Pub Date : 2024-04-17DOI: 10.1097/MOG.0000000000001033
Christina M Ray, R. Panaccione, Christopher Ma
PURPOSE OF THE REVIEW To provide an overview of the current literature regarding the use of advanced combination therapy (ACT) in patients with inflammatory bowel disease (IBD). Although the treatment of IBD has come a long way, many patients do not respond or will lose response to currently available treatments over time. ACT has been proposed as a model to create sustained remission in difficult-to-treat IBD patient populations. This review discusses the available literature supporting the use of ACT, followed by practical tips for applying this model of treatment to clinical practice. RECENT FINDINGS Both observational and controlled evidence have demonstrated that there may be an increased benefit of ACT in specific IBD patient populations compared to advanced targeted immunomodulator (TIM) monotherapy. Additional data is required to understand how to best use combination TIMs and the long-term risks associated with this strategy. SUMMARY While the literature has demonstrated the potential for benefit in both Crohn's disease and ulcerative colitis, the use of ACT is currently off-label and long-term controlled data is needed. The successful application of ACT requires careful consideration of both patient and disease profiles as well as close monitoring of treatment response and adverse events.
{"title":"A practical guide to combination advanced therapy in inflammatory bowel disease.","authors":"Christina M Ray, R. Panaccione, Christopher Ma","doi":"10.1097/MOG.0000000000001033","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001033","url":null,"abstract":"PURPOSE OF THE REVIEW\u0000To provide an overview of the current literature regarding the use of advanced combination therapy (ACT) in patients with inflammatory bowel disease (IBD). Although the treatment of IBD has come a long way, many patients do not respond or will lose response to currently available treatments over time. ACT has been proposed as a model to create sustained remission in difficult-to-treat IBD patient populations. This review discusses the available literature supporting the use of ACT, followed by practical tips for applying this model of treatment to clinical practice.\u0000\u0000\u0000RECENT FINDINGS\u0000Both observational and controlled evidence have demonstrated that there may be an increased benefit of ACT in specific IBD patient populations compared to advanced targeted immunomodulator (TIM) monotherapy. Additional data is required to understand how to best use combination TIMs and the long-term risks associated with this strategy.\u0000\u0000\u0000SUMMARY\u0000While the literature has demonstrated the potential for benefit in both Crohn's disease and ulcerative colitis, the use of ACT is currently off-label and long-term controlled data is needed. The successful application of ACT requires careful consideration of both patient and disease profiles as well as close monitoring of treatment response and adverse events.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.1097/MOG.0000000000001034
N. Gimpaya, William T Tran, Samir C. Grover
PURPOSE OF REVIEW Endoscopy-related injuries (ERIs) are prevalent in gastrointestinal endoscopy. The aim of this review is to address the growing concern of ERIs by evaluating the ergonomic risk factors and the efficacy of interventions and educational strategies aimed at mitigating these risks, including novel approaches. RECENT FINDINGS ERIs are highly prevalent, exacerbated by factors such as repetitive strain, nonneutral postures, suboptimal equipment design, and the procedural learning curve. Female sex and smaller hand sizes have been identified as specific risk factors. Recent guidelines underscore the importance of ergonomic education and the integration of ergonomic principles into the foundational training of gastroenterology fellows. Advances in equipment design focus on adaptability to different hand sizes and ergonomic positions. Furthermore, the incorporation of microbreaks and macrobreaks, along with neutral monitor and bed positioning, has shown promise in reducing the incidence of ERIs. Wearable sensors may be helpful in monitoring and promoting ergonomic practices among trainees. SUMMARY Ergonomic wellness is paramount for gastroenterology trainees to prevent ERIs and ensure a sustainable career. Effective strategies include ergonomic education integrated into curricula, equipment design improvements, and procedural adaptations such as scheduled breaks and optimal positioning. Sensor-based and camera-based systems may allow for education and feedback to be provided regarding ergonomics to trainees in the future.
