Najwa F Mourad, Jana G Hashash, Viraj C Kariyawasam, Fadi H Mourad
{"title":"Management of inflammatory bowel disease: a holistic approach beyond pharmacotherapy.","authors":"Najwa F Mourad, Jana G Hashash, Viraj C Kariyawasam, Fadi H Mourad","doi":"10.1080/17474124.2025.2508970","DOIUrl":"10.1080/17474124.2025.2508970","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel diseases (IBD) management extends beyond pharmacotherapy, incorporating psychosocial support, patient education, physical activity, and dietary strategies. These components are often overlooked despite their impact on quality of life (QoL) and treatment adherence. This review explores the role of non-pharmacological strategies in optimizing IBD care.</p><p><strong>Areas covered: </strong>This article examines the significance of patient-physician communication, disease-specific education, mental health support, exercise, and diet in IBD management. A strong patient-physician relationship fosters trust and adherence to treatment. Knowledge empowers patients, improving long-term control. Psychosocial challenges, including anxiety, depression, and fatigue, further complicate disease management, highlighting the need for timely interventions. Physical activity and dietary interventions play essential roles in reducing sarcopenia and malnutrition, though standardized guidelines are lacking. Literature was reviewed to assess their effectiveness and clinical integration.</p><p><strong>Expert opinion: </strong>Holistic, multidisciplinary care should be standard in IBD management. Education, mental health screening, and structured diet and exercise plans must be integrated into routine care. Medical training should emphasize communication skills and patient-centered strategies. Future research should establish evidence-based guidelines for implementing these approaches effectively, ensuring improved long-term outcomes for IBD patients.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093257","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":"A narrative literature review of the incidence and prevalence of safety outcomes in patients with ulcerative colitis.","authors":"Milena Gianfrancesco, Abiola Awofeso, Diogo Branquinho, Xiang Guo, Aoibhinn McDonnell, Wilco Jacobs, Miguel Regueiro","doi":"10.1080/17474124.2025.2501224","DOIUrl":"https://doi.org/10.1080/17474124.2025.2501224","url":null,"abstract":"<p><strong>Introduction: </strong>Information on rates of safety outcomes in patients with ulcerative colitis [UC] is helpful to better understand the benefit-risk profile of more recent therapies approved for UC.</p><p><strong>Areas covered: </strong>This narrative review provides an updated examination of the incidence and prevalence of safety outcomes in the UC patient population. Incidence and prevalence estimates were determined for outcomes including cardiac conduction disorders, infections, and malignancies from published literature [2013-2023].</p><p><strong>Expert opinion: </strong>While information for certain outcomes was more frequently recorded, such as herpes viral infection (incidence rate [IR] 0.0-4.47 per 100 person-years [PY]) and malignancies [all; IR 0.0-1.77 per 100 PY], rarer outcome estimates such as bradycardia [IR 0.2 per 100 PY] and macular edema [IR 0.2 per 100 PY] were limited. Our knowledge of certain, uncommon safety outcomes and concomitant medical conditions in the UC population remains limited given the lack of data available. Even though larger cohorts with longer follow-up are warranted, estimates provided in this review will contribute to an improved understanding of the safety profile of UC therapies.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1-18"},"PeriodicalIF":3.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970910","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}
Xun Zhao, Talia Dufault, Gonzalo Sapisochin, Anna Saborowski, Arndt Vogel
{"title":"The clinical implications of trial endpoints in immunotherapy for hepatocellular carcinoma.","authors":"Xun Zhao, Talia Dufault, Gonzalo Sapisochin, Anna Saborowski, Arndt Vogel","doi":"10.1080/17474124.2025.2500369","DOIUrl":"https://doi.org/10.1080/17474124.2025.2500369","url":null,"abstract":"<p><strong>Introduction: </strong>Investigative work in the treatment of hepatocellular carcinoma is rapidly growing with the advent of immunotherapy. Nonetheless, trial endpoints and, more importantly, clinically meaningful endpoints need to be accurately chosen depending on the phase of trial and the patient population studied. We provide a scoping review focusing on trial endpoints on the use of immunotherapy in hepatocellular carcinoma.