Best Practice & Research Clinical Gastroenterology最新文献

英文中文

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-12-01 DOI: 10.1016/S1521-6918(25)00117-9

引用次数: 0

Ultra-processed foods in inflammatory bowel disease: an emerging global health challenge 超加工食品与炎症性肠病：一个新兴的全球健康挑战

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-12-01 DOI: 10.1016/j.bpg.2025.102072

Julie Vanderstappen , Sien Hoekx , Eva Vissers , Judith Wellens , João Sabino

Throughout history, the act of food processing has played an important role in human nutrition and evolution. At first, minimal processing such as cooking, curing, and smoking was used to improve shelf-life and enable transport. Afterwards more advanced processing techniques became the norm to increase food availability and safety. However, in the last decades scientific and technological advancements enabled ‘ultra-processing leading to ultra-processed foods (UPFs). Rapidly adopted by many, the increase in the intake of UPFs is especially pronounced in low-middle and upper-middle income countries. However, several studies have focused on the detrimental effects UPFs have on human health, showing an increased risk for non-communicable diseases such as obesity, diabetes type 2, cancer, cardiovascular diseases and inflammatory bowel diseases. Since UPFs are omnipresent and a condition to maintain a growing global population, we review the literature on the duality of food processing, encompassing both detrimental effects as well as positive aspects. Doing so we identify the need for future studies to better understand which components of UPFs affect health to help shape healthy and sustainable UPFs of the future.

纵观历史，食品加工行为在人类营养和进化中发挥了重要作用。起初，为了延长保质期和便于运输，使用了最小的加工，如烹饪、腌制和吸烟。后来，更先进的加工技术成为增加食品供应和安全的标准。然而，在过去的几十年里，科学和技术的进步使得“超加工”导致了超加工食品（upf）。被许多国家迅速采纳，在中低收入和中高收入国家中，upf摄入量的增加尤其明显。然而，有几项研究侧重于upf对人类健康的有害影响，表明肥胖症、2型糖尿病、癌症、心血管疾病和炎症性肠病等非传染性疾病的风险增加。由于upf无处不在，并且是维持全球人口增长的条件，我们回顾了关于食品加工双重性的文献，包括有害影响和积极方面。这样做，我们确定需要进行未来的研究，以更好地了解upf的哪些组成部分影响健康，以帮助塑造健康和可持续的未来upf。

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引用次数: 0

Avoidant/restrictive food intake disorder in disorders of gut-brain interaction 肠脑相互作用障碍中的回避/限制性食物摄入障碍

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-12-01 DOI: 10.1016/j.bpg.2025.102078

Madeline Berschback , Sophie Abber , Janelle Smith , Kyle Staller , Helen Burton-Murray , Micaela Atkins

Avoidant/Restrictive Food Intake Disorder (ARFID) is a disorder of food avoidance and/or restriction leading to medical or psychosocial consequences. Unlike other eating disorders, ARFID is not driven by shape or weight concerns but instead by three primary motivations: lack of interest or low appetite, fear of aversive consequences of eating, and sensory sensitivity. Increasing evidence highlights a bidirectional relationship between ARFID and disorders of gut-brain interaction (DGBI), with gastrointestinal (GI) symptoms precipitating restrictive eating patterns consistent with ARFID, and restrictive eating further exacerbating GI symptoms. Screening instruments such as the Nine-Item ARFID screen (NIAS) and the Pica, ARFID, and Rumination Disorder-Interview-ARFID Questionnaire (PARDI-AR-Q) may aid clinicians in identifying at-risk patients, but further work is needed to validate cutoff scores in patients with DGBI to distinguish adaptive dietary modification from excessive restriction. Management should involve multidisciplinary care between gastroenterologists, psychologists, and registered dietitian nutritionists (RDN). Medical management of GI symptoms, brain-gut behavioral therapies, and RDN-driven management of nutrition are arms of treatment that may be used individually or together to reduce restriction and expand dietary intake. In this narrative review, we aim to provide clinicians with a practical framework for identifying and managing ARFID in patients with DGBI.

