Current Gastroenterology Reports最新文献_第6页

Barrier Dysfunction in Eosinophilic Esophagitis. 嗜酸性粒细胞性食管炎的屏障功能障碍。

Current Gastroenterology Reports Pub Date : 2023-12-01 Epub Date: 2023-11-11 DOI: 10.1007/s11894-023-00904-6

Emily C McGowan, Roopesh Singh, David A Katzka

引用次数: 0

Chronic Liver Disease in the Older Patient-Evaluation and Management. 老年慢性肝病患者的评价与管理。

Current Gastroenterology Reports Pub Date : 2023-12-01 Epub Date: 2023-11-22 DOI: 10.1007/s11894-023-00908-2

Daniel Anthony DiLeo, Tolga Gidener, Ayse Aytaman

{"title":"Chronic Liver Disease in the Older Patient-Evaluation and Management.","authors":"Daniel Anthony DiLeo, Tolga Gidener, Ayse Aytaman","doi":"10.1007/s11894-023-00908-2","DOIUrl":"10.1007/s11894-023-00908-2","url":null,"abstract":"Purpose of review: As our population ages, the number of elderly patients with advanced chronic liver disease (ACLD) will increase. In this review we explore risk factors for liver injury, noninvasive assessment of liver disease, complications of cirrhosis, and management of frailty and sarcopenia in the older patient with ACLD.Recent findings: Multiple guidelines regarding ACLD have been updated over the past few years. New cutoffs for FIB-4 and NAFLD (MASLD - Metabolic Dysfunction Associated Steatotic Liver Disease) fibrosis scores for elderly patients are being validated. Older patients with MASLD benefit from caloric restriction, exercise programs, and GLP-1 agonists. Patients with ACLD need to be screened for alcohol use disorder with modified scoring systems, and if positive, benefit from referral to chemical dependency programs. Carvedilol and diuretics may safely be used in the elderly for portal hypertension and ascites, respectively, with careful monitoring. Malnutrition, frailty, sarcopenia, and bone mineral disease are common in older patients with ACLD, and early intervention may improve outcomes. Early identification of ACLD in elderly patients allows us to manage risk factors for liver injury, screen for complications, and implement lifestyle and pharmacological therapy to reduce decompensation and death. Future studies may clarify the role of noninvasive imaging in assessing liver fibrosis in the elderly and optimal interventions for nutrition, frailty, sarcopenia, bone health in addition to reevaluation of antibiotic prophylaxis for liver conditions with rising antibiotic resistance.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"390-400"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound? 小肠超声在乳糜泻中的作用?

Current Gastroenterology Reports Pub Date : 2023-12-01 Epub Date: 2023-11-18 DOI: 10.1007/s11894-023-00907-3

Roberta Elisa Rossi, Anita Busacca, Luca Brandaleone, Benedetta Masoni, Sara Massironi, Mirella Fraquelli, Alessandro Repici

{"title":"Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?","authors":"Roberta Elisa Rossi, Anita Busacca, Luca Brandaleone, Benedetta Masoni, Sara Massironi, Mirella Fraquelli, Alessandro Repici","doi":"10.1007/s11894-023-00907-3","DOIUrl":"10.1007/s11894-023-00907-3","url":null,"abstract":"Purpose of review: The incidence of celiac disease (CD) has increased over the last decades in part due to better disease awareness. Small bowel ultrasound (sb US) enables dynamic assessment of the bowel; although this topic has been addressed, the use of sb US in the diagnosis and in the follow-up of CD patients is limited to a few specialized tertiary referral centers. Herein, we aimed at summarizing the available literature on this topic to better define the potential clinical implications of sb US in CD, also through a comparison with other available diagnostic techniques.Recent findings: According to available data, sb US can be of help in confirming or excluding CD in patients with clinical suspicion; specifically, the finding of increased gall bladder volume, free abdominal fluid and enlargement of mesenteric lymph nodes reliably and accurately predicts the diagnosis of CD, whereas the absence of bowel dilatation and increased peristalsis may exclude the diagnosis. However, the place of intestinal US in the diagnostic algorithm of CD is likely to vary depending on the probability of the disease in a given population. There are only a few studies on the role of sb US in complicated CD, even if recent reports suggest a possible clinical role. There is a lack of data on follow-up of CD patients, particularly with the aim of detecting a poor diet adherence. According to current data sb US parameters have been shown to be of value in confirming and excluding the diagnosis of CD. Prospective studies with large sample size are warranted to determine whether to include sb US in the available guidelines for CD diagnosis and monitoring.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"430-439"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136396730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Point-of-Care Intestinal Ultrasound in Pediatric Inflammatory Bowel Disease. 儿童炎症性肠病的即时肠超声诊断。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-25 DOI: 10.1007/s11894-023-00892-7