</p><p><strong>Areas covered: </strong>We searched PubMed and Google Scholar for prospective phase II and III trials using immunotherapy, whether in the neoadjuvant, adjuvant, bridging, downstaging, or palliative settings, while discussing the clinical implications of trial endpoints.</p><p><strong>Expert opinion: </strong>The field of immune oncology is rapidly progressing and has become the standard of care in advanced hepatocellular carcinoma. However, the role of immunotherapy in the treatment of early and intermediate stage hepatocellular carcinoma is yet to be defined. Prospective trials for all stages of disease must strive for endpoints that are not only statistically significant but also clinically consequential. Whereas overall response rate may be a reasonable trial endpoint in phase II trials, phase III trials should rather aim for the improvement of overall survival or quality of life to have clinically meaningful impacts.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975771","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}
Leonidas Mavroeidis, Foteini Kalofonou, Ruth Casey, Andrea Napolitano, Ramesh Bulusu, Robin L Jones
{"title":"Identifying and managing rare subtypes of gastrointestinal stromal tumors.","authors":"Leonidas Mavroeidis, Foteini Kalofonou, Ruth Casey, Andrea Napolitano, Ramesh Bulusu, Robin L Jones","doi":"10.1080/17474124.2025.2486304","DOIUrl":"10.1080/17474124.2025.2486304","url":null,"abstract":"<p><strong>Introduction: </strong>A subset of gastrointestinal stromal tumors (GISTs) lacks the common mutations in <i>KIT/PDGFRa</i> genes. This is a rare and heterogeneous group of challenging GISTs due to their diversity and absence of sensitivity to the tyrosine kinase inhibitor (TKI) imatinib.</p><p><strong>Areas covered: </strong>In this manscript, we review the pathogenesis, natural history, diagnostic features and management of <i>KIT/PDGFRa</i> wild-type (WT) GISTs, including SDH-deficient GISTs, GISTs with mutations in the RAS/RAF pathway, and quadruple WT GISTs which lack mutations in either <i>KIT/PDGFRa</i> and <i>SDH</i> genes or components of the RAS/RAF pathway, and syndromic GISTs as well as GISTs with rare <i>KIT/PDGFRa</i> mutations.</p><p><strong>Expert opinion: </strong>Patients should be managed in reference centers. There has been progress in the understanding of the biology of these GISTs, and promising therapeutic targets have been identified. In SDH-deficient GISTs, the TKI olverembatinib has shown encouraging clinical activity but requires further clinical validation, while the HIF2a inhibitor bezultifan and temozolomide alone or in combination with the death receptor agonist 5 are under clinical investigation. Targeting the RAS/RAF pathway in RAS/RAF-mutated GISTs warrants evaluation in clinical trials. Rare molecular alterations in quadruple WT GISTs require investigation for their oncogenic potential. Collaborative research and patient advocacy is critical for these extremely rare tumors.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"549-561"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742693","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}
Abdulsalam I Aliyu, Ryo Katsumata, Hans Törnblom, Magnus Simrén
{"title":"Gastrointestinal transit abnormalities in irritable bowel syndrome and their relation to symptoms.","authors":"Abdulsalam I Aliyu, Ryo Katsumata, Hans Törnblom, Magnus Simrén","doi":"10.1080/17474124.2025.2493867","DOIUrl":"10.1080/17474124.2025.2493867","url":null,"abstract":"<p><strong>Introduction: </strong>Measurement of gastrointestinal (GI) transit is increasingly becoming a valuable tool in understanding the pathophysiology of symptoms of many digestive diseases, including irritable bowel syndrome (IBS). The objective of this article is to review the relevance of GI transit abnormalities for symptoms of IBS. These abnormalities relate to gastric emptying, small bowel transit, and colonic transit (whole gut transit).</p><p><strong>Areas covered: </strong>The article briefly describes the current methods of assessment, factors that influence the result of these methods and the relationship of abnormalities of GI transit with symptoms that have been reported in IBS patients. Finally, a recommendation to guide the application of transit studies in IBS in both clinical practice and research is provided.</p><p><strong>Expert opinion: </strong>Gastrointestinal transit is relevant to symptoms of bowel habits (stool frequency and form) and the relevance for other GI symptoms in IBS is not straightforward and needs further characterization. Intervention studies in IBS that incorporate objective measures of gut transit alongside symptom evaluation are warranted. Incorporating artificial intelligence into the methods of measuring transit could improve accuracy and simplify the measurements.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"447-454"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960771","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}
