Current Gastroenterology Reports最新文献_第9页

Managing Pouchitis: Where do Antibiotics End, and Advanced Therapies Begin? 治疗袋炎：抗生素何时结束，先进治疗何时开始？

IF 4.1

Current Gastroenterology Reports Pub Date : 2025-06-14 DOI: 10.1007/s11894-025-00994-4

Arpita Jajoo, Shahrad Hakimian, Gaurav Syal

{"title":"Managing Pouchitis: Where do Antibiotics End, and Advanced Therapies Begin?","authors":"Arpita Jajoo, Shahrad Hakimian, Gaurav Syal","doi":"10.1007/s11894-025-00994-4","DOIUrl":"10.1007/s11894-025-00994-4","url":null,"abstract":"Purpose of review: Pouchitis is a common complication in patients with ulcerative colitis who undergo total colectomy with ileal pouch anal anastomosis that presents a challenge to clinicians. In the article, we review the management of patients with pouchitis based on best available evidence.Recent findings: Pouchitis can be practically classified into acute intermittent pouchitis (AIP), chronic antibiotic dependent pouchitis (CADP) and chronic antibiotic refractory pouchitis (CARP) based on the frequency of pouchitis episodes and response to antibiotics. Antibiotics are effective for treatment of AIP and CADP. However, prolonged antibiotic use, which is often necessary in CADP, may be associated with the risk of side effects and antibiotic resistance. Advanced immunosuppressive therapy can be a reasonable alternative to antibiotics in CADP. Advanced immunosuppressive therapies are effective in CARP and Crohn's like disease of the pouch (CLDP) and are the recommended treatments for these conditions. Evaluation to confirm pouchitis and rule out other etiologies that can present with pouchitis-like symptoms should be considered in antibiotic refractory patients. Antibiotics are the mainstay of medical treatment of pouchitis. Advanced immunosuppressive therapies can be effective in situations where antibiotics are not preferred or are ineffective. The treatment targets in pouchitis need to be better defined.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"40"},"PeriodicalIF":4.1,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293385","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

Does Increasing Size of Bougienage Improve Response to Esophageal Dilation? 增大食管癌大小是否能改善食管扩张反应？

Current Gastroenterology Reports Pub Date : 2025-06-11 DOI: 10.1007/s11894-025-00982-8

Amal Shine, Mohamed Eisa, Endashaw Omer, Matthew Heckroth, Michael Eiswerth, Benjamin Rogers, Paul Tennant, Vincent Nguyen, Aye Aye Maung, Maiying Kong, Stephen A McClave

{"title":"Does Increasing Size of Bougienage Improve Response to Esophageal Dilation?","authors":"Amal Shine, Mohamed Eisa, Endashaw Omer, Matthew Heckroth, Michael Eiswerth, Benjamin Rogers, Paul Tennant, Vincent Nguyen, Aye Aye Maung, Maiying Kong, Stephen A McClave","doi":"10.1007/s11894-025-00982-8","DOIUrl":"10.1007/s11894-025-00982-8","url":null,"abstract":"Purpose of review: Because dysphagia occurs when the esophageal luminal diameter is < 13 mm, the traditional goal of dilation is set at 14-16 mm (42-48 Fr) to relieve symptoms. This study was designed to determine whether increasing the size of dilators further would improve durability of response to bougienage.Recent findings: Patients with severe or non-severe esophageal stricture and dysphagia were randomized to two different sizes of dilators. Diet and Dysphagia scores were calculated before and after index dilation, then every 4-8 weeks by phone for 12 months. Of 35 patients (mean age 63.1 yrs, 37.1% male) in the study, 11 had severe post-radiation strictures randomized to 42 Fr (n = 5) vs. 51 Fr (n = 6) Savary, 24 had non-severe strictures randomized to 46 Fr (n = 11) vs. 60 Fr (n = 13) Maloney. For severe strictures, number of dilations was nonsignificantly less with the larger 51 Fr versus 42 Fr (4.0 ± 1.73 vs. 5.2 ± 2.17, p = 1.00), and duration between dilations was longer (167 ± 154 vs. 64 ± 25 days, p = 0.41). For non-severe strictures, the smaller size 46 Fr dilator versus 60 Fr was associated with nonsignificantly fewer dilations (1.74 ± 0.81 vs. 1.77 ± 0.83, p = 0.70) and longer duration between sessions (265 ± 123 vs. 239 ± 103 days, p = 0.63). Bougienage with dilators larger than 14-16 mm (42-48 Fr) does not improve durability of symptomatic relief, either by decreasing the total number of dilations required or by increasing the symptom-free duration of response between sessions.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"39"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265450","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