Michael Todd Dolinger, Amelia Kellar

引用次数: 0

Precision Dosing of Anti-TNF Therapy in Pediatric Inflammatory Bowel Disease. 抗肿瘤坏死因子治疗在儿童炎症性肠病中的精确剂量

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-11 DOI: 10.1007/s11894-023-00895-4

Abigail Samuels, Kaitlin G Whaley, Phillip Minar

{"title":"Precision Dosing of Anti-TNF Therapy in Pediatric Inflammatory Bowel Disease.","authors":"Abigail Samuels, Kaitlin G Whaley, Phillip Minar","doi":"10.1007/s11894-023-00895-4","DOIUrl":"10.1007/s11894-023-00895-4","url":null,"abstract":"Purpose of the review: This review focuses on recent advancements in anti-TNF therapeutic drug monitoring (TDM), pharmacogenetics and personalized drug selection for children with inflammatory bowel disease (IBD).Recent findings: Several real-world studies and one clinical trial in children have demonstrated that proactive TDM, targeting higher exposure concentrations (> 5 µg/mL), can improve disease remission rates and enhance durability of the anti-TNF biologics. Recent data from both adult and pediatric IBD patients have revealed an association between a genetic polymorphism (HLA-DQA1*05) and the development of auto-drug antibodies. The impact of this association on clinical outcomes, considering more routine use proactive TDM and dose optimization in children, is still under investigation. Additionally, recent studies have identified potential inflammatory signatures and biomarkers that may serve as companion diagnostics for anti-TNF biologics. The effective management of anti-TNF therapies in children with IBD requires evidence-based precision dosing strategies, including routine TDM and proactive pharmacodynamic assessments.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"323-332"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10865142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical Options for End-Stage Achalasia. 终末期失弛缓症的手术选择。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-30 DOI: 10.1007/s11894-023-00889-2

Melissa DeSouza

{"title":"Surgical Options for End-Stage Achalasia.","authors":"Melissa DeSouza","doi":"10.1007/s11894-023-00889-2","DOIUrl":"10.1007/s11894-023-00889-2","url":null,"abstract":"Purpose of review: Achalasia is one of the most commonly described primary esophageal motility disorders worldwide, but there is significant controversy regarding ideal management of end-stage disease. This article reviews the definition of end-stage achalasia and summarizes past and present surgical treatment.Recent findings: Myotomy of the lower esophageal sphincter remains the mainstay of treatment of achalasia, even in advanced disease. Esophagectomy may have benefit as a primary treatment modality in end-stage achalasia with sigmoid esophagus, but international guidelines recommend consideration of laparoscopic or endoscopic approaches initially in most patients. Novel peroral esophageal plication techniques may provide alternative treatment options in patients with significant esophageal dilation that fail myotomy or esophagectomy.Summary: End-stage achalasia is characterized by progressive tortuosity and dilation of the esophagus as a failure of primary peristalsis. Up to 20% of patients with achalasia will progress to end-stage disease. In most cases, laparoscopic or endoscopic myotomy is recommended as initial approach to surgical management.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"267-274"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10113014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Climate Change and the Esophagus: Speculations on Changing Disease Patterns as the World Warms. 气候变化与食道:随着全球变暖对疾病模式变化的推测。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-01 DOI: 10.1007/s11894-023-00888-3

Yeong Yeh Lee, Nur Sakinah Roslan, Vincent Tee, Thai Hau Koo, Yusof Shuaib Ibrahim

