Expert Review of Gastroenterology & Hepatology最新文献_第10页

Strengths and limitations of risk stratification tools for patients with upper gastrointestinal bleeding: a narrative review. 上消化道出血患者风险分层工具的优势和局限性：叙述性综述。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-07-31 DOI: 10.1080/17474124.2023.2242252

Ali A Alali, Antoine Boustany, Myriam Martel, Alan N Barkun

{"title":"Strengths and limitations of risk stratification tools for patients with upper gastrointestinal bleeding: a narrative review.","authors":"Ali A Alali, Antoine Boustany, Myriam Martel, Alan N Barkun","doi":"10.1080/17474124.2023.2242252","DOIUrl":"10.1080/17474124.2023.2242252","url":null,"abstract":"Introduction: Despite advances in the management of patients with upper gastrointestinal bleeding (UGIB), associated morbidity and mortality remain significant. Most patients, however, will experience favorable outcomes without a need for hospital-based interventions. Risk assessment scores may assist in such early risk-stratification. These scales may optimize identification of low-risk patients, resulting in better resource utilization, including a reduced need for early endoscopy and fewer hospital admissions. The aim of this article is to provide an updated detailed review of risk assessment scores in UGIB.Area covered: A literature review identified past and currently available pre-endoscopic risk assessment scores for UGIB, with a focus on low-risk prediction. Strengths and weaknesses of the different scales are discussed as well as their impact on clinical decision-making.Expert opinion: The current evidence supports using the Glasgow Blatchford Score as it is the most accurate tool available when attempting to identify low-risk patients who can be safely managed on an outpatient basis. Currently, no risk assessment tool appears accurate enough in confidently classifying patients as high risk. Future research should utilize more standardized methodologies, while favoring interventional trial designs to better characterize the clinical impact attributable to the use of such risk stratification schemes.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":"17 8","pages":"795-803"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125423","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}

引用次数: 1

Alagille syndrome: understanding the genotype-phenotype relationship and its potential therapeutic impact. Alagille综合征：了解基因型-表型关系及其潜在的治疗影响。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-09-05 DOI: 10.1080/17474124.2023.2255518

Jennifer Halma, Henry C Lin

{"title":"Alagille syndrome: understanding the genotype-phenotype relationship and its potential therapeutic impact.","authors":"Jennifer Halma, Henry C Lin","doi":"10.1080/17474124.2023.2255518","DOIUrl":"10.1080/17474124.2023.2255518","url":null,"abstract":"Introduction: Alagille syndrome (ALGS) is an autosomal dominant, multisystem genetic disorder with wide phenotypic variability caused by mutations in the Notch signaling pathway, specifically from mutations in either the Jagged1 (JAG1) or NOTCH2 gene. The range of clinical features in ALGS can involve various organ systems including the liver, heart, eyes, skeleton, kidney, and vasculature. Despite the genetic mutations being well-defined, there is variable expressivity and individuals with the same mutation may have different clinical phenotypes.Areas covered: While no clear genotype-phenotype correlation has been identified in ALGS, this review will summarize what is currently known about the genotype-phenotype relationship and how this relationship influences the treatment of the multisystemic disorder. This review includes discussion of numerous studies which have focused on describing the genotype-phenotype relationship of different organ systems in ALGS as well as relevant basic science and population studies of ALGS. A thorough literature search was completed via the PubMed and National Library of Medicine GeneReviews databases including dates from 1969, when ALGS was first identified, to February 2023.Expert opinion: The genetics of ALGS are well defined; however, ongoing investigation to identify genotype-phenotype relationships as well as genetic modifiers as potential therapeutic targets is needed. Clinicians and patients alike would benefit from identification of a correlation to aid in diagnostic evaluation and management.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"883-892"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10210855","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}

引用次数: 0

Efficacy and safety of tolvaptan in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials. Tolvaptan治疗肝硬化患者的疗效和安全性：随机对照试验的系统综述和荟萃分析。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-10-24 DOI: 10.1080/17474124.2023.2267421

