Expert Review of Gastroenterology & Hepatology最新文献

{"title":"How to deal with lower gastrointestinal defects: the role of endoscopy.","authors":"Maria Valeria Matteo, Giulia Santi, Vincenzo Bove, Martina De Siena, Loredana Gualtieri, Valerio Pontecorvi, Federico Barbaro, Cristiano Spada, Ivo Boškoski","doi":"10.1080/17474124.2025.2564388","DOIUrl":"https://doi.org/10.1080/17474124.2025.2564388","url":null,"abstract":"<p><strong>Introduction: </strong>Lower gastrointestinal (GI) defects, including leaks, perforations, and fistulas, pose significant challenges for diagnosis and management. These conditions are associated with high morbidity and mortality rates, necessitating effective treatment strategies to restore GI continuity and improve patient outcomes.</p><p><strong>Areas covered: </strong>This special report examines current evidence and future perspectives on the endoscopic management of lower GI defects. A literature search was conducted in PubMed, Google Scholar, and Scopus for studies published up to July 2025 that focused on the endoscopic management of lower GI defects. It provides an overview of various endoscopic techniques, including clips, endosuturing, stents, endoscopic internal drainage, endoscopic vacuum therapy, and emerging regenerative approaches, and their underlying advantages and limitations. The need for more standardized and larger studies to establish guidelines has been addressed.</p><p><strong>Expert opinion: </strong>Endoscopy is increasingly being recognized as a therapeutic option for lower GI defects, offering less invasive alternatives to traditional surgery. The challenges in developing standardized protocols are due to diverse clinical scenarios and limited prospective data. Future advancements are expected in technologies and personalization of treatments. A multidisciplinary approach is essential to achieve optimal outcomes in this complex field.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive assessment of liver fibrosis in MASLD: the need of sex-adjusted scores.","authors":"Fabio Novielli, Carlo De Matteis, Antonio Moschetta, Lucilla Crudele","doi":"10.1080/17474124.2025.2557243","DOIUrl":"10.1080/17474124.2025.2557243","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum of conditions from simple steatosis to advanced fibrosis that may represent the cradle for hepatocellular carcinoma. Thus, an accurate assessment of fibrosis is critical for patient management. Noninvasive tools, including serum biomarkers and imaging techniques, have emerged as practical alternatives to liver biopsy, which presents limitations for invasiveness, cost, and sampling variability.</p><p><strong>Areas covered: </strong>In this review, we examined references from relevant articles on PubMed, to investigate the most used noninvasive scores, focusing on their specific applications in various pathological conditions, including those beyond the liver. The application of these tools is particularly vital in challenging subpopulations, where conventional metabolic risk factors may be absent, or to target new therapeutical approaches. Sex-specific differences in hormonal and metabolic profiles, however, influence fibrosis progression and the interpretation of noninvasive tools, necessitating further refinement to optimize their clinical utility.</p><p><strong>Expert opinion: </strong>Despite these complexities, integrating noninvasive scores with imaging techniques has proven effective in stratifying risk, guiding treatment decisions, and improving long-term outcomes. As research continues to enhance these tools, their routine use in clinical practice represents a cornerstone for the early detection, monitoring, and personalized management of MASLD with sex-specific cutoffs.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1-20"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carcinoid syndrome mimicking irritable bowel syndrome: don't fall into the trap.","authors":"Sara Massironi, Camilla Gallo, Marianna Franchina, Caterina Sbarigia, Maura Corsetti, Silvio Danese","doi":"10.1080/17474124.2025.2557245","DOIUrl":"10.1080/17474124.2025.2557245","url":null,"abstract":"<p><strong>Introduction: </strong>Carcinoid syndrome (CS) is a complex condition caused by the systemic release of bioactive substances from neuroendocrine neoplasms (NENs), particularly small bowel tumors (sbNENs). Its symptoms-flushing, abdominal pain, and diarrhea-often resemble irritable bowel syndrome (IBS), resulting in misdiagnosis and delayed therapy.</p><p><strong>Areas covered: </strong>This review examines the pathophysiology of CS, especially serotonin overproduction and its effects on gut motility and secretion. The overlap between CS and IBS is analyzed, with emphasis on diagnostic pitfalls and warning signs. Distinctive features include \"dry\" flushing without sweating, typical of CS, versus \"wet\" or emotional flushing in IBS or anxiety. Poor response to standard IBS treatments and symptom exacerbation after specific foods or alcohol may also indicate CS. The utility of biomarkers such as 5-HIAA and imaging modalities including intestinal ultrasound and 68 Ga-DOTATATE PET/CT is discussed. A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library for English-language studies published between January 2000 and March 2024.</p><p><strong>Expert opinion: </strong>Early recognition of subtle differences and red-flag symptoms, combined with appropriate use of biomarkers and imaging, can minimize misdiagnosis. Timely identification of CS may improve patient outcomes by enabling earlier and more effective interventions.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1-14"},"PeriodicalIF":2.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic closure of Gastrointestinal defects: Devices and Techniques.","authors":"Zaheer Nabi, D Nageshwar Reddy","doi":"10.1080/17474124.2025.2539793","DOIUrl":"10.1080/17474124.2025.2539793","url":null,"abstract":"<p><strong>Introduction: </strong>Advancements in therapeutic endoscopy have expanded the management of gastrointestinal (GI) diseases. Procedures such as endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR) frequently result in iatrogenic GI defects requiring secure closure to prevent complications like bleeding and perforation. While through-the-scope clips (TTSCs) are effective for small defects, larger or full-thickness defects necessitate alternative closure techniques.</p><p><strong>Areas covered: </strong>This review discusses the endoscopic closure devices, including TTSCs, over-the-scope clips (OTSCs), and endoscopic suturing systems. A structured literature search was conducted using PubMed and Embase, focusing on device efficacy, retention rates, and safety outcomes. Novel closure devices and robotic-assisted techniques are also discussed.</p><p><strong>Expert opinion: </strong>The choice of closure technique depends on defect size, location, and tissue characteristics. TTSCs are suitable for small mucosal defects, while OTSCs and suturing devices enable robust closure for full thickness defects. While endoscopic suturing offers high closure strength, technical expertise is required. In near future, robotic-assisted endoscopy may enhance precision and efficiency of resection as well as closure of post-resection defects. Further research should focus on refining closure techniques and optimizing device selection to improve clinical outcomes.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"973-983"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive biomarkers for monitoring portal hypertension in metabolic dysfunction-associated steatotic liver disease (MASLD).","authors":"Shreya C Pal, Mariana M Ramírez-Mejía, Andrew P Keaveny, Nahum Méndez-Sánchez","doi":"10.1080/17474124.2025.2548526","DOIUrl":"10.1080/17474124.2025.2548526","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide and a major cause of morbidity and mortality. Portal hypertension (pHTN), previously thought to occur only with cirrhosis, is now recognized in MASLD even before advanced fibrosis, due to endothelial dysfunction and increased portal pressure. This underscores the need for early, noninvasive detection and treatment.</p><p><strong>Areas covered: </strong>This review examines the pathophysiological mechanisms leading to pHTN in MASLD, highlighting the role of vascular remodeling and endothelial dysfunction in portal pressure elevation. Although hepatic venous pressure gradient remains the gold standard for diagnosis, its invasive nature requires alternative strategies. This article discusses emerging noninvasive techniques, including imaging modalities and circulating biomarkers reflecting intrahepatic resistance, liver injury, and inflammation, that may improve early detection and risk stratification of pHTN in MASLD. A comprehensive literature search was performed in PubMed and Embase for studies published between January 2000 and June 2025.</p><p><strong>Expert opinion: </strong>Given the increasing burden of MASLD, noninvasive assessment of pHTN is essential. The combination of imaging and biomarkers could improve diagnosis and guide treatment. Future research should validate these tools and develop targeted therapies to prevent pHTN progression and improve outcomes.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1021-1032"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food insecurity is an emerging risk factor for liver disease: a scoping review.","authors":"Amedeo Lonardo, Ming-Hua Zheng, Ralf Weiskirchen","doi":"10.1080/17474124.2025.2545812","DOIUrl":"10.1080/17474124.2025.2545812","url":null,"abstract":"<p><strong>Introduction: </strong>Food insecurity, the household-level socio-economic condition of having limited or uncertain ability to acquire adequate and safe food, has affected 13.8 million households in the United States in 2020 and is a cofactor in the onset and worsening of metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Areas covered: </strong>To illustrate the epidemiological evidence linking MASLD with food insecurity, and the potential pathobiological mechanisms underlying their association we searched the PubMed, Web of Science, and Scopus database from inception to April 2025 for relevant keywords pertaining to the topic. Finally, we discuss promising areas of future research in this field.</p><p><strong>Expert opinion: </strong>Research on food insecurity contributes to the establishment of the biopsychosocial disease model in the MASLD field. Understanding the broader sociocultural factors influencing food choices, which may disproportionately affect certain vulnerable populations, can help shift the focus from individual responsibility to a more comprehensive approach to addressing obesity-related metabolic dysfunction. Future studies should focus on quantifying descriptors of food insecurity more effectively. Additionally, further research is necessary to determine whether and to what extent global cultural advancements and specific education in food security can prevent and reverse the negative outcomes of food insecurity-associated MASLD.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1033-1049"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of irritable bowel syndrome as a group of organic diseases: a narrative review.","authors":"Evan Saidara, Gillian M Barlow, Mark Pimentel","doi":"10.1080/17474124.2025.2549381","DOIUrl":"10.1080/17474124.2025.2549381","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, irritable bowel syndrome (IBS) has been classified as a functional disorder, diagnosed through symptom-based criteria and managed by a uniform algorithm. However, current research suggests IBS may represent a group of disorders, each with an organic basis, such as post-infectious changes to the intestinal tract, inflammation, and immune activation, gut-brain axis dysfunction, bile acid dysregulation, or gut microbiome irregularities.</p><p><strong>Areas covered: </strong>This literature review examines the historical classification of IBS, the revisions/changes in diagnostic criteria over time, and innovative research into potential causes of the disease. Key advances including bile acid profiling, stool microbiome analysis, mast cell markers, and breath testing are explored. Additionally, emerging treatments targeting these mechanisms are reviewed. These include microbiome-directed therapies, including antibiotics, probiotics, anti-inflammatory agents, and bile acid modulators. The literature search included peer-reviewed studies, clinical trials, and meta-analyses from major medical databases.</p><p><strong>Expert opinion: </strong>Although existing symptom-based diagnostic criteria for IBS have been useful, they have contributed to a situation whereby current treatments address symptoms, not the underlying causes. Approaching IBS as a constellation of diseases with individual organic bases will allow the development of more precisely targeted and effective treatments.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1007-1020"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous swallowing frequency in the evaluation of swallowing function.","authors":"Lucilla Guidotti, Daniel Españo, Noemí Tomsen, Pere Clavé, Omar Ortega","doi":"10.1080/17474124.2025.2550525","DOIUrl":"https://doi.org/10.1080/17474124.2025.2550525","url":null,"abstract":"<p><strong>Introduction: </strong>Oropharyngeal dysphagia (OD) is a common but underdiagnosed condition associated with serious complications such as malnutrition, aspiration pneumonia, and increased mortality. Spontaneous swallowing frequency (SSF) has recently emerged as a potential noninvasive biomarker for dysphagia screening.</p><p><strong>Areas covered: </strong>This narrative review explores the current state of knowledge on SSF in both healthy individuals and patients with OD, including stroke, Parkinson's disease, head and neck cancer, and cerebral palsy. The review discusses the physiological and neurological bases of SSF, summarizes the available measurement techniques (such as acoustic, electromiography, accelerometry), and examines its diagnostic and therapeutic implications. The literature search was conducted in PubMed, Scopus, and Web of Science, without publication date restrictions; studies included were published between 1965 and 2023. Literature was selected based on relevance, novelty, and methodological robustness, focusing on recent clinical studies and technical advances.</p><p><strong>Expert opinion: </strong>SSF holds promise as a clinical tool to assess brainstem function and detect dysphagia, particularly when integrated with AI-based systems. However, standardization of methods and large-scale validation are essential for its widespread implementation. In the future, SSF may complement existing assessments, enabling earlier and more precise management of OD.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":"19 9","pages":"985-1005"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for MASLD in patients with type 2 diabetes: is an early diagnosis a good diagnosis?","authors":"Chinonso Nwoguh, Christopher D Byrne, Tina Reinson, Ryan M Buchanan","doi":"10.1080/17474124.2025.2546597","DOIUrl":"10.1080/17474124.2025.2546597","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction associated steatotic liver disease (MASLD) is prevalent among patients with type 2 diabetes mellitus (T2DM) and is a growing cause of morbidity and mortality in Western countries. MASLD contributes to serious complications in individuals with T2DM, such as hepatocellular carcinoma, variceal bleeding, hepatic decompensation, and death.</p><p><strong>Areas covered: </strong>Via a search of Pubmed, Google Scholar, and Embase (no date restrictions) this review explores the rationale for screening for MASLD in patients with T2DM and highlights the nutritional, pharmacological, and interventional advantages of early diagnosis. In particular, we examine the effectiveness of novel anti-fibrotic therapies, recently assessed in clinical trials. Alongside these potential benefits, we consider the financial implications for the healthcare system and possible adverse effects on patients. To contextualize the discussion, we compare MASLD screening with the established diabetic retinopathy screening program in England and reference the World Health Organization's principles for disease screening.</p><p><strong>Expert opinion: </strong>Currently, there is insufficient evidence to support the implementation of a MASLD screening program for patients with T2DM. Key evidence gaps remain, particularly regarding: (1) the natural history of MASLD in patients with T2DM; (2) optimal timing and utilization of novel anti-fibrotic therapies; and (3) the impact of screening on major adverse liver outcomes compared to targeted testing approaches.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"941-951"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative gastroenterological evaluation for anti-reflux surgery: strengthening surgeon-gastroenterologist collaboration and improving patient selection.","authors":"Amir Farah, Wisam Abboud, Fahmi Shibli, Vincenzo Savarino, Elisa Marabotto, Edoardo V Savarino, Amir Mari","doi":"10.1080/17474124.2025.2549377","DOIUrl":"10.1080/17474124.2025.2549377","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal reflux disease (GERD) is a common condition characterized by heartburn and regurgitation, affecting up to 20% of the adult population in Western countries. While proton pump inhibitors (PPIs) effectively manage symptoms for many, about 30% of patients experience refractory symptoms, emphasizing the need for accurate diagnostic techniques and potential surgical interventions. This review discusses the integration of various diagnostic tools such as high-resolution manometry, impedance-pH monitoring, and endoscopic evaluations in preoperative assessments. These modalities help in confirming GERD, evaluating esophageal motility, and identifying conditions like Barrett's esophagus, which are crucial for determining the appropriateness of anti-reflux surgery such as laparoscopic fundoplication. Through a comprehensive diagnostic approach, clinicians can enhance patient selection, optimize surgical outcomes, and manage the increasing prevalence of GERD effectively.</p><p><strong>Areas covered: </strong>This review discusses the integration of various diagnostic tools such as high-resolution manometry, impedance-pH monitoring, and endoscopic evaluations in preoperative assessments. These modalities help in confirming GERD, evaluating esophageal anatomy and motility, which are crucial for determining the appropriateness of anti-reflux surgery such as laparoscopic fundoplication.</p><p><strong>Expert opinion: </strong>GERD management is shifting toward a more precise, personalized approach, supported by advanced diagnostics like endoscopy, HRM, pH monitoring, and barium esophagography. Tailored interventions are guided by these tools, particularly in surgical decision-making. The integration of interdisciplinary training, emerging technologies, and patient-centered innovations, such as wearables and simulation-based learning, promises to enhance outcomes and improve long-term quality of life.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"963-972"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}