回避/限制性食物摄入障碍（ARFID）是一种导致医学或社会心理后果的食物回避和/或限制的障碍。与其他饮食失调不同，ARFID不是由体型或体重问题驱动的，而是由三个主要动机驱动的：缺乏兴趣或食欲不振，对饮食不良后果的恐惧，以及感觉敏感。越来越多的证据表明ARFID与肠-脑相互作用障碍（DGBI）之间存在双向关系，胃肠道（GI）症状促成与ARFID一致的限制性饮食模式，而限制性饮食进一步加剧了胃肠道症状。筛查工具，如九项ARFID筛查（NIAS）和异食癖、ARFID和反刍障碍访谈ARFID问卷（PARDI-AR-Q）可以帮助临床医生识别有风险的患者，但需要进一步的工作来验证DGBI患者的临界值，以区分适应性饮食改变和过度限制。管理应涉及胃肠病学家、心理学家和注册营养师（RDN）之间的多学科护理。胃肠道症状的医学管理、脑-肠行为疗法和rdn驱动的营养管理是治疗方法的一部分，可以单独使用，也可以一起使用，以减少限制和扩大饮食摄入。在这篇叙述性综述中，我们的目标是为临床医生提供一个识别和管理DGBI患者ARFID的实用框架。

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引用次数: 0

Oral nutritional management in short bowel syndrome 短肠综合征的口服营养管理

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-12-01 DOI: 10.1016/j.bpg.2025.102082

Astrid Verbiest , Lise De Meyere , Nelle Pauwels , Yasna Overloop , Tim Vanuytsel

Patients with short bowel syndrome (SBS) have less than 200 cm of functional small intestine resulting in significantly impaired digestion and absorption of nutrients and fluids. When malabsorption becomes severe and cannot be compensated by oral intake, patients develop intestinal failure (IF) and require parenteral support (PS) to survive. Over time, however, intestinal adaptation may improve absorption and reduce the need for PS. Oral nutrition plays a central role in the management of SBS and can positively influence the clinical outcomes. This review synthesizes current knowledge on the role of oral nutrition in SBS and provides practical, ready-to-use recommendations for clinical practice. We focus on nutritional assessment, energy- and macronutrient needs, and fluid intake tailored to the different SBS anatomy types. Additionally, we discuss risks associated with oral nutrition, such as high outputs, dehydration and enteric hyperoxaluria. Overall, this review highlights the importance of combining evidence-based strategies with practical guidelines to optimize oral nutritional support and improve long-term outcomes in SBS.

短肠综合征（SBS）患者的小肠功能不足200厘米，导致营养物质和液体的消化和吸收明显受损。当吸收不良变得严重，不能通过口服摄入来补偿时，患者会出现肠衰竭（IF），需要肠外支持（PS）才能生存。然而，随着时间的推移，肠道适应可能会改善吸收并减少对PS的需求。口服营养在SBS的管理中起着核心作用，并能对临床结果产生积极影响。这篇综述综合了目前关于口服营养在SBS中的作用的知识，并为临床实践提供了实用的、现成的建议。我们专注于营养评估、能量和常量营养素需求以及针对不同SBS解剖类型量身定制的液体摄入量。此外，我们还讨论了与口服营养相关的风险，如高输出、脱水和肠内高草酸尿。总的来说，这篇综述强调了将循证策略与实用指南相结合的重要性，以优化口服营养支持和改善SBS的长期预后。

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引用次数: 0

Modeling gut inflammation using intestinal organoids: Advances, challenges, and future perspectives 用肠道类器官模拟肠道炎症：进展、挑战和未来展望

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpg.2025.102048

Justina Guzauskiene , Deimante Valentelyte , Goda Butaite , Ugne Kulokiene , Viltaute Laukaitiene , Ruta Inciuraite , Jurgita Skieceviciene

Intestinal organoids have emerged as powerful in vitro system for studying epithelial biology in a tissue-relevant context. Derived from adult stem cells or patient-specific induced pluripotent stem cells, these three-dimensional structures recapitulate key features of the intestinal epithelium, including crypt-villus architecture, cellular diversity, and functional barrier properties. Recent advances have enabled the modeling of gut inflammation using organoids through defined cytokine stimulation, co-culture with immune cells, and exposure to microbial components. These approaches have provided insights into epithelial barrier dysfunction, immune–epithelial crosstalk, and disease-specific responses, particularly in inflammatory bowel disease. Innovations such as gene-editing technologies, single-cell and spatial transcriptomics, and microengineered platforms like organoid-on-chip systems have advanced organoid-based research in various contexts, laying a strong foundation for their future application in modeling inflammation. Despite these advances, challenges remain in achieving long-term immune co-culture, media compatibility, and standardized readouts. This article highlights current strategies, key limitations, and future directions for using intestinal organoids to model gut inflammation and guide translational research.