Navigating Endoscopic Surveillance and Management of Barrett's Esophagus in Elderly Patients: Balancing the Risks and Benefits. 老年患者Barrett食管导航内镜监测和管理：平衡风险和收益。

IF 4.1

Current Gastroenterology Reports Pub Date : 2025-06-09 DOI: 10.1007/s11894-025-00984-6

Natalie J Wilson, Cary C Cotton, Nicholas J Shaheen

{"title":"Navigating Endoscopic Surveillance and Management of Barrett's Esophagus in Elderly Patients: Balancing the Risks and Benefits.","authors":"Natalie J Wilson, Cary C Cotton, Nicholas J Shaheen","doi":"10.1007/s11894-025-00984-6","DOIUrl":"10.1007/s11894-025-00984-6","url":null,"abstract":"Purpose of review: This review examines the current evidence and practical considerations for endoscopic surveillance of Barrett's esophagus (BE) in elderly patients, focusing on balancing the potential benefits and risks associated with endoscopic surveillance and eradication therapies in this population.Recent findings: Elderly patients with BE have a higher baseline prevalence of dysplasia and esophageal adenocarcinoma (EAC). Additionally, the risk of progression from BE to EAC increases with advancing age, making surveillance particularly relevant in this population. However, recent studies suggest the benefits of surveillance decline with increasing age, greater comorbidities, and reduced life expectancy. Despite increasing awareness that ongoing surveillance endoscopy may be of minimal benefit for certain patient groups, there remains a paucity of data to guide decisions regarding discontinuation of surveillance. The management of BE in elderly patients requires a careful balance between the potential benefits of endoscopic surveillance and eradication therapies and the risks and costs associated with repeated invasive procedures. Decisions to continue endoscopic surveillance in this population should be individualized, taking into account life-expectancy and comorbidities rather than focusing solely on chronological age.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"38"},"PeriodicalIF":4.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246872","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 Bleeding Due to Vascular Lesions: Pathogenesis and Management. 血管病变引起的小肠出血：发病机制和处理。

Current Gastroenterology Reports Pub Date : 2025-06-07 DOI: 10.1007/s11894-025-00989-1

Sunny Sandhu, Jonathan Gross, Jodie A Barkin

{"title":"Small Bowel Bleeding Due to Vascular Lesions: Pathogenesis and Management.","authors":"Sunny Sandhu, Jonathan Gross, Jodie A Barkin","doi":"10.1007/s11894-025-00989-1","DOIUrl":"10.1007/s11894-025-00989-1","url":null,"abstract":"Purpose of review: The purpose of this review is to provide a comprehensive review and recent updates in the understanding of the pathogenesis, diagnosis, and management of small bowel vascular lesions.Recent findings: Recent terminology has shifted from \"obscure GI bleeding\" to \"small bowel bleeding\", with the former reserved for cases when the source of bleeding is not detected despite a thorough evaluation of the entire GI tract, including the small bowel. Recent diagnostic advances including imaging, video capsule endoscopy (VCE), and deep enteroscopy have allowed for the identification of most small bowel bleeding sources. The incidence of small bowel bleeding remains a relatively uncommon event. Vascular lesions remain the most common etiology of small bowel bleeding, with angiodysplasia representing the majority of vascular small bowel lesions. Standard therapeutic approach includes adequate resuscitation and endoscopic evaluation, with consideration of medical therapy (including somatostatin analogues and antiangiogenic agents), endoscopic interventions, radiologic procedures, or surgical therapy in select patients.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246873","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

Evolving Role of GLP-1 Therapies in Liver Disease. GLP-1在肝脏疾病治疗中的作用

IF 4.1

Current Gastroenterology Reports Pub Date : 2025-06-06 DOI: 10.1007/s11894-025-00988-2