Lu Chai, Zhe Li, Ting Wang, Ran Wang, Kanokwan Pinyopornpanish, Gang Cheng, Xingshun Qi

{"title":"Efficacy and safety of tolvaptan in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials.","authors":"Lu Chai, Zhe Li, Ting Wang, Ran Wang, Kanokwan Pinyopornpanish, Gang Cheng, Xingshun Qi","doi":"10.1080/17474124.2023.2267421","DOIUrl":"10.1080/17474124.2023.2267421","url":null,"abstract":"Background and aims: Tolvaptan has been approved for the management of cirrhosis-related complications according to the Japanese and Chinese practice guidelines, but not the European or American practice guidelines in view of FDA warning about its hepatotoxicity. This study aimed to systematically evaluate its efficacy and safety in cirrhosis.Methods: The PubMed, EMBASE, and Cochrane library databases were searched to identify randomized controlled trials (RCTs) evaluating the efficacy and/or safety of tolvaptan in cirrhosis. Risk ratios (RRs) and weight mean differences (WMDs) were calculated. The incidence of common adverse events (AEs) was pooled.Results: Eight RCTs were included. Tolvaptan was significantly associated with higher rates of improvement of ascites (RR = 1.49, P < 0.001) and hyponatremia (RR = 1.80, P = 0.005) and incidence of any AEs (RR = 1.18, P = 0.003), but not serious AEs (RR = 0.86, P = 0.410). Tolvaptan was significantly associated with reductions in body weight (WMD = -1.30 kg, P < 0.001) and abdominal circumference (WMD = -1.71 cm, P < 0.001), and increases in daily urine volume (WMD = 1299.84 mL, P < 0.001) and serum sodium concentration (WMD = 2.57 mmol/L, P < 0.001). The pooled incidences of dry mouth, thirst, constipation, and pollakiuria were 16%, 24%, 6%, and 17%, respectively.Conclusion: Short-term use of tolvaptan may be considered in cirrhotic patients with ascites who have inadequate response to conventional diuretics and those with hyponatremia.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1041-1051"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41104562","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}

引用次数: 0

Targeting liver metabolism: a pathway to cure hepatitis B virus? 靶向肝代谢：治疗乙型肝炎病毒的途径？

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-06-18 DOI: 10.1080/17474124.2023.2226390

Harout Ajoyan, Mark W Douglas, Thomas Tu

引用次数: 0

Nutritional aspects of inflammatory bowel disease. 炎症性肠病的营养方面。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-07-10 DOI: 10.1080/17474124.2023.2231340

Ramit Magen-Rimon, Andrew S Day, Ron Shaoul

{"title":"Nutritional aspects of inflammatory bowel disease.","authors":"Ramit Magen-Rimon, Andrew S Day, Ron Shaoul","doi":"10.1080/17474124.2023.2231340","DOIUrl":"10.1080/17474124.2023.2231340","url":null,"abstract":"Introduction: The number of people diagnosed with inflammatory bowel disease (IBD) continues to increase in most parts of the world. Although the exact etiology of this chronic intestinal disease is not fully understood, nutritional factors appear to play key roles. Furthermore, individuals with IBD are at increased risk of adverse nutritional impacts, including micronutrient deficiencies.Areas covered: This review aims to summarize recent reports focusing on nutritional factors relevant to the development of IBD and to also review data on nutritional deficiencies seen in individuals with IBD.Expert opinion: The typical western diet, characterized by high-fat/high-sugar foods, along with food additives, appears to contribute to the etiopathogenesis of IBD. In contrast, some reports indicate that some foods are likely protective. However, there are inconsistencies in the currently available data, reflecting study design and other confounding factors. Furthermore, some of the conclusions are inferred from animal or in vitro studies. The presence of IBD can compromise the nutrition of individuals with one of these disorders: ongoing monitoring is critical. Nutrition and diet in the setting of IBD remain key areas for further and ongoing study.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":"17 7","pages":"731-740"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9825737","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}

引用次数: 0

Histamine-producing bacteria and their role in gastrointestinal disorders. 组胺产生菌及其在胃肠道疾病中的作用。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-07-06 DOI: 10.1080/17474124.2023.2230865

Marcello Fiorani, Livio Enrico Del Vecchio, Pasquale Dargenio, Francesco Kaitsas, Tommaso Rozera, Serena Porcari, Antonio Gasbarrini, Giovanni Cammarota, Gianluca Ianiro

{"title":"Histamine-producing bacteria and their role in gastrointestinal disorders.","authors":"Marcello Fiorani, Livio Enrico Del Vecchio, Pasquale Dargenio, Francesco Kaitsas, Tommaso Rozera, Serena Porcari, Antonio Gasbarrini, Giovanni Cammarota, Gianluca Ianiro","doi":"10.1080/17474124.2023.2230865","DOIUrl":"10.1080/17474124.2023.2230865","url":null,"abstract":"Introduction: Gut microbiota produces thousands of metabolites, which have a huge impact on the host health. Specific microbial strains are able to synthesize histamine, a molecule with a crucial role in many physiologic and pathologic mechanisms of the host. This function is mediated by the histidine decarboxylase enzyme (HDC) that converts the amino acid histidine to histamine.Areas covered: This review summarizes the emerging data on histamine production by gut microbiota, and the effect of bacterial-derived histamine in different clinical contexts, including cancer, irritable bowel syndrome, and other gastrointestinal and extraintestinal pathologies. This review will also outline the impact of histamine on the immune system and the effect of probiotics that can secrete histamine. Search methodology: we searched the literature on PubMed up to February 2023.Expert opinion: The potential of modulating gut microbiota to influence histamine production is a promising area of research, and although our knowledge of histamine-secreting bacteria is still limited, recent advances are exploring their diagnostic and therapeutical potential. Diet, probiotics, and pharmacological treatments directed to the modulation of histamine-secreting bacteria may in the future potentially be employed in the prevention and management of several gastrointestinal and extraintestinal disorders.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":"17 7","pages":"709-718"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9825747","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}

引用次数: 0

A spotlight on intestinal permeability and inflammatory bowel diseases. 关注肠道通透性和炎症性肠病。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-08-22 DOI: 10.1080/17474124.2023.2242772

Timo Rath, Raja Atreya, Markus F Neurath

{"title":"A spotlight on intestinal permeability and inflammatory bowel diseases.","authors":"Timo Rath, Raja Atreya, Markus F Neurath","doi":"10.1080/17474124.2023.2242772","DOIUrl":"10.1080/17474124.2023.2242772","url":null,"abstract":"Introduction: The intestinal barrier is a multi-faced structure lining the surface of the intestinal mucosa of the GI tract. To exert its main functions as a physical and immunological defense barrier, several components of the intestinal barrier act in a concerted and cooperative manner.Areas covered: Herein, we first introduce to the basic organization of the intestinal barrier and then summarize different methods to assess barrier function in and ex vivo. Finally, we provide an in-depth overview of the relevance of intestinal barrier dysfunction in inflammatory bowel diseases.Expert opinion: In parallel to a more fundamental understanding of the intestinal barrier as a key component for intestinal integrity is the notion that intestinal barrier defects are associated with a variety of diseases such as inflammatory bowel diseases. Recent research has fueled and perpetuated the concept that barrier defects are critical components of disease development, disease behavior, and potentially also an area of therapeutic intervention in IBD patients. Although being far away from standard, new technologies can be used to easily assess barrier healing in IBD and to derive clinical consequences from these findings such as more accurate forecasting of future disease behavior or the identification of novel therapeutic targets.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"893-902"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10037750","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}

引用次数: 1

Managing pediatric Crohn's disease: recent insights. 管理儿童克罗恩病：最近的见解。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-10-24 DOI: 10.1080/17474124.2023.2267431