Kenneth S H Chok, Tiffany Y T Joeng, Darren M C Poon
{"title":"Proton beam therapy in the management of hepatocellular carcinoma.","authors":"Kenneth S H Chok, Tiffany Y T Joeng, Darren M C Poon","doi":"10.1080/17474124.2025.2495080","DOIUrl":"10.1080/17474124.2025.2495080","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Photon radiotherapy shows efficacy in treating HCC but carries risks of high exit dose and radiation-induced liver disease. Additionally, HCCs with portal vein tumor thrombosis (PVTT) have a poor prognosis and are associated with higher risk of death. In recent years, proton beam therapy (PBT) has emerged as a novel treatment with the ability to downstage HCC for liver transplant (LT).</p><p><strong>Areas covered: </strong>This review will provide an overview of dosimetric benefits of PBT, efficacy of PBT in treating HCC, downstaging HCC-PVTT for LT, and a comparison of PBT with other non-surgical techniques. A search of PubMed until 3 September 2024 was conducted using free search and the following keywords: hepatocellular carcinoma, proton beam therapy, portal vein tumor thrombosis, local ablative therapy, trans-arterial chemoembolization, stereotactic body radiotherapy, Y-90 radioembolization.</p><p><strong>Expert opinion: </strong>Various clinical trials using PBT have shown promising tumor local control and overall survival rates. PBT is mostly safe and efficacious for downstaging HCC-PVTT for LT. PBT has also been shown to be non-inferior to various other treatment modalities. Future research should focus on combinations of PBT with other modalities.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"495-504"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992287","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}
Richard K Russell, Andrew Fagbemi, Jalil Benyacoub, Maria E Capobianco, Laura E Wells, Rita Shergill-Bonner, Preeti Sharma, Minal Patel
{"title":"Specialized and standard nutritional formulas for the dietary management of pediatric patients with Crohn's disease: a systematic literature review.","authors":"Richard K Russell, Andrew Fagbemi, Jalil Benyacoub, Maria E Capobianco, Laura E Wells, Rita Shergill-Bonner, Preeti Sharma, Minal Patel","doi":"10.1080/17474124.2025.2488887","DOIUrl":"10.1080/17474124.2025.2488887","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic literature review (SLR) aims to compare the clinical, humanistic, and economic outcomes associated with specialized and standard nutritional formulas for the treatment of mild-to-moderate pediatric Crohn's disease.</p><p><strong>Methods: </strong>Search strategies were applied across MEDLINE, Cochrane and Web of Science (January 2000-October 2023) and recent congress proceedings (January 2021-October 2023). PRISMA-P guidelines were followed. Quality assessment evaluated risk of bias.</p><p><strong>Results: </strong>Twenty-three unique studies met the inclusion criteria. Nineteen studies (754 patients) evaluated specialized formula, 10 assessed standard formula (246 patients). Mucosal healing (7 studies), induction (20 studies) and maintenance of remission (9 studies) were reported over various timeframes. High proportions of patients who received specialized formula achieved mucosal healing (63-89% 8 weeks; 25-74% 10 weeks), and remission (50-100% 8 weeks). Specialized formula sustained remission (34-62.5% 6 months and 24-87.5% 1 year). Results were not directly comparable with standard formula due to significant heterogeneity in study methodology, patient populations, and remission definition.</p><p><strong>Conclusions: </strong>The evidence predominantly supports the benefits of specialized formula in inducing mucosal healing, remission, and sustaining positive outcomes across multiple timepoints. Direct comparison of nutritional interventions is required to further support the findings of this SLR.<b>Protocol registration:</b> PROSPERO CRD42023472370.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"455-465"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803003","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}
A Dalbeni, F Cattazzo, L A Natola, M Zoncapè, D Faccincani, B Stefanini, F Ravaioli, R Villani, A Auriemma, D Sacerdoti
{"title":"What can real-world data teach us about treating patients with unresectable hepatocellular carcinoma?","authors":"A Dalbeni, F Cattazzo, L A Natola, M Zoncapè, D Faccincani, B Stefanini, F Ravaioli, R Villani, A Auriemma, D Sacerdoti","doi":"10.1080/17474124.2025.2476541","DOIUrl":"10.1080/17474124.2025.2476541","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatocellular carcinoma (HCC) remains a major global health concern, as it is the most common primary liver cancer and the fourth leading cause of cancer-related mortality.</p><p><strong>Areas covered: </strong>Immune checkpoint inhibitors (ICIs) have significantly shifted the treatment paradigm, offering promising survival outcomes. However, the controlled conditions of randomized clinical trials (RCTs) often fail to reflect real-world complexities, emphasizing the necessity for strong real-world evidence (RWE). RWE, in most cases derived from observational studies, provides critical insights into the effectiveness, safety, and tolerability of systemic therapies across diverse populations and settings. The authors searched MEDLINE, Ovid Embase, and Scopus for full-text published articles in any language from the inception to 30 June 2024.This review evaluates RWE on systemic therapies for advanced HCC, including tyrosine kinase inhibitors (TKIs) like sorafenib and lenvatinib, ICIs such as nivolumab and pembrolizumab, and combination therapies like atezolizumab/bevacizumab and durvalumab/tremelimumab.</p><p><strong>Expert opinion: </strong>Studies reveal discrepancies in treatment efficacy and adverse event profiles between RCTs and routine clinical practice, underscoring the need for individualized treatment strategies. RWE highlights the influence of liver disease etiology, liver function, and tumor burden on treatment outcomes, guiding therapy selection.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"389-398"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556225","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}
Madunil A Niriella, Pathum Premaratna, Mananjala Senanayake, Senerath Kodisinghe, Uditha Dassanayake, Anuradha Dassanayake, Dileepa S Ediriweera, H Janaka de Silva
{"title":"The reliability of freely accessible, baseline, general-purpose large language model generated patient information for frequently asked questions on liver disease: a preliminary cross-sectional study.","authors":"Madunil A Niriella, Pathum Premaratna, Mananjala Senanayake, Senerath Kodisinghe, Uditha Dassanayake, Anuradha Dassanayake, Dileepa S Ediriweera, H Janaka de Silva","doi":"10.1080/17474124.2025.2471874","DOIUrl":"10.1080/17474124.2025.2471874","url":null,"abstract":"<p><strong>Background: </strong>We assessed the use of large language models (LLMs) like ChatGPT-3.5 and Gemini against human experts as sources of patient information.</p><p><strong>Research design and methods: </strong>We compared the accuracy, completeness and quality of freely accessible, baseline, general-purpose LLM-generated responses to 20 frequently asked questions (FAQs) on liver disease, with those from two gastroenterologists, using the Kruskal-Wallis test. Three independent gastroenterologists blindly rated each response.</p><p><strong>Results: </strong>The expert and AI-generated responses displayed high mean scores across all domains, with no statistical difference between the groups for accuracy [H(2) = 0.421, <i>p</i> = 0.811], completeness [H(2) = 3.146, <i>p</i> = 0.207], or quality [H(2) = 3.350, <i>p</i> = 0.187]. We found no statistical difference between rank totals in accuracy [H(2) = 5.559, <i>p</i> = 0.062], completeness [H(2) = 0.104, <i>p</i> = 0.949], or quality [H(2) = 0.420, <i>p</i> = 0.810] between the three raters (R1, R2, R3).</p><p><strong>Conclusion: </strong>Our findings outline the potential of freely accessible, baseline, general-purpose LLMs in providing reliable answers to FAQs on liver disease.</p>","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"437-442"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476091","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":"Thinking outside the box: unconventional artificial intelligence algorithms in the detection and management of liver cirrhosis.","authors":"Ahmed Hashim, Bernardo Stefanini, Fabio Piscaglia","doi":"10.1080/17474124.2025.2483995","DOIUrl":"10.1080/17474124.2025.2483995","url":null,"abstract":"","PeriodicalId":12257,"journal":{"name":"Expert Review of Gastroenterology & Hepatology","volume":" ","pages":"443-445"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691444","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}