综述目的内窥镜相关损伤（ERIs）在消化道内窥镜检查中十分普遍。本综述旨在通过评估人体工程学风险因素以及旨在降低这些风险的干预措施和教育策略（包括新方法）的有效性，解决人们日益关注的内镜相关损伤问题。女性和小手被认为是特定的风险因素。最近的指导方针强调了人体工程学教育的重要性，并将人体工程学原则纳入消化内科研究员的基础培训中。设备设计的进步侧重于适应不同的手型和人体工学姿势。此外，微小间歇和大间歇以及中立的监护仪和床位也有望降低 ERI 的发生率。摘要胃肠病学受训人员的人体工程学健康对于预防 ERI 和确保可持续的职业生涯至关重要。有效的策略包括将人体工程学教育纳入课程、改进设备设计以及调整程序，如安排休息时间和最佳体位。基于传感器和摄像头的系统可在未来为学员提供人体工程学方面的教育和反馈。
{"title":"Ergonomic wellness for the trainee in gastrointestinal endoscopy.","authors":"N. Gimpaya, William T Tran, Samir C. Grover","doi":"10.1097/MOG.0000000000001034","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001034","url":null,"abstract":"PURPOSE OF REVIEW\u0000Endoscopy-related injuries (ERIs) are prevalent in gastrointestinal endoscopy. The aim of this review is to address the growing concern of ERIs by evaluating the ergonomic risk factors and the efficacy of interventions and educational strategies aimed at mitigating these risks, including novel approaches.\u0000\u0000\u0000RECENT FINDINGS\u0000ERIs are highly prevalent, exacerbated by factors such as repetitive strain, nonneutral postures, suboptimal equipment design, and the procedural learning curve. Female sex and smaller hand sizes have been identified as specific risk factors. Recent guidelines underscore the importance of ergonomic education and the integration of ergonomic principles into the foundational training of gastroenterology fellows. Advances in equipment design focus on adaptability to different hand sizes and ergonomic positions. Furthermore, the incorporation of microbreaks and macrobreaks, along with neutral monitor and bed positioning, has shown promise in reducing the incidence of ERIs. Wearable sensors may be helpful in monitoring and promoting ergonomic practices among trainees.\u0000\u0000\u0000SUMMARY\u0000Ergonomic wellness is paramount for gastroenterology trainees to prevent ERIs and ensure a sustainable career. Effective strategies include ergonomic education integrated into curricula, equipment design improvements, and procedural adaptations such as scheduled breaks and optimal positioning. Sensor-based and camera-based systems may allow for education and feedback to be provided regarding ergonomics to trainees in the future.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1097/MOG.0000000000001025
Wissam Ghusn, Edward V. Loftus, Amanda M Johnson
PURPOSE OF REVIEW This review examines the complex relationship between obesity and inflammatory bowel disease (IBD), encompassing their potentially shared pathogenesis, the impact of obesity on the natural history and treatment outcomes of IBD, and the management of obesity in the patient with IBD. RECENT FINDINGS Obesity represents a state of chronic inflammation that may not only contribute to IBD pathogenesis, but also influence disease progression, complications, and response to treatment. Increased visceral adiposity may carry negative prognostic implications for disease and treatment-specific outcomes. Antiobesity medications, endoscopic bariatric therapies, and even bariatric surgery may be effective and well tolerated in selected patients with IBD. SUMMARY The intersection of obesity and IBD presents a significant clinical challenge, with obesity influencing the natural history of IBD and potentially affecting treatment efficacy. As obesity prevalence among IBD patients rises, a tailored approach to management is crucial, taking into account the individualized risks and benefits of various treatment strategies, including lifestyle interventions, pharmacotherapy, endoscopic procedures, and bariatric surgery.