{"title":"Climate Change and the Esophagus: Speculations on Changing Disease Patterns as the World Warms.","authors":"Yeong Yeh Lee, Nur Sakinah Roslan, Vincent Tee, Thai Hau Koo, Yusof Shuaib Ibrahim","doi":"10.1007/s11894-023-00888-3","DOIUrl":"10.1007/s11894-023-00888-3","url":null,"abstract":"Purpose of review: Esophageal disorders, including gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and esophageal cancer, may be affected by climate change. Our review describes the impact of climate change on risk factors associated with esophageal diseases and speculates how these climate-related factors impacted esophageal disorders and their management.Recent findings: Climate change is responsible for extreme weather conditions (shifts in rainfall, floods, droughts, and forest fires) and global warming. These consequences affect basic human needs of water and food, causing changes in population dynamics and pose significant threats to digestive health, including common esophageal disorders like GERD, EoE, and esophageal cancers. The changing patterns of esophageal diseases with climate change are likely mediated through risk factors, including nutrition, pollutants, microplastics, and the microbiota-gut-brain axis. The healthcare process itself, including GI endoscopy practices commonly employed in diagnosing and therapeutics of esophageal diseases, may, in turn, contribute to climate change through plastic wastage and greenhouse gas emissions, thus creating the climate change lifecycle. Breaking the cycle would involve changes at the individual level, community level, and national policy level. Prevention is key, with individuals identifying and remediating risk factors and reducing carbon footprints. The ABC (Advocacy, Broadcast, and Collaborate) activities would help enhance awareness at the community level. Higher-level programs such as the Bracing Resilience Against Climate Effects (BRACE) would lead to broader and larger-scale adoption of public health adaptation strategies at the national level. The impact of climate change on esophageal disorders is likely real, mediated by several risk factors, and creates a climate change lifecycle that may only break if changes are made at individual, community, and national levels.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"280-288"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10120835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Esophageal Cancer: Overview, Risk Factors, and Reasons for the Rise. 癌症食管癌：概述，危险因素和发病原因。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-10-09 DOI: 10.1007/s11894-023-00899-0

Steve Lander, Eric Lander, Michael K Gibson

{"title":"Esophageal Cancer: Overview, Risk Factors, and Reasons for the Rise.","authors":"Steve Lander, Eric Lander, Michael K Gibson","doi":"10.1007/s11894-023-00899-0","DOIUrl":"10.1007/s11894-023-00899-0","url":null,"abstract":"Purpose of review: Esophageal cancer (EC) is a common cancer affecting many regions of the world and carries significant morbidity and mortality. In this article, we review the key risk factors and their associated impact on the changing incidence and prevalence of EC subtypes within different global regions. We also highlight potential reasons for the ever-changing epidemiology of this prevalent cancer type.Recent findings: There has been a shift in incidence of Esophageal Adenocarcinoma (AC) and Squamous Cell Carcinoma (SCC) within certain populations primarily due to an increase prevalence of primary risk factors. In Western nations, more often the United States, there has been a shift from SCC predominance to the majority of new cases of EC being adenocarcinoma. This shift within the United States has largely correlated with a rise in obesity. The prevalence of AC in Asia is also starting to rise as more countries adopt a western diet. The pathophysiology, associated risk factors, and presentation of ESCC and AC are different. This difference is seen in varying lifestyles, population health, and certain genetic risks. With further development closer analysis of primary risk factors and implementation of policies and programs that promote public health literacy, there is a potential to decrease esophageal cancer's global disease burden.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"275-279"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41123023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment of Cholestasis in Infants and Young Children. 婴幼儿胆汁淤积症的治疗。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-31 DOI: 10.1007/s11894-023-00891-8

Nicole Heinz, Jennifer Vittorio

{"title":"Treatment of Cholestasis in Infants and Young Children.","authors":"Nicole Heinz, Jennifer Vittorio","doi":"10.1007/s11894-023-00891-8","DOIUrl":"10.1007/s11894-023-00891-8","url":null,"abstract":"Purpose of review: Cholestasis is characterized by a conjugated hyperbilirubinemia secondary to impaired bile synthesis, transport, or excretion from the liver. It is always pathologic and can be indicative of an underlying hepatobiliary, genetic, or metabolic disorder, several of which require timely diagnosis to ensure proper management and optimal outcomes. This review provides an overview of the evaluation of cholestasis with a focus on current and emerging treatment strategies.Recent findings: Increased accessibility of next generation sequencing (NGS) allows for utilization of genetic testing early in the diagnostic process. This may alter the clinical algorithm for diagnosis of cholestatic disorders. An enhanced understanding of the underlying pathophysiology may help guide future development of targeted therapies, such as ileal bile acid transporter (IBAT) inhibitors. These were recently approved for treatment of cholestatic pruritus in patients with Alagille syndrome and Progressive Familial Intrahepatic Cholestasis. Current management of cholestasis is aimed at the biochemical consequences of impaired bile flow, including malnutrition, pruritus, and progressive fibrosis. NGS has led to an enhanced understanding of biliary pathology and may guide development of future treatment modalities based on specific gene mutations. Rapid discernment of the underlying etiology is essential as new treatment modalities emerge.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"344-354"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10178040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease. 儿童炎症性肠病中的艰难梭菌感染。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-30 DOI: 10.1007/s11894-023-00890-9

Seth A Reasoner, Maribeth R Nicholson

引用次数: 0