JGH Open最新文献

Rising antibiotic resistance has challenged empirical regimens for Helicobacter pylori eradication. While concomitant therapy is widely used, its effectiveness is reduced in resistant settings. Tailored therapy, guided by antimicrobial susceptibility testing, may improve outcomes. We performed a meta-analysis of randomized controlled trials (RCTs) comparing tailored versus concomitant therapy as a first-line treatment. We searched PubMed, Google Scholar, Cochrane, and ClinicalTrials.gov through April 2025 for RCTs enrolling treatment-naïve adults with confirmed H. pylori infection. The primary outcome was the eradication rate by intention-to-treat (ITT) and per-protocol (PP) analyses, with adverse events as a secondary outcome. We included eight RCTs with 2524 patients (1332 tailored, 1192 concomitant). Tailored therapy achieved higher eradication rates than concomitant therapy in the ITT analysis (87.4% vs. 83.2%; RR = 1.05; 95% CI: 1.00–1.10; p = 0.05) and the PP analysis (92.6% vs. 89.1%; RR = 1.04; 95% CI: 1.00–1.07; p = 0.03). Furthermore, tailored therapy was associated with a significantly lower incidence of adverse events (35.6% vs. 45.6%; RR = 0.71; 95% CI: 0.58–0.86; p = 0.0007). In conclusion, tailored therapy provides modestly higher H. pylori eradication rates and significantly fewer adverse events compared to empirical concomitant therapy. These findings support using tailored therapy as the preferred first-line option, particularly in regions with high antibiotic resistance and as access to rapid molecular testing expands.

Cronkhite–Canada syndrome (CCS) is a rare nonhereditary disorder characterized by multiple gastrointestinal polyps and ectodermal changes. The mortality rate can reach up to 50% in patients with delayed diagnosis or inadequate treatment. A 78-year-old Japanese woman presented with diarrhea as the primary complaint. Her clinical presentation included diarrhea, dysgeusia, anorexia, and weight loss. Physical examination revealed alopecia, nail atrophy, and hyperpigmentation. Abdominal computed tomography (CT) revealed multiple enlarged mesenteric lymph nodes, whereas endoscopic examination showed numerous hyperplastic polyps extending from the stomach to the colon. Following the diagnosis of CCS, the patient was treated with prednisolone (30 mg/day). Abdominal CT imaging one month later showed a reduction in the mesenteric lymph node size. Although it is uncommon, mesenteric lymphadenopathy can appear in CCS and may regress with corticosteroid therapy.

Dietary therapy has an established role in managing gastrointestinal disorders, as a short-term induction therapy (e.g., exclusive enteral nutrition for Crohn's disease), a long-term monotherapy (e.g., gluten-free diet for coeliac disease and a personalized FODMAP diet) or adjunct therapy (e.g., Mediterranean diet). As use of dietary therapies rises, it is becoming increasingly common for gastroenterologists and dietitians to encounter patients who are simultaneously following two or more dietary therapies to achieve optimal symptom control, to manage multiple concurrent medical issues, or for social or religious reasons. This practice is termed ‘diet stacking’. The aim of this review is to clarify the principles behind the safe and effective combination of dietary interventions with specific attention to potential risks, mitigation of risk and practical application. For gastroenterologists, awareness of current dietary practices of their patients prior to advising dietary therapy is warranted and, in those who are diet stacking, risk assessment is essential. Validated screening tools to evaluate risks, particularly of disordered eating, are limited. The management of those who currently or are at risk of diet stacking is best directed toward gastrointestinal dietitians who offer time, appropriate skills for assessment, and the delivery of pragmatic patient education to safely implement appropriate dietary interventions, and assess for the need for engaging psychological primary management or co-management. In conclusion, diet stacking is common, and requires awareness and often multi-disciplinary management to ensure it is implemented safely.

Non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD), has emerged as the most common chronic liver disease worldwide, affecting nearly one in three adults. Despite its growing prevalence, there is still no approved pharmacological treatment, making lifestyle modification the cornerstone of management. Among the most promising strategies are nutritional interventions and structured fasting regimens, which target the underlying metabolic dysfunction driving disease progression. This review explores the impact of various dietary patterns—including the Mediterranean diet, low-glycemic index and low-carbohydrate diets, plant-based approaches, and the DASH diet—on hepatic steatosis, liver enzymes, and metabolic health. Evidence from randomized trials and meta-analyses highlights the Mediterranean diet as particularly effective in reducing liver fat and improving cardiometabolic outcomes, especially when combined with physical activity. Plant-based and DASH diets also demonstrate significant benefits, although accessibility, adherence, and cultural factors remain as challenges. Fasting interventions, such as intermittent fasting, time-restricted eating, alternate-day fasting, periodic fasting, and the fasting-mimicking diet, have gained increasing attention. These regimens improve insulin sensitivity, promote fat oxidation, and reduce intrahepatic fat, with growing evidence supporting their safety and effectiveness in MASLD management. While results are encouraging, long-term adherence, standardization of fasting protocols, and individualized patient considerations remain key areas for future research. In summary, nutritional and fasting strategies represent practical, non-pharmacological options to prevent and manage MASLD. By addressing both hepatic and systemic metabolic dysfunction, they hold promise not only for improving liver health but also for reducing the broader burden of obesity, diabetes, and cardiovascular disease.