肠道类器官已成为在组织相关背景下研究上皮生物学的强大体外系统。来源于成体干细胞或患者特异性诱导多能干细胞，这些三维结构概括了肠上皮的关键特征，包括隐窝绒毛结构、细胞多样性和功能屏障特性。最近的进展使得通过定义的细胞因子刺激、与免疫细胞共培养以及暴露于微生物成分中使用类器官来模拟肠道炎症成为可能。这些方法提供了对上皮屏障功能障碍、免疫-上皮串扰和疾病特异性反应的见解，特别是在炎症性肠病中。基因编辑技术、单细胞和空间转录组学以及类器官芯片系统等微工程平台等创新，在各种背景下推进了基于类器官的研究，为其未来在炎症建模中的应用奠定了坚实的基础。尽管取得了这些进展，但在实现长期免疫共培养、介质兼容性和标准化读数方面仍然存在挑战。本文重点介绍了利用肠道类器官模拟肠道炎症并指导转化研究的当前策略、关键限制和未来方向。

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引用次数: 0

Cutting edge developments and novel targets in IBD: Microbiome in IBD IBD的前沿发展和新靶点：IBD中的微生物组

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpg.2025.102060

Sara Deleu , João Sabino

Inflammatory bowel disease (IBD), a non-communicable disease encompassing Crohn's disease and ulcerative colitis, is a chronic disorder with increasing prevalence and complex etiology. Emerging evidence highlights the gut microbiome's pivotal role in IBD pathogenesis, driving interest in microbiome-targeted therapeutic strategies. This narrative review explores the latest advancements in microbiome modulation for IBD management, encompassing antibiotics, prebiotics, probiotics, synbiotics, postbiotics, and fecal microbiota transplantation. Additionally, dietary interventions, physical activity, as well as non-bacterial microbiota components such as fungi, archaea, and bacteriophages are examined for their potential roles in restoring microbial equilibrium and mitigating intestinal inflammation. As research progresses, a multimodal approach integrating microbiota-targeted therapies with lifestyle modifications and conventional pharmacologic treatments may offer a personalized and effective strategy for IBD management.

炎症性肠病（IBD）是一种包括克罗恩病和溃疡性结肠炎在内的非传染性疾病，是一种患病率不断上升且病因复杂的慢性疾病。新出现的证据强调了肠道微生物组在IBD发病机制中的关键作用，推动了对微生物组靶向治疗策略的兴趣。这篇叙述性综述探讨了IBD管理中微生物组调节的最新进展，包括抗生素、益生元、益生菌、合成菌、后益生菌和粪便微生物群移植。此外，研究人员还研究了饮食干预、身体活动以及非细菌微生物群成分（如真菌、古细菌和噬菌体）在恢复微生物平衡和减轻肠道炎症方面的潜在作用。随着研究的进展，将微生物群靶向治疗与生活方式改变和传统药物治疗相结合的多模式方法可能为IBD治疗提供个性化和有效的策略。

引用次数: 0

The way forward: Towards pragmatic preclinical microbiome research in inflammatory bowel disease 前进的道路：迈向炎症性肠病的临床前微生物组研究

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpg.2025.102054

Valentina Petito , Sara Deleu , Loris R. Lopetuso , Theresa T. Pizarro , Franco Scaldaferri