Mark Lindsay, Gretchen Arndt, Amanda Wieland, Thomas Jensen

引用次数: 0

Interleukin-23 Inhibitors for Inflammatory Bowel Disease: Pivotal Trials and Practical Considerations. 白细胞介素-23抑制剂治疗炎症性肠病：关键试验和实际考虑。

IF 4.1

Current Gastroenterology Reports Pub Date : 2025-06-04 DOI: 10.1007/s11894-025-00987-3

Sarah Rotondo-Trivette, William Jennings, David Fudman

引用次数: 0

Current Perspectives on Colorectal Cancer Screening and Surveillance in the Geriatric Population. 老年人群结直肠癌筛查和监测的现状。

Current Gastroenterology Reports Pub Date : 2025-06-02 DOI: 10.1007/s11894-025-00985-5

Jahnavi Udaikumar, Rithish Nimmagadda, Sushrut Ingawale, Vindhya Vasini Lella, Keerthika Vijayakumar, Adam S Faye, Aasma Shaukat

{"title":"Current Perspectives on Colorectal Cancer Screening and Surveillance in the Geriatric Population.","authors":"Jahnavi Udaikumar, Rithish Nimmagadda, Sushrut Ingawale, Vindhya Vasini Lella, Keerthika Vijayakumar, Adam S Faye, Aasma Shaukat","doi":"10.1007/s11894-025-00985-5","DOIUrl":"10.1007/s11894-025-00985-5","url":null,"abstract":"Purpose of review: Colorectal cancer (CRC) is a leading cause of cancer-related mortality, with 44% of deaths occurring in individuals aged 75 years and older. With 78 million adults over 65 years projected by 2035, optimizing CRC screening and surveillance is crucial. This review examines guidelines, risks, and personalized approaches.Recent findings: CRC screening reduces incidence by 17-33% and mortality by 11-53%. Colonoscopy lowers mortality by 61% but has a 6.8% complication rate in those aged 75 years and older. The risk of gastrointestinal bleeding is 8.7 per 1,000 for polypectomy, and perforation occurs in 0.6 per 1,000. Frailty indices assess suitability, but surveillance guidelines lack clear discontinuation criteria. Screening should balance risk, complications, and health status. It may be cost-effective up to age 86 years in healthy individuals, but more research is needed to refine surveillance strategies and reduce overtreatment in older adults.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198368","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

Genetic Mutations and Small Bowel Ulcerating Disease: Role in Diagnosis? 基因突变和小肠溃疡：在诊断中的作用？

Current Gastroenterology Reports Pub Date : 2025-05-21 DOI: 10.1007/s11894-025-00978-4

Rangesh Modi, Tanner Storozuk, Namrata Setia

{"title":"Genetic Mutations and Small Bowel Ulcerating Disease: Role in Diagnosis?","authors":"Rangesh Modi, Tanner Storozuk, Namrata Setia","doi":"10.1007/s11894-025-00978-4","DOIUrl":"10.1007/s11894-025-00978-4","url":null,"abstract":"Purpose of review: This review examines the role of genetic variations in the pathogenesis of small bowel (SB) ulcers associated with Crohn's disease (CD), NSAID enteropathy, and Cryptogenic Multifocal Ulcerous Stenosing Enteritis (CMUSE)/Chronic Non-Specific Ulcers of the Small Intestine (CNSU), aiming to address current diagnostic challenges.Recent findings: Advances in molecular genetics have revealed significant genetic contributors to SB ulceration. In CD, the NOD2 gene on chromosome 16 and several additional risk variants identified through genome-wide association studies (GWAS)-with key insights from the International Inflammatory Bowel Disease Genetics Consortium-have enhanced our understanding of the pathobiology of the disease. In NSAID enteropathy, polymorphisms in CYP enzymes have been associated with altered drug metabolism and gastrointestinal complications. However, the genetic mechanisms underlying deep ulcers in NSAID enteropathy, as well as CMUSE/CNSU, remain poorly understood. Genetic insights are crucial for understanding SB ulcerative diseases. Future research should focus on identifying specific genetic determinants to improve diagnostic accuracy and therapeutic strategies.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119149","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

Success Rates for Endoscopic Placement of Post-Pyloric Nasoenteric Tube Underperform Expectations. 内镜下放置幽门后鼻肠管的成功率低于预期。

IF 4.1

Current Gastroenterology Reports Pub Date : 2025-05-10 DOI: 10.1007/s11894-025-00965-9

Cristina Chiodi, Shesh Rai, Gerald Dryden

{"title":"Success Rates for Endoscopic Placement of Post-Pyloric Nasoenteric Tube Underperform Expectations.","authors":"Cristina Chiodi, Shesh Rai, Gerald Dryden","doi":"10.1007/s11894-025-00965-9","DOIUrl":"10.1007/s11894-025-00965-9","url":null,"abstract":"Purpose of review: Enteral nutrition plays a pivotal role in maintaining nutritional status and supporting recovery in hospitalized patients who are unable to meet their caloric requirements. The benefits of enteral nutrition include preserving gut integrity, reducing infection risks, and supporting immune function, which are vital in critically ill and post-operative patients. Nasoenteric feeding tubes often serve as important tools to deliver enteral nutrition efficiently, yet their optimal placement remains a subject of significant clinical consideration.Recent findings: Nasoenteric feeding tubes can be compromised by placement-related complications such as displacement, malpositioning, and tube-related discomfort. Our review of the relevant literature is complemented by review of our recent data. Our own clinical experience suggests that endoscopic placement of naso-enteric feeding tubes fails during the wire exchange process.Summary: This report reviews the importance of enteral nutrition for enhancing patient outcomes, documents findings from our retrospective study on endoscopically placed nasoenteric feeding tubes and focuses on the challenges and future advancements in nasoenteric feeding tube placement techniques.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"32"},"PeriodicalIF":4.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977778","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

Severe Refractory Post-Radiation Strictures: Lessons Learned from Long-term Follow-up after Combined Antegrade Retrograde Dilation. 严重难治性放射后狭窄：联合顺逆行扩张术后长期随访的经验教训。

Current Gastroenterology Reports Pub Date : 2025-05-07 DOI: 10.1007/s11894-025-00981-9

Mohamed Eisa, Amal Shine, Endashaw Omer, Matthew Heckroth, Michael Eiswerth, Vincent Nguyen, Benjamin Rogers, Paul Tennant, Stephen A McClave

{"title":"Severe Refractory Post-Radiation Strictures: Lessons Learned from Long-term Follow-up after Combined Antegrade Retrograde Dilation.","authors":"Mohamed Eisa, Amal Shine, Endashaw Omer, Matthew Heckroth, Michael Eiswerth, Vincent Nguyen, Benjamin Rogers, Paul Tennant, Stephen A McClave","doi":"10.1007/s11894-025-00981-9","DOIUrl":"10.1007/s11894-025-00981-9","url":null,"abstract":"Purpose of review: Dysphagia with an identifiable stricture occurs frequently following chemoradiation therapy for head/neck cancer patients, some developing complete obliteration of the esophageal lumen. Combined Antegrade Retrograde Dilation (CARD) is designed to restore luminal patency. This paper reports how experience at one institution shaped a more effective strategy for the long-term management of this difficult patient population.Recent findings: Twenty patients, mean age 62.6 years, initially undergoing CARD procedure, subsequently required a total of 278 dilation sessions (average 13.9 sessions/patient) performed on average every 8.2 weeks (range 2.7-12.6). All patients achieved luminal patency. Complications occurred in 7 patients (35.0% of patients, 2.5% of all procedures) and included traumatic bleeding, pneumothorax, overt esophageal perforation, microscopic perforation with cervical osteomyelitis, and perforation at the gastrostomy site. Diet and dysphagia scores were ineffective at directing the schedule for maintenance dilation. The CARD procedure is effective at restoring initial esophageal patency, but must be followed closely with long-term maintenance dilation. Over a large number of dilations, complications are infrequent and difficult to predict. Their incidence may be reduced by use of prophylactic antibiotics, prior removal of a tracheoesophageal prosthesis, avoiding dilation of the gastrostomy tract, modest dilation goal, and scheduled \"stricture surveillance\" with dilations performed under fluoroscopic guidance.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977966","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