Gastroenterology and Hepatology最新文献

Parkinson disease (PD) is a rapidly growing neurologic disorder affecting millions of people worldwide. While bradykinesia, rigidity, and tremor define its motor phenotype, gastrointestinal (GI) symptoms are highly prevalent and significantly impact quality of life. These symptoms often persist or worsen despite dopaminergic therapy and result from dysmotility involving the entire GI tract. Notably, many patients exhibit substantial objective motility disturbances despite minimal or no reported symptoms. This mismatch reflects impaired gut-brain communication and profound gut hyposensitivity, which dampen symptom perception and awareness. As such, reliance solely on patient-reported symptoms risks overlooking clinically significant dysmotility that can impair drug absorption, promote malnutrition, and increase the risk of complications such as bacterial overgrowth or aspiration. In response, diagnostic strategies are evolving to incorporate objective assessments, including videofluoroscopy, cough reflex testing, high-resolution manometry, and transit studies. These tools enhance the detection and characterization of unrecognized GI dysfunction in PD. A more nuanced, mechanism-based approach to evaluation is critical, as improved recognition of pan-gut dysmotility can guide individualized management strategies. This article reviews the underlying mechanisms of GI dysfunction in PD and provides a framework for its clinical assessment and care, emphasizing the need for proactive, objective evaluation beyond symptom reporting alone.

Barrett esophagus (BE) is the precursor for esophageal adenocarcinoma (EAC), with an at-risk screening population clearly defined by gastroenterology society guidelines. BE with high-grade dysplasia (HGD) and early EAC are actionable diagnoses, where endoscopic eradication therapy (EET) is effective in avoiding progression to invasive EAC. EsoGuard (EG) is a methylated DNA biomarker assay performed on esophageal cells collected nonendoscopically with EsoCheck (EC) to facilitate in-office BE screening. This case series presents 4 cases of HGD/early EAC diagnosed in patients who first tested positive on EG. Case presentations: Two patients met American College of Gastroenterology guideline criteria for BE screening, and 2 lacked chronic gastroesophageal reflux disease (GERD) but met other risk criteria. The patients with chronic GERD had well-controlled symptoms on proton pump inhibitors, and none of the patients had ever previously undergone screening for BE with esophagogastroduodenoscopy (EGD). All 4 patients underwent confirmatory EGD after receiving positive EG results, with HGD diagnosed on biopsy specimens. All patients were subsequently referred to advanced endoscopists for EET, during which time a T1a lesion was identified in 1 patient's endoscopic mucosal resection specimen. All achieved complete disease eradication after EET. Conclusion: These cases demonstrate EG/EC as an in-office nonendoscopic triage test that facilitated the timely diagnosis and subsequent treatment of HGD/early EAC in 4 patients who would otherwise not have undergone screening EGD and would have been at risk for progression to EAC. EG/EC allows BE screening in nonspecialized facilities and may be a reasonable option for patients who have not already been referred for endoscopy.

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction that significantly impacts quality of life. Studies indicate that more than one-third of patients with IBS use nonphar-macologic therapies, which include natural products and mind-body therapies, with higher prevalence identified among women, younger individuals, and those with higher education levels. This article examines the efficacy and safety of various natural products for the treatment of IBS, including fiber supplements, probiotics, herbal remedies (including Aloe vera and peppermint oil), and dietary supplements. Although some therapies show promise in symptom management, the evidence remains mixed for many of these interventions. Further high-quality research is needed to establish the role of many of these therapies in IBS treatment.