{"title":"Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management.","authors":"Wissam Ghusn, Edward V. Loftus, Amanda M Johnson","doi":"10.1097/MOG.0000000000001025","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001025","url":null,"abstract":"PURPOSE OF REVIEW\u0000This review examines the complex relationship between obesity and inflammatory bowel disease (IBD), encompassing their potentially shared pathogenesis, the impact of obesity on the natural history and treatment outcomes of IBD, and the management of obesity in the patient with IBD.\u0000\u0000\u0000RECENT FINDINGS\u0000Obesity represents a state of chronic inflammation that may not only contribute to IBD pathogenesis, but also influence disease progression, complications, and response to treatment. Increased visceral adiposity may carry negative prognostic implications for disease and treatment-specific outcomes. Antiobesity medications, endoscopic bariatric therapies, and even bariatric surgery may be effective and well tolerated in selected patients with IBD.\u0000\u0000\u0000SUMMARY\u0000The intersection of obesity and IBD presents a significant clinical challenge, with obesity influencing the natural history of IBD and potentially affecting treatment efficacy. As obesity prevalence among IBD patients rises, a tailored approach to management is crucial, taking into account the individualized risks and benefits of various treatment strategies, including lifestyle interventions, pharmacotherapy, endoscopic procedures, and bariatric surgery.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140696042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1097/MOG.0000000000001028
Benjamin Clement, Juan Reyes Genere
PURPOSE OF REVIEW Inflammatory bowel diseases (IBD) are associated with several well described neoplastic and structural complications. Increasing disease prevalence, healthcare barriers, and medication refractory phenotypes contribute to ongoing complications despite significant strides in medical management. Enhancements in endoscopic technology and techniques have allowed a minimally invasive approach for what has historically required surgery. In this article, we review the current and future landscape of endoscopic IBD intervention. RECENT FINDINGS Endoscopic resection is the first line for managing conventional and complex colitis-associated dysplasia. Evidence supporting endoscopic submucosal dissection is mounting, yet there is a paucity of studies evaluating modified endoscopic mucosal resection techniques or hybrid endoscopic submucosal dissection. We also have more clarity in how best to approach fibrostenotic disease, as we learn how to position endoscopic stricturotomy and stenting, relative to balloon dilation. Finally, applications in managing penetrating and postsurgical complications have been described, but still require further study. SUMMARY While important knowledge gaps still exist, the application of endoscopic therapies in IBD is more refined, especially within the management of colitis-associated dysplasia and strictures. The indications for endoscopy in perianal disease and other penetrating manifestations of Crohn's disease presents exciting opportunities for growth.
{"title":"Interventional inflammatory bowel disease: current and future practice.","authors":"Benjamin Clement, Juan Reyes Genere","doi":"10.1097/MOG.0000000000001028","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001028","url":null,"abstract":"PURPOSE OF REVIEW\u0000Inflammatory bowel diseases (IBD) are associated with several well described neoplastic and structural complications. Increasing disease prevalence, healthcare barriers, and medication refractory phenotypes contribute to ongoing complications despite significant strides in medical management. Enhancements in endoscopic technology and techniques have allowed a minimally invasive approach for what has historically required surgery. In this article, we review the current and future landscape of endoscopic IBD intervention.\u0000\u0000\u0000RECENT FINDINGS\u0000Endoscopic resection is the first line for managing conventional and complex colitis-associated dysplasia. Evidence supporting endoscopic submucosal dissection is mounting, yet there is a paucity of studies evaluating modified endoscopic mucosal resection techniques or hybrid endoscopic submucosal dissection. We also have more clarity in how best to approach fibrostenotic disease, as we learn how to position endoscopic stricturotomy and stenting, relative to balloon dilation. Finally, applications in managing penetrating and postsurgical complications have been described, but still require further study.\u0000\u0000\u0000SUMMARY\u0000While important knowledge gaps still exist, the application of endoscopic therapies in IBD is more refined, especially within the management of colitis-associated dysplasia and strictures. The indications for endoscopy in perianal disease and other penetrating manifestations of Crohn's disease presents exciting opportunities for growth.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1097/MOG.0000000000001022
A. Smout, A. Bredenoord, Renske A B Oude Nijhuis
PURPOSE OF REVIEW To review recent publications on the inability to belch syndrome. RECENT FINDINGS Five recent retrospective case series indicate that the inability to belch syndrome usually starts in early childhood and is often accompanied by gurgling noises in the chest, pain in the chest or upper abdomen, bloating, and excessive flatulence. Currently, the vast majority of patients who have been identified with inability to belch have self-diagnosed the syndrome on the basis of information available on the internet. A favorable response to injection of botulinum toxin in the cricopharyngeus muscle is regarded as confirmation of the diagnosis. In a mechanistic study in eight patients, absence of reflexogenic relaxation of the upper esophageal sphincter upon rapid gaseous esophageal distension was confirmed to play a pivotal role in the pathogenesis of the syndrome. SUMMARY The inability to belch syndrome, caused by failure of the upper esophageal sphincter to relax when the esophageal body is distended, clearly exists and may not be as rare as thought hitherto. However, overdiagnosis is also likely to occur because the diagnosis is usually made on the basis of symptoms only. The efficacy of botulinum toxin injection in the upper sphincter needs to be assessed in double-blind placebo-controlled studies.
{"title":"Inability to belch syndrome: what the gastroenterologist needs to know.","authors":"A. Smout, A. Bredenoord, Renske A B Oude Nijhuis","doi":"10.1097/MOG.0000000000001022","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001022","url":null,"abstract":"PURPOSE OF REVIEW\u0000To review recent publications on the inability to belch syndrome.\u0000\u0000\u0000RECENT FINDINGS\u0000Five recent retrospective case series indicate that the inability to belch syndrome usually starts in early childhood and is often accompanied by gurgling noises in the chest, pain in the chest or upper abdomen, bloating, and excessive flatulence. Currently, the vast majority of patients who have been identified with inability to belch have self-diagnosed the syndrome on the basis of information available on the internet. A favorable response to injection of botulinum toxin in the cricopharyngeus muscle is regarded as confirmation of the diagnosis. In a mechanistic study in eight patients, absence of reflexogenic relaxation of the upper esophageal sphincter upon rapid gaseous esophageal distension was confirmed to play a pivotal role in the pathogenesis of the syndrome.\u0000\u0000\u0000SUMMARY\u0000The inability to belch syndrome, caused by failure of the upper esophageal sphincter to relax when the esophageal body is distended, clearly exists and may not be as rare as thought hitherto. However, overdiagnosis is also likely to occur because the diagnosis is usually made on the basis of symptoms only. The efficacy of botulinum toxin injection in the upper sphincter needs to be assessed in double-blind placebo-controlled studies.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1097/MOG.0000000000001026
Vanisha Patel, Ahmed Abdelbaki, Nirav C. Thosani, Somashekar G. Krishna
PURPOSE OF REVIEW Surgery is a cornerstone in the management of pancreatic cancer and precancerous pancreatic lesions. However, many patients are not suitable candidates for surgery at the time of diagnosis for various reasons. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) appears to be a promising treatment option for patients who are ineligible for surgery for management of pancreatic adenocarcinoma (PDAC), and pancreatic neuroendocrine tumors (PNETs), and pancreatic cystic lesions (PCLs). RECENT FINDINGS EUS-RFA may serve as an adjunct to chemotherapy or palliative measures for inoperable cases of PDAC. Given its feasibility and efficacy, EUS-RFA has an evolving niche as a minimally invasive and potentially definitive treatment for PNETs and high-risk PCLs such as intraductal papillary mucinous neoplasms (IPMNs). EUS-RFA is a generally well tolerated procedure, with abdominal pain and acute pancreatitis being the most common adverse effects, though the risk can be mitigated through prophylactic measures. SUMMARY There is an increasing body of evidence to support the use of EUS-RFA in managing pancreatic lesions, either as definitive, adjunctive, or palliative treatment, depending on lesion type.
{"title":"Endoscopic ultrasound-guided radiofrequency ablation of pancreatic tumors.","authors":"Vanisha Patel, Ahmed Abdelbaki, Nirav C. Thosani, Somashekar G. Krishna","doi":"10.1097/MOG.0000000000001026","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001026","url":null,"abstract":"PURPOSE OF REVIEW\u0000Surgery is a cornerstone in the management of pancreatic cancer and precancerous pancreatic lesions. However, many patients are not suitable candidates for surgery at the time of diagnosis for various reasons. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) appears to be a promising treatment option for patients who are ineligible for surgery for management of pancreatic adenocarcinoma (PDAC), and pancreatic neuroendocrine tumors (PNETs), and pancreatic cystic lesions (PCLs).\u0000\u0000\u0000RECENT FINDINGS\u0000EUS-RFA may serve as an adjunct to chemotherapy or palliative measures for inoperable cases of PDAC. Given its feasibility and efficacy, EUS-RFA has an evolving niche as a minimally invasive and potentially definitive treatment for PNETs and high-risk PCLs such as intraductal papillary mucinous neoplasms (IPMNs). EUS-RFA is a generally well tolerated procedure, with abdominal pain and acute pancreatitis being the most common adverse effects, though the risk can be mitigated through prophylactic measures.\u0000\u0000\u0000SUMMARY\u0000There is an increasing body of evidence to support the use of EUS-RFA in managing pancreatic lesions, either as definitive, adjunctive, or palliative treatment, depending on lesion type.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1097/MOG.0000000000001031
Anisa Shaker
PURPOSE OF REVIEW Eosinophilic esophagitis (EoE) is a Th2 immune/antigen-mediated disorder characterized by esophageal dysfunction and eosinophilic inflammation. Worsening dysphagia and food impactions are significant complications associated with esophageal remodeling and fibrostenotic disease. This review highlights the most recent research findings pertaining to mechanisms of sub-epithelial fibrosis in EoE, current diagnostic tools, and therapeutic approaches. RECENT FINDINGS Recent studies leveraging publicly available single cell sequencing databases and comparative proteomics have furthered our understanding of the mechanisms mediating fibrosis. Fibroblast crosstalk with the extracellular matrix and with epithelial, endothelial, and T cells have been implicated, with the likely existence of multiple fibroblast sub-types. Accurate diagnosis of remodeling with biopsies remains a challenge due to inadequate depth of sampling. Web-based tools incorporating epithelial findings show promise in predicting subepithelial fibrosis. Impedance planimetry with esophageal distensibility measurements are increasingly utilized tools to assess fibrostenotic severity. Immunostaining and luminal captured proteins associated with remodeling show promise as potential molecular markers of fibrosis. Anti-inflammatory therapy may improve esophageal fibrosis and distensibility, although specific fibrosis-targeted therapy is lacking. SUMMARY Recent studies highlight novel mechanisms of fibrosis in EoE. Improved understanding of these mechanisms may lead to novel diagnostic strategies and therapies, and thereby inform treatment decisions.
综述目的嗜酸性粒细胞食管炎（EoE）是一种 Th2 免疫/抗原介导的疾病，其特征是食管功能障碍和嗜酸性粒细胞炎症。吞咽困难和食物嵌塞是与食管重塑和纤维增生性疾病相关的重要并发症。本综述重点介绍了有关食管上皮下纤维化机制、当前诊断工具和治疗方法的最新研究成果。最近的发现最近的研究利用公开的单细胞测序数据库和比较蛋白质组学进一步加深了我们对纤维化介导机制的了解。成纤维细胞与细胞外基质以及上皮细胞、内皮细胞和 T 细胞之间的串扰已被证实，并可能存在多种成纤维细胞亚型。由于取样深度不够，利用活检对重塑进行准确诊断仍是一项挑战。结合上皮发现的网络工具在预测上皮下纤维化方面大有可为。阻抗平面测量法和食管扩张性测量法越来越多地被用来评估纤维化的严重程度。与重塑相关的免疫染色和管腔捕获蛋白有望成为潜在的纤维化分子标记物。抗炎治疗可改善食管纤维化和扩张性，但目前还缺乏针对纤维化的特异性疗法。对这些机制的进一步了解可能会带来新的诊断策略和疗法，从而为治疗决策提供依据。
{"title":"Esophageal remodeling in eosinophilic esophagitis.","authors":"Anisa Shaker","doi":"10.1097/MOG.0000000000001031","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001031","url":null,"abstract":"PURPOSE OF REVIEW\u0000Eosinophilic esophagitis (EoE) is a Th2 immune/antigen-mediated disorder characterized by esophageal dysfunction and eosinophilic inflammation. Worsening dysphagia and food impactions are significant complications associated with esophageal remodeling and fibrostenotic disease. This review highlights the most recent research findings pertaining to mechanisms of sub-epithelial fibrosis in EoE, current diagnostic tools, and therapeutic approaches.\u0000\u0000\u0000RECENT FINDINGS\u0000Recent studies leveraging publicly available single cell sequencing databases and comparative proteomics have furthered our understanding of the mechanisms mediating fibrosis. Fibroblast crosstalk with the extracellular matrix and with epithelial, endothelial, and T cells have been implicated, with the likely existence of multiple fibroblast sub-types. Accurate diagnosis of remodeling with biopsies remains a challenge due to inadequate depth of sampling. Web-based tools incorporating epithelial findings show promise in predicting subepithelial fibrosis. Impedance planimetry with esophageal distensibility measurements are increasingly utilized tools to assess fibrostenotic severity. Immunostaining and luminal captured proteins associated with remodeling show promise as potential molecular markers of fibrosis. Anti-inflammatory therapy may improve esophageal fibrosis and distensibility, although specific fibrosis-targeted therapy is lacking.\u0000\u0000\u0000SUMMARY\u0000Recent studies highlight novel mechanisms of fibrosis in EoE. Improved understanding of these mechanisms may lead to novel diagnostic strategies and therapies, and thereby inform treatment decisions.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1097/mog.0000000000001029
Elizabeth A Scoville, Sara N Horst
This review details the three new agents, including two novel mechanisms of action, approved to treat Crohn's disease in recent years. We review efficacy, safety, prescribing information, and available data on positioning these new therapies.
{"title":"A Practical guide to selecting and using new Crohn's disease therapies.","authors":"Elizabeth A Scoville, Sara N Horst","doi":"10.1097/mog.0000000000001029","DOIUrl":"https://doi.org/10.1097/mog.0000000000001029","url":null,"abstract":"This review details the three new agents, including two novel mechanisms of action, approved to treat Crohn's disease in recent years. We review efficacy, safety, prescribing information, and available data on positioning these new therapies.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1097/mog.0000000000001023
Tara Nagaraj, John Shinn, Kara De Felice
Several new biologics (mirizikizumab) and small molecules (upadacitinib, ozanimod, etrasimod) are approved for the treatment of moderate-to-severe ulcerative colitis. To date, there are no head-to-head trials to guide positioning and use of these newer agents.
{"title":"A practical guide to selecting and using new ulcerative colitis therapies.","authors":"Tara Nagaraj, John Shinn, Kara De Felice","doi":"10.1097/mog.0000000000001023","DOIUrl":"https://doi.org/10.1097/mog.0000000000001023","url":null,"abstract":"Several new biologics (mirizikizumab) and small molecules (upadacitinib, ozanimod, etrasimod) are approved for the treatment of moderate-to-severe ulcerative colitis. To date, there are no head-to-head trials to guide positioning and use of these newer agents.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1097/mog.0000000000001030
Vincent Bos, Man Wai Chan, Roos E Pouw
This review aims to discuss recent advancements in the endoscopic management of early esophageal adenocarcinoma (T1 EAC).
本综述旨在讨论早期食管腺癌（T1 EAC）内镜治疗的最新进展。
{"title":"Towards personalized management of early esophageal adenocarcinoma.","authors":"Vincent Bos, Man Wai Chan, Roos E Pouw","doi":"10.1097/mog.0000000000001030","DOIUrl":"https://doi.org/10.1097/mog.0000000000001030","url":null,"abstract":"This review aims to discuss recent advancements in the endoscopic management of early esophageal adenocarcinoma (T1 EAC).","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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