Journal of Gastroenterology and Hepatology最新文献

Metabolic dysfunction–associated steatotic liver disease (MASLD) is quickly emerging as a global public health concern, primarily fueled by the rising consumption of processed and ultraprocessed foods. This global health issue, showing a 50% increase in prevalence over two decades to 38% of the global population, is now the second most common cause of end-stage liver disease and liver transplants in Europe and the United States and an emerging driver of hepatocellular carcinoma, particularly in Hispanic and non-Hispanic White populations. Its prevalence, driven by increasing consumption of ultraprocessed foods, obesity, and sedentary lifestyles, disproportionately impacts racial and ethnic minorities, exacerbating health disparities. Genetic polymorphisms contribute to interindividual and interethnic variations in disease susceptibility. However, genetics alone cannot explain the disparities; social determinants, food insecurity, and limited access to healthcare also play pivotal roles. MASLD prevalence is rising fastest among older adults and Hispanic women, particularly in low-income and rural communities. Despite advances in pharmacologic therapies, access remains inequitable. Lifestyle interventions remain essential. Integrating genetic and epigenetic insights into risk stratification and treatment can support precision medicine approaches. A comprehensive MASLD management framework must include policy reforms to address food deserts, healthcare access, and socioeconomic inequities. Culturally tailored public health programs and personalized care models are crucial for enhancing outcomes in vulnerable populations. In this narrative review, we examine the multifaceted contributors to MASLD pathogenesis and disparities, with a focus on genetic risk, social determinants, dietary patterns, and cancer risk and policy-level interventions to inform more equitable liver health strategies.

Biliary tract cancers (BTCs)—including cholangiocarcinoma and gallbladder cancer—are increasing in incidence worldwide and carry a poor prognosis, constituting a growing global health burden. Early-stage disease can be potentially cured with surgical resection; however, the majority present with advanced disease, and palliative systemic therapy is the mainstay of treatment. In the first-line setting, gemcitabine plus cisplatin (GemCis) chemotherapy served as the long-standing standard of care; subsequently, TOPAZ-1 and KEYNOTE-966 established GemCis plus durvalumab or pembrolizumab as the current standard. For patients who progressed after frontline therapy and lack actionable alterations, fluoropyrimidine plus oxaliplatin and fluoropyrimidine plus liposomal irinotecan are recommended second-line options, supported by ABC-06 and NIFTY, respectively. Several targeted agents have demonstrated clinically meaningful efficacy in phase 2–3 trials and are recommended as subsequent-line therapy for biomarker-selected disease, including FGFR2 gene rearrangements, IDH1 mutations, and HER2 amplification. Although recent advances have improved clinical outcomes in patients with advanced BTC, median overall survival remains around 1 year, underscoring the need for further therapeutic innovation. This review provides a comprehensive overview of the current standards of care and highlights emerging therapeutic strategies for advanced BTC.

Gastric cancer remains a major public health concern, particularly in Asia, where both incidence and mortality rates are among the highest worldwide. While endoscopic screening enables early detection and improves prognosis, it requires substantial healthcare resources and specialized manpower. Growing evidence supports population-based Helicobacter pylori screening and eradication as an effective and cost-efficient primary prevention strategy, enabling elimination of the etiological factor while directing endoscopic resources toward individuals at the highest risk. Randomized controlled trials and cohort studies, predominantly from Asian countries, have demonstrated significant reductions in gastric cancer incidence following successful H. pylori treatment. To maximize the impact of this strategy, implementation should follow the principles of an organized screening program, with clearly structured pathways for invitation, testing, treatment, and outcome monitoring. Test selection must be tailored to local prevalence and healthcare capacity, and eradication regimens should be guided by regional antibiotic resistance patterns to achieve high cure rates while upholding antibiotic stewardship. Integrating H. pylori screening into existing preventive services can further enhance cost-effectiveness and population coverage. Ongoing challenges include managing antibiotic resistance, stratifying the residual risk of gastric cancer after eradication to inform endoscopic surveillance, and ensuring consistent quality and equity of screen-and-treat programs across different healthcare systems.

Esophageal cancer remains a global health burden with poor survival, largely due to late diagnosis. The two main subtypes—esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC)—differ in their epidemiology, risk factors, and geographic distribution, highlighting the importance of region-specific screening. In areas with a high incidence of ESCC, population-based endoscopic screening has improved early detection and outcomes. In contrast, in Western countries where EAC predominates, targeted screening for Barrett's esophagus (BE) offers the most practical approach. Advances in high-definition endoscopy, virtual chromoendoscopy, and minimally invasive resection have enhanced diagnostic precision and treatment efficacy. At the same time, novel nonendoscopic methods such as swallowable devices, biomarker assays, and artificial intelligence–assisted imaging are reshaping screening paradigms. This review outlines current and emerging strategies for early detection of ESCC and EAC, emphasizing technological innovation and its potential to improve global outcomes.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. Malnutrition is highly prevalent among people living with HCC and has a substantial impact on morbidity and mortality. Nutrition influences the development of HCC and is also a consequence of chronic liver disease and liver cancer. Routine screening and nutritional assessment using validated tools, along with evaluation of muscle mass and functional status, are essential in the optimal care of patients with HCC. Nutritional interventions may change throughout the disease trajectory depending on the stage of HCC, the severity of liver cirrhosis, and the overall treatment options and intent. Evidence supports the use of oral nutritional supplements, branched-chain amino acids, exercise interventions, and the preferential use of enteral over parenteral nutrition. Optimizing nutrition is integral to HCC management across all disease stages and is best accomplished with a multidisciplinary team to individualize the nutritional care across the disease continuum. In this review, we summarize current evidence on the impact and role of nutritional therapy in HCC and provide actionable recommendations for clinical practice. We highlight the current challenges and provide future directions for future HCC nutritional care pathways.