Gastroenterology and Hepatology最新文献

Chronic cough, defined as cough persisting longer than 8 weeks, affects approximately 10% of the global population and significantly impairs quality of life. Gastroesophageal reflux disease is a recognized cause of chronic cough, yet the relationship remains complex and poorly understood. Up to 75% of patients with reflux-related cough lack classic gastroesophageal symptoms such as heartburn or regurgitation, making diagnosis particularly challenging. Although direct tissue irritation by refluxate has been proposed as a primary mechanism, evidence also supports a vagally mediated esophageal- tracheobronchial reflex. Cough hypersensitivity is also recognized as an important mechanism, amplifying responses to reflux and contributing to persistent symptoms despite reflux-directed therapy. Diagnostic evaluation requires a structured approach integrating clinical assessment, empiric treatment trials, and objective testing including ambulatory reflux monitoring. Upper endoscopy may reveal reflux complications, but most patients with reflux-related cough have normal endoscopic findings. Management involves a stepwise approach beginning with lifestyle modifications and proton pump inhibitor therapy, with neuromodulators and behavioral interventions reserved for refractory cases. Surgical intervention may benefit carefully selected patients but requires shared decision-making regarding risks and benefits. Development of more accurate diagnostic tools and unified clinical guidelines will be critical for advancing the management of this difficult-to-treat condition. This article reviews reflux-related cough, including its diagnostic evaluation and management strategies.

Chronic pancreatitis (CP) is a progressive fibroinflammatory disease of the pancreas with complex pathogenesis and diverse etiologies. CP can lead to numerous complications, including pain, exocrine pancreatic insufficiency, and endocrine insufficiency. Although CP is challenging to treat, there are a broad array of treatment strategies, including medical management, endoscopic interventions, and surgery. The goal of this article is to provide a systematic approach to management of CP and an overview of the evidence supporting different therapies.

Remote patient monitoring (RPM) has emerged as a valuable complement to traditional in-person clinical assessments, particularly since the COVID-19 pandemic. RPM encompasses a wide range of tools and technologies that enable the longitudinal collection of biometric, behavioral, and biochemical data outside the conventional clinic setting. These programs have been successfully integrated across several medical subspecialties, such as cardiology, endocrinology, and psychiatry, where the availability of real-time data has facilitated timely evaluation and management of chronic conditions. Building on these successes, the field of inflammatory bowel disease (IBD) has begun adopting RPM and connected health technologies to enhance both access to and quality of care. These innovations include the integration of point-of-care testing for conventional biomarkers, the development of novel biomarkers from other biospecimens (eg, mucus and sweat), and the advent of passive physiologic monitoring aimed at predicting and preventing disease relapses. This article examines current literature on RPM across chronic diseases, explores its emerging applications in IBD, and presents key barriers hindering its broader implementation.