Current Opinion in Gastroenterology最新文献

Management of reflux hypersensitivity. 反流超敏反应的处理。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-21 DOI: 10.1097/MOG.0000000000001107

Sudharshan Achalu, Adily N Elmi, Afrin N Kamal

{"title":"Management of reflux hypersensitivity.","authors":"Sudharshan Achalu, Adily N Elmi, Afrin N Kamal","doi":"10.1097/MOG.0000000000001107","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001107","url":null,"abstract":"Purpose of review: The challenges in distinguishing reflux hypersensitivity (RH) from other functional esophageal disorders demand a comprehensive understanding of RH. This review aims to discuss the latest practices in diagnosis and management of RH, examining the pathophysiology, diagnostic criteria, and evolving treatment strategies for RH, with an emphasis on the role of effective patient-physician communication.Recent findings: Esophageal hypersensitivity appears to play a significant role in symptoms generation for RH patients. Diagnostic algorithms have improved with updates from the Lyon consensus. Management strategies including treatments with neuromodulators, proton-pump inhibitors, behavioral interventions, and antireflux surgery are potential therapeutic options for patients with RH.Summary: Effective RH management requires a patient-centered approach that considers possible pharmacologic, behavioral, and surgical strategies. Effective patient-physician communication is essential to educate patients and address their concerns about neuromodulators, and to reframe treatment strategies to target esophageal hypersensitivity rather than a psychiatric disorder.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129459","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

Management of paraesophageal hernia 2025. 食管旁疝的治疗2025。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-15 DOI: 10.1097/MOG.0000000000001111

Erwin Rieder, Sebastian F Schoppmann

{"title":"Management of paraesophageal hernia 2025.","authors":"Erwin Rieder, Sebastian F Schoppmann","doi":"10.1097/MOG.0000000000001111","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001111","url":null,"abstract":"Purpose of review: A paraesophageal hernia (PEH) is the condition in which the fundus of the stomach protrudes through the diaphragmatic hiatus into the chest adjacent to the esophagus. Such hernias can result in serious complications such as bleeding, obstruction, ischemia, and perforation. There is considerable controversy regarding the optimal management of PEH and, in this report, we review recent publications that address this issue.Recent findings: After surgical repair of PEH, the rate of recurrence remains high, and recent data do not document a clear advantage for the use of a mesh for crural buttressing in preventing recurrence. There also appears to be no significant difference among different types of mesh for preventing recurrence in the long term. The optimal shape, positioning, and material for mesh remain controversial topics. Recent reports suggest benefit for performing gastropexy routinely during PEH repair, and the addition of a fundoplication does not seem to reduce rates of recurrence or gastroesophageal reflux. Promising early results have been described for new techniques of PEH repair such as the use of posterior rectus sheath fascia for hiatal augmentation, and anterior crural reconstruction.Summary: This report summarizes the most recent data on key issues in the management of PEH such as the use of mesh, gastropexy, fundoplication, the role of age, and novel techniques for PEH repair.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129389","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

The current state of esophageal lichen planus. 食管扁平苔藓的现状。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-15 DOI: 10.1097/MOG.0000000000001112

Megan B Ghai, Nasim Parsa, Joshua A Sloan

{"title":"The current state of esophageal lichen planus.","authors":"Megan B Ghai, Nasim Parsa, Joshua A Sloan","doi":"10.1097/MOG.0000000000001112","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001112","url":null,"abstract":"Purpose of review: The purpose of this review article is to: describe the clinical manifestations of esophageal lichen planus (ELP), understand its epidemiological risk factors, elaborate the common endoscopic and histopathologic findings of ELP, summarize current thinking on treatment and surveillance, and understand the long-term sequelae of ELP.Recent findings: A combination of clinical, endoscopic, and histopathologic findings are required to make a diagnosis of ELP. While there is no consensus on management of ELP, there is evidence of clinical and endoscopic improvement with the use of topical steroids among other therapies. There is a known risk of malignant transformation of ELP to esophageal squamous cell carcinoma (ESCC).Summary: ELP is an idiopathic condition that primarily affects Caucasian females ages 50-70 years. This review of current literature suggests that a combination of clinical, endoscopic, and histologic findings are required to make a diagnosis; topical steroids with or without esophageal dilation show overall improvement of ELP; and endoscopic surveillance to monitor for ESCC is recommended.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128093","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

Update on laryngopharyngeal reflux disease. 喉咽反流病最新进展。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-15 DOI: 10.1097/MOG.0000000000001108

Miguel A Algara, Walter W Chan

{"title":"Update on laryngopharyngeal reflux disease.","authors":"Miguel A Algara, Walter W Chan","doi":"10.1097/MOG.0000000000001108","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001108","url":null,"abstract":"Purpose of review: Chronic laryngopharyngeal symptoms (LPS) are increasingly prevalent presentations to gastroenterologists' offices, and clinicians often make a presumptive diagnosis of laryngopharyngeal reflux disease (LPRD) based on LPS symptoms or laryngoscopic findings alone. Such presumptive diagnoses of LPRD often are incorrect, and establishing the correct diagnosis poses significant challenges for clinicians. This review addresses the timely need for advances in evaluating and managing LPS/LPRD, given their diagnostic complexity and the healthcare burden of ineffective empiric treatments.Recent findings: Recent evidence emphasizes the diverse etiologies of LPS including LPRD, oropharyngeal or other airway pathologies, allergic conditions, and cognitive-affective processes or altered brain-larynx interaction. The diagnostic approach should be individualized and multimodal, including upfront reflux testing over empiric acid suppression trials for possible LPRD, given the poor correlation between LPS and objective evidence of reflux. Predictive models and risk stratification tools such as the COuGH RefluX score show promise to help guide testing and therapeutic strategies. Reflux testing modalities include wireless pH monitoring and impedance-based testing (traditional impedance-pH or combined hypopharyngeal-esophageal reflux monitoring). Biochemical testing for salivary pepