Carmen Lara-Romero, Miguel Angel Fernández-Gómez, Franz Martín, Luis Castilla-Guerra, Jesús Funuyet-Salas, Genoveva Berná, Raquel Millán-Domínguez, Manuel Romero-Gómez
{"title":"Highlighting the relevance of a multidisciplinary approach in metabolic-asociated steatotic liver disease (MASLD).","authors":"Carmen Lara-Romero, Miguel Angel Fernández-Gómez, Franz Martín, Luis Castilla-Guerra, Jesús Funuyet-Salas, Genoveva Berná, Raquel Millán-Domínguez, Manuel Romero-Gómez","doi":"10.1080/17474124.2025.2584022","DOIUrl":"10.1080/17474124.2025.2584022","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic-associated steatotic liver disease (MASLD) represents a prevalent and multifaceted systemic condition, characterized by its intricate interplay of obesity, type 2 diabetes, and various metabolic perturbations. Given its complexity, MASLD necessitates a comprehensive multidisciplinary strategy for both prevention and management.</p><p><strong>Areas covered: </strong>Each of the experts who contributed to this review has made an in-depth review of the literature within their field of knowledge using PubMed. This review covers nutrition, physical activity and exercise, type 2 diabetes mellitus, cardiovascular risk factors, psychological approach, and clinical care by hepatologists in MASLD patients.</p><p><strong>Expert opinion: </strong>Adherence to the Mediterranean diet and engagement in exercise have been shown to ameliorate and potentially reverse MASLD. The hepatologist plays a pivotal role in diagnosis, assessment of liver comorbidities, and disease staging, emphasizing lifestyle modification and tailored therapy. Nutritionists are vital in dietary interventions, while specialists in sports medicine are essential for overcoming sedentary lifestyles, requiring fitness evaluations to customize exercise prescriptions. Psychological support addresses social and adherence challenges, enhancing patient management. Additionally, metabolic medicine experts are crucial for managing associated comorbidities, including cardiovascular risk factors and type 2 diabetes.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1153-1165"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654118","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":"Impact of GLP-1 receptor agonists on gastrointestinal function and symptoms.","authors":"Rosita D Frazier, William L Hasler","doi":"10.1080/17474124.2025.2579117","DOIUrl":"10.1080/17474124.2025.2579117","url":null,"abstract":"<p><strong>Introduction: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are approved for diabetes, obesity, and metabolic liver disease, but are also used off-label for other conditions. Adverse events associated with GLP-1RAs have become evident with their increased use.</p><p><strong>Areas covered: </strong>This review characterizes GLP-1 physiology and GLP-1RA effects on gastrointestinal (GI) function and symptoms. A comprehensive literature search was conducted accessing PubMed and EMBASE databases from July 1987 through August 2025. Effects of GLP-1RAs on parameters of dysfunctional GI transit and motility and symptoms potentially associated with these impairments are highlighted. The additional impact of GLP-1RA induced gastric food retention on the risk for pulmonary aspiration during anesthesia is a focus of concern. Extraintestinal complications including biliary tract disease and pancreatitis are discussed. Management of GLP-1RA adverse events is reviewed including adjustment of dosing protocols, dietary modifications, and pharmacotherapy to target GI symptoms, however these recommendations lack evidence-based support. New GLP-1RAs are in testing, many with action on other incretin pathways, but these may have adverse consequences similar to existing agents.</p><p><strong>Expert opinion: </strong>Prospective investigations of multicenter databases are advocated to transform management approaches of these GLP-1RA induced GI functional consequences and adverse symptoms from empiric treatments to more evidence-based protocols.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1181-1195"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370127","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":"1119-1132"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","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}
Maria Valeria Matteo, Giulia Santi, Vincenzo Bove, Martina De Siena, Loredana Gualtieri, Valerio Pontecorvi, Federico Barbaro, Cristiano Spada, Ivo Boškoski
{"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":"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":"1051-1061"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","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}
Chiara Viganò, Alice Laffusa, Lorena Pirola, Laura Cristoferi, Giovanna Zuin, Naire Sansotta, Daphne D'Amato, Stefania Orlando, Francesco Medici, Alberto Scirè Carlo, Pietro Invernizzi
{"title":"Extra-intestinal manifestations in inflammatory bowel disease: a comparative review of pediatric and adult-onset disease.","authors":"Chiara Viganò, Alice Laffusa, Lorena Pirola, Laura Cristoferi, Giovanna Zuin, Naire Sansotta, Daphne D'Amato, Stefania Orlando, Francesco Medici, Alberto Scirè Carlo, Pietro Invernizzi","doi":"10.1080/17474124.2025.2550518","DOIUrl":"10.1080/17474124.2025.2550518","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory Bowel Diseases (IBD) are chronic immune-mediated disorders diagnosed in both adult and pediatric populations. In recent years, there has been a significant global increase in pediatric-onset IBD, not only in Western countries but also in newly industrialized regions. Age of onset plays a crucial role in disease behavior and prognosis, with pediatric onset often associated with a more extensive and aggressive disease. As a systemic inflammatory condition, IBD can involve multiple organ systems beyond the gastrointestinal tract, thus resulting in extraintestinal manifestations (EIMs) of variable severity. These manifestations (musculoskeletal, dermatological, oral, ocular, and hepatobiliary) may significantly impact patients' quality of life, sometimes even more than intestinal symptoms. To support this review, a PubMed search was conducted using the terms inflammatory bowel disease, Crohn's disease, ulcerative colitis, pediatric inflammatory bowel disease, extraintestinal manifestations, focusing on the most relevant papers with no time restrictions.</p><p><strong>Areas covered: </strong>This review aims to provide a comprehensive revision and comparison of the presentation, course, and management of EIMs in pediatric- versus adult-onset IBD.</p><p><strong>Expert opinion: </strong>A deeper understanding of EIMs in different age groups is essential for timely diagnosis and holistic care, ultimately improving the overall quality of clinical management of patients with IBD.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1133-1147"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947883","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":"Chronic atrophic gastritis and dyspepsia: a forgotten link?","authors":"C Sbarigia, M Carabotti, M Corsetti, B Annibale","doi":"10.1080/17474124.2025.2550524","DOIUrl":"10.1080/17474124.2025.2550524","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between chronic atrophic gastritis and dyspeptic symptoms has been suggested since the early 20th century, however, current evidence is scarce and no study has sistematically assessed this link.</p><p><strong>Areas covered: </strong>We conducted a narrative review to assess the association between chronic atrophic gastritis (either corpus-restricted or multifocal) and dyspeptic symptoms based on the available evidence. A literature search was conducted on PubMed up to February 2025, using the SANRA scale. About 30% of patients with corpus atrophic gastritis report dyspeptic symptoms, while the prevalence of dyspepsia in patients with corpus atrophic gastritis was about 8%. Other issues addressed were: the pathogenetic mechanisms involved in dyspeptic symptoms generation, the topographic assessment of gastric atrophy, the characterization of dyspeptic symptoms and the paucity of available medical treatment.</p><p><strong>Expert opinion: </strong>In the coming years, more rigorous studies should be conducted to achieve a deeper understanding of the association between corpus atrophic gastritis and dyspeptic symptoms, to better elucidate the pathogenetic mechanisms underlying this link, and to evaluate possible treatment options.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1109-1117"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947979","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}
Fabio Novielli, Carlo De Matteis, Antonio Moschetta, Lucilla Crudele
{"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":"1081-1100"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","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}
Thanaboon Chaemsupaphan, Arteen Arzivian, Rupert W Leong
{"title":"Comprehensive care of ulcerative colitis: new treatment strategies.","authors":"Thanaboon Chaemsupaphan, Arteen Arzivian, Rupert W Leong","doi":"10.1080/17474124.2025.2457451","DOIUrl":"10.1080/17474124.2025.2457451","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis is a chronic inflammatory condition of the colon driven by aberrant immune activation. Although advanced medical therapies form the cornerstone of ulcerative colitis management, unmet needs include failure to induce and sustain remission in a substantial proportion of patients and in managing acute severe ulcerative colitis. We review new treatment strategies that might improve patient outcomes in the management of moderate-to-severe ulcerative colitis.</p><p><strong>Areas covered: </strong>A literature search was conducted using the PubMed database, including studies published from inception to October 2024, selected for their relevance. Recognizing current limitations, this article reviews strategies to improve treatment outcomes in ulcerative colitis using advanced therapies. These approaches include early treatment initiation, dose optimization, positioning newer agents as first-line therapies, combination therapy, targeting novel therapeutic endpoints, and the management of acute severe ulcerative colitis.</p><p><strong>Expert opinion: </strong>The strategies discussed may contribute to establishing new standards of care aimed at achieving long-term remission and enhancing patient outcomes. Personalized therapy, which tailors treatment based on individual disease characteristics and risk factors, is anticipated to become a critical aspect of delivering more effective care in the future.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1063-1079"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045960","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":"What's new in the critical care management of acute liver failure: a focus on global accessibility.","authors":"Priya Walabh, Constantine J Karvellas","doi":"10.1080/17474124.2025.2551265","DOIUrl":"10.1080/17474124.2025.2551265","url":null,"abstract":"<p><strong>Introduction: </strong>Acute liver failure (ALF) is a rare syndrome characterized by acute severe liver dysfunction and hepatic encephalopathy. The etiology of ALF varies according to age and geographical distribution and hence management depends on the etiology and clinical condition.</p><p><strong>Areas covered: </strong>While high-income-countries (HIC) most often see acetaminophen (APAP) and drug-induced liver injury (DILI) as causes of ALF, low-middle-income countries (LMIC) face a higher burden of viral hepatitis (particularly hepatitis A and E virus) and herbal/traditional/toxin medicine-related ALF transplant-free survival from ALF continues to improve with corresponding reduced rates of intracranial hypertension and cerebral edema particularly in APAP-ALF.</p><p><strong>Expert opinion: </strong>In this review, we will provide an update on the epidemiology and management of ALF with a particular focus on the differences in worldwide populations.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1101-1108"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947928","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}