Clinical trials for inflammatory bowel disease are primarily randomized clinical trials, which have been the gold standard since the 1940s. However, these trials often focus on a specific group of patients, are expensive, and focus on one treatment option over a short period. Challenges in IBD research include environmental triggers, preclinical mechanisms, novel technologies, precision medicine, and pragmatic clinical research. Pragmatic research aims to generate evidence for real-world clinical practice by including diverse patient populations and assessing outcomes that matter to patients and healthcare providers. Advancements in biomedical research require high-quality translational research and successfully preclinical models able to convert promising laboratory results into clinical applications. Such approaches increase external validity of results, informs decision-making, optimizes care strategies, and improves outcomes for IBD patients. Specifically, increasing both internal and external validity remains a challenge in both in vitro/ex vivo and in vivo preclinical research. Therefore, we here aim to give an overview of recent advances in preclinical research models for IBD both in vitro/ex vivo and in vivo and pragmatic strategies to implement with a specific focus on microbiome research. While each model has its limitations, combining and implementing various techniques can provide a comprehensive preclinical evaluation. Advances in the field, such as personalized gut-on-a-chip models and humanized spontaneous animal models, will facilitate more pragmatic and effective strategies for identifying, evaluating, and predicting responses to potential new therapeutics in future research.

炎症性肠病的临床试验主要是随机临床试验，这是自20世纪40年代以来的黄金标准。然而，这些试验通常只针对一组特定的患者，费用昂贵，而且短期内只针对一种治疗方案。IBD研究面临的挑战包括环境诱因、临床前机制、新技术、精准医学和实用临床研究。实用主义研究旨在通过包括不同的患者群体和评估对患者和医疗保健提供者重要的结果，为现实世界的临床实践产生证据。生物医学研究的进步需要高质量的转化研究和成功的临床前模型，能够将有希望的实验室结果转化为临床应用。这些方法增加了结果的外部有效性，为决策提供了信息，优化了护理策略，并改善了IBD患者的预后。具体来说，在体外/离体和体内临床前研究中，提高内部和外部有效性仍然是一个挑战。因此，我们在此旨在概述IBD临床前研究模型的最新进展，包括体外/离体和体内，以及具体关注微生物组研究的实用策略。虽然每个模型都有其局限性，但结合和实施各种技术可以提供全面的临床前评估。该领域的进步，如个性化芯片肠道模型和人源化自发动物模型，将有助于在未来的研究中更务实、更有效地识别、评估和预测对潜在新疗法的反应。

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引用次数: 0

A comprehensive guide to intestinal ultrasound in ulcerative colitis 溃疡性结肠炎肠道超声综合指南

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpg.2025.102057

Mignini Irene, Iaccarino Jacopo, Esposto Giorgio, Borriello Raffaele, Galasso Linda, Coppola Gaetano, Ainora Maria Elena, Gasbarrini Antonio, Zocco Maria Assunta

Ulcerative colitis (UC) is traditionally considered a mucosal disease, with endoscopy as the gold standard for diagnosis and monitoring. However, emerging evidence increasingly supports the integration of intestinal ultrasound (IUS) as a non-invasive, accurate, and dynamic imaging modality in the management of UC. Traditionally confined to the assessment of Crohn's disease due to its transmural nature, IUS has demonstrated strong associations with clinical, endoscopic, and histologic scores in UC, enabling real-time assessment of disease activity, therapeutic response, and long-term outcomes. In this comprehensive review, we summarize the current evidence on the diagnostic and prognostic utility of IUS in UC, with a focus on validated ultrasonographic scores. Moreover, we explore novel applications of IUS in special clinical settings, including acute severe ulcerative colitis (ASUC), as well as in specific disease localizations such as proctitis and pouchitis, where transperineal ultrasound (TPUS) may offer diagnostic advantages. Furthermore, we review its emerging role in point-of-care scenarios and its utility within specific patient populations, notably pediatric patients.

溃疡性结肠炎（UC）传统上被认为是一种粘膜疾病，内窥镜检查是诊断和监测的金标准。然而，越来越多的新证据支持将肠道超声（IUS）作为一种无创、准确和动态的UC治疗成像方式。由于克罗恩病的跨壁性，传统上仅限于对克罗恩病的评估，IUS已证明与UC的临床、内镜和组织学评分有很强的相关性，能够实时评估疾病活动性、治疗反应和长期结果。在这篇全面的综述中，我们总结了目前关于IUS在UC中的诊断和预后应用的证据，重点是经过验证的超声评分。此外，我们探索IUS在特殊临床环境中的新应用，包括急性严重溃疡性结肠炎（ASUC），以及特定疾病定位，如直肠炎和袋炎，其中经会阴超声（tpu）可能提供诊断优势。此外，我们回顾了其在点护理场景中的新兴作用及其在特定患者群体中的效用，特别是儿科患者。