Katherine Baldwin, Victoria Grossi, Jeffrey S Hyams

{"title":"Managing pediatric Crohn's disease: recent insights.","authors":"Katherine Baldwin, Victoria Grossi, Jeffrey S Hyams","doi":"10.1080/17474124.2023.2267431","DOIUrl":"10.1080/17474124.2023.2267431","url":null,"abstract":"Introduction: Children and adolescents with Crohn's disease present unique challenges due to extensive disease at diagnosis and the effect of bowel inflammation on growth. Historical approaches with corticosteroids and immunomodulators are far less effective than early treatment with anti-TNF biologics.Areas covered: This review covers recent literature delineating the crucial role of early anti-TNF therapy in the treatment of moderate- to- severe Crohn's disease in children and adolescents. The potential risks and benefits of concomitant immunomodulators are discussed, along with therapeutic anti-TNF drug monitoring, and reassessment by endoscopy and cross-sectional imaging to evaluate success beyond symptom control.Expert opinion: Standard of care therapy for moderate-to-severe pediatric Crohn's disease now entails precision dosing of anti-TNF therapy with periodic reassessment of bowel inflammation. The role of dietary modification continues to evolve. Current and future efforts need to be directed to elucidating ways to predict response to anti-TNF therapy and quickly changing to agents with other mechanisms of action when needed. Inordinate regulatory delays in approval of new therapies approved for adults continue to handicap pediatric clinicians and frequently limits their treatment choices, or forces them to give medications \"off label.\" Only a concerted effort by clinicians, pharma, and regulators will improve this situation.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"949-958"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41137536","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}

引用次数: 0

Hemostatic powders and gels in gastrointestinal endoscopy: current perspective and future recommendations. 胃肠镜中的止血粉末和凝胶：当前观点和未来建议。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-11-23 DOI: 10.1080/17474124.2023.2274913

Jahnvi Dhar, Daryl Ramai, Jayanta Samanta, Antonio Facciorusso

引用次数: 0

Terlipressin in the management of adults with hepatorenal syndrome-acute kidney injury (HRS-AKI). 特利加压素治疗成人肝肾综合征急性肾损伤（HRS-AKI）。

IF 3.9 3区医学

Expert Review of Gastroenterology & Hepatology Pub Date : 2023-07-01 Epub Date: 2023-11-23 DOI: 10.1080/17474124.2023.2273494

Anand V Kulkarni, Jason Lee, K Rajender Reddy

{"title":"Terlipressin in the management of adults with hepatorenal syndrome-acute kidney injury (HRS-AKI).","authors":"Anand V Kulkarni, Jason Lee, K Rajender Reddy","doi":"10.1080/17474124.2023.2273494","DOIUrl":"10.1080/17474124.2023.2273494","url":null,"abstract":"Introduction: Kidney is the most common extra-hepatic organ involved in patients with advanced liver cirrhosis and acute-on-chronic liver failure. Hepatorenal syndrome-acute kidney injury (HRS-AKI) accounts for most hospitalizations, and liver transplantation (LT) remains the ultimate and long-term treatment in such patients. However, HRS-AKI, being a functional renal failure, has a fair chance of reversal, and as such, patients who achieve reversal of HRS-AKI have better outcomes post-LT.Areas covered: In this review, we discuss the pharmacokinetics, pharmacodynamics and evidence to support the use of terlipressin in HRS-AKI while we also address predictors of response and the associated adverse events. Further, we discuss the role of terlipressin in the context of LT.Expert opinion: The recommended treatment for HRS-AKI reversal includes a vasoconstrictor in addition to volume expansion with albumin. The three vasoconstrictor regimens generally used to treat HRS-AKI include octreotide plus midodrine, noradrenaline, and terlipressin. Of these, terlipressin is a widely used drug and has been recently approved by US Food and Drug Administration (USFDA) for HRS-AKI. Terlipressin is the most effective drug for HRS-AKI reversal and is associated with a decreased need for renal replacement therapy pre- and post-transplant. Furthermore, terlipressin responders have improved transplant-free and post-transplant survival.","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1067-1079"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676053","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}

引用次数: 0