decompensation, and death.

Areas covered: Via a search of Pubmed, Google Scholar, and Embase (no date restrictions) this review explores the rationale for screening for MASLD in patients with T2DM and highlights the nutritional, pharmacological, and interventional advantages of early diagnosis. In particular, we examine the effectiveness of novel anti-fibrotic therapies, recently assessed in clinical trials. Alongside these potential benefits, we consider the financial implications for the healthcare system and possible adverse effects on patients. To contextualize the discussion, we compare MASLD screening with the established diabetic retinopathy screening program in England and reference the World Health Organization's principles for disease screening.

Expert opinion: Currently, there is insufficient evidence to support the implementation of a MASLD screening program for patients with T2DM. Key evidence gaps remain, particularly regarding: (1) the natural history of MASLD in patients with T2DM; (2) optimal timing and utilization of novel anti-fibrotic therapies; and (3) the impact of screening on major adverse liver outcomes compared to targeted testing approaches.

Introduction: Gastroesophageal reflux disease (GERD) is a common condition characterized by heartburn and regurgitation, affecting up to 20% of the adult population in Western countries. While proton pump inhibitors (PPIs) effectively manage symptoms for many, about 30% of patients experience refractory symptoms, emphasizing the need for accurate diagnostic techniques and potential surgical interventions. This review discusses the integration of various diagnostic tools such as high-resolution manometry, impedance-pH monitoring, and endoscopic evaluations in preoperative assessments. These modalities help in confirming GERD, evaluating esophageal motility, and identifying conditions like Barrett's esophagus, which are crucial for determining the appropriateness of anti-reflux surgery such as laparoscopic fundoplication. Through a comprehensive diagnostic approach, clinicians can enhance patient selection, optimize surgical outcomes, and manage the increasing prevalence of GERD effectively.

Areas covered: This review discusses the integration of various diagnostic tools such as high-resolution manometry, impedance-pH monitoring, and endoscopic evaluations in preoperative assessments. These modalities help in confirming GERD, evaluating esophageal anatomy and motility, which are crucial for determining the appropriateness of anti-reflux surgery such as laparoscopic fundoplication.

Expert opinion: GERD management is shifting toward a more precise, personalized approach, supported by advanced diagnostics like endoscopy, HRM, pH monitoring, and barium esophagography. Tailored interventions are guided by these tools, particularly in surgical decision-making. The integration of interdisciplinary training, emerging technologies, and patient-centered innovations, such as wearables and simulation-based learning, promises to enhance outcomes and improve long-term quality of life.

Introduction: Chronic gastroduodenal disorders are highly prevalent with significant impact on patients and healthcare systems, yet their diagnosis and specific management remain challenging. Patients with gastroparesis and overlapping disorders of the gut-brain interaction frequently lack actionable biomarkers of specific underlying pathophysiologies with which to direct care.

Areas covered: The recent emergence of novel noninvasive biomarkers related to underlying contributory disease mechanisms, enabled by body-surface gastric mapping systems, offers a significant opportunity to advance diagnosis and personalized care. These biomarkers, their associated platforms, and their arising clinical implications are reviewed.

Expert opinion: A spectrum of motor and sensory mechanisms is known to contribute to chronic gastroduodenal symptoms, yet these mechanisms are not adequately addressed by current diagnostic tools, disease nomenclature, or management guidelines. A mechanism-centric diagnostic platform, enabled by new noninvasive actionable biomarkers, presents a significant opportunity to advance care in neurogastroenterology.

Background: Gender disparity has been documented in celiac disease (CD) with a female (F)-to-male (M) ratio of 2-2.5:1. Studies examining gender differences have yielded conflicting results.

Aims: To investigate gender differences in clinical presentation at diagnosis, adherence to gluten-free diet (GFD), and modification of clinical symptoms with the GFD in adult CD patients.

Methods: Single-center retrospective study, including all consecutive CD patients referred to our Center between September 2022-July 2024.

Results: One hundred and ninety-one patients, 141 F/50 M, mean age at diagnosis of 35.4/37.4 years, were included. In 59% F/54% M the diagnosis was prompted by gastrointestinal symptoms. At the diagnosis 13 F (9.1%) and 11 M (22%) were asymptomatic. Extra-intestinal manifestations were reported by 34 women (23.9%) and 6 men (12%). A low/absent adherence to GFD was reported by 17 women (12%) and 9 men (18%). Statistically significant differences were found regarding the prevalence of bone mineral density alterations (> in M, p-value = 0.017) and the degree of duodenal damage at the diagnosis (> in F, p-value = 0.021).

Conclusions: Only slight discrepancies in the clinical presentation at CD diagnosis between the two genders were identified, which are mostly resolved with the GFD. No significant difference with regard to dietary adherence between F/M was found.

Introduction: Besides hepatic impairment in critical illness and sepsis, patients with specific liver diseases such as acute liver failure (ALF), alcohol-associated hepatitis (AAH), liver cirrhosis with acute decompensation or acute-on-chronic liver failure (ACLF) regularly requires management in intensive care. Uncertainties exist, if and when liver biopsy is needed for diagnosis and treatment at the intensive care unit (ICU).

Areas covered: We review the role of liver biopsy in the diagnostic workup of liver dysfunction and organ failure at the ICU. We summarize the recommended indications by international guidelines, preferred biopsy techniques and add clinical experience from our tertiary liver center.

Expert opinion: The diagnostic workup of liver failure should be performed at specialized hepatology centers. Several conditions of suspected liver disease, particularly ALF, AAH, autoimmune hepatitis, and ACLF, may benefit for prognosis assessment and treatment decisions from liver histology. However, biopsy results need to consider the clinical context and require center expertise. In comparison to percutaneous approaches, transjugular liver biopsy is generally preferred due to lower procedure-related risks and acceptable tissue yield. Mini-laparoscopy or endoscopic ultrasound (EUS)-guided biopsy might be alternatives. Scientific evidence for liver biopsy in intensive care medicine is quite scarce, necessitating further research on clinical algorithms.

Introduction: The oral and esophageal microbiota are gaining recognition for their significance in managing Eosinophilic Esophagitis (EoE). They serve as diagnostic biomarkers and therapeutic targets.

Areas covered: The primary goal of EoE treatment is to alleviate symptoms such as dysphagia, heartburn, nausea, and chest pain. These symptoms are often associated with dysfunction of the esophageal barrier, closely linked to the esophageal microbiota. The composition of the esophageal microbiota can be affected by pharmacological treatments, particularly proton pump inhibitors, corticosteroids, and dietary interventions suggested for EoE management. As a result, the intestinal microbiota may also be influenced by these pharmacological approaches. Emerging research points to the potential of probiotic treatments as a complementary option to pharmacological therapy in the management of EoE. Publications linking 'EoE' to 'microbiome-microbiota' from 2013 to 2025 have been considered.

Expert opinion: Further investigation into probiotics could expand the range of therapeutic options available alongside conventional treatments, potentially improving EoE remission rates, enhancing patient compliance, and reducing treatment-related side effects.