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引用次数: 0

Fatigue in inflammatory bowel disease 炎症性肠病的疲劳

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpg.2025.102059

Ulrike von Arnim , Karina Scholz

Fatigue is a burdensome, complex, and multifactorial symptom that is associated with a wide range of chronic diseases and occurs in nearly 50 % of patients with inflammatory bowel disease (IBD). Although common, physicians often fail to recognize the disabling nature of this symptom due to its subjective character and therefore treat it inadequately. Several factors can contribute to fatigue in IBD patients, including disease activity, anemia, medications, psychosomatic symptoms, and alterations in the gut–brain axis.

Managing fatigue in IBD can be challenging as it is often multidimensional. This review summarizes the available tools for diagnosing and measuring fatigue, discusses its causes, and provides treatment recommendations. We identify knowledge gaps in the diagnosis and management of fatigue and propose an algorithm to help physicians assess and treat fatigue in IBD patients. However, further research is needed to close knowledge gaps and improve fatigue management in IBD.

疲劳是一种累人的、复杂的、多因素的症状，与多种慢性疾病相关，近50%的炎症性肠病（IBD）患者出现疲劳。虽然常见，但由于其主观性，医生往往不能认识到这种症状的致残性质，因此治疗不当。有几个因素可导致IBD患者的疲劳，包括疾病活动、贫血、药物、心身症状和肠脑轴的改变。管理IBD患者的疲劳可能具有挑战性，因为它通常是多方面的。这篇综述总结了现有的诊断和测量疲劳的工具，讨论了其原因，并提供了治疗建议。我们确定了疲劳诊断和管理方面的知识差距，并提出了一种算法来帮助医生评估和治疗IBD患者的疲劳。然而，需要进一步的研究来缩小知识差距并改善IBD的疲劳管理。

引用次数: 0

Advanced diagnostic and resection endoscopic techniques in managing colitis-associated neoplasia: standard of care or still utopia? 先进的内镜诊断和切除技术治疗结肠炎相关肿瘤：标准治疗还是空想？

IF 4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.bpg.2025.102051

Rossella Maresca , Giulio Calabrese , Stefano Andrea Marchitto , Tommaso Schepis , Silvia Pecere , Marcello Maida , Cristiano Spada , Sandro Sferrazza , Federico Barbaro , Olga Maria Nardone

Patients with long-standing inflammatory bowel disease (IBD) are at increased risk of developing colitis-associated neoplasia (CAN), requiring a comprehensive approach from surveillance to endoscopic management. This narrative review provides an integrated overview of the entire pathway, including surveillance strategies for dysplasia detection, characterization of lesion types, and selection of appropriate resection techniques. Real-life examples and a proposed step-up approach are presented to guide clinical practice. The choice of endoscopic resection technique depends on lesion size, morphology, and the degree of fibrosis. Conventional EMR is suitable for small, lifting lesions, while ESD is preferred for larger or fibrotic lesions to achieve en bloc resection. In addition, emerging approaches—like underwater techniques—can also provide valuable options in complex cases. However, integrating effective surveillance with personalized resection techniques is essential to improve outcomes and reduce the need for surgery in patients with IBD-associated neoplasia.

患有长期炎症性肠病（IBD）的患者发生结肠炎相关瘤变（CAN）的风险增加，需要从监测到内镜治疗的综合方法。这篇叙述性综述提供了整个途径的综合概述，包括异常增生检测的监测策略，病变类型的表征，以及选择适当的切除技术。现实生活中的例子和提出的逐步提高的方法，以指导临床实践。内镜切除技术的选择取决于病变的大小、形态和纤维化程度。传统EMR适用于小的、隆起的病变，而ESD适用于较大的或纤维化的病变，以实现整体切除。此外，新兴的方法——比如水下技术——也可以在复杂的情况下提供有价值的选择。然而，将有效的监测与个性化的切除技术相结合对于改善ibd相关肿瘤患者的预后和减少手术需求至关重要。

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引用次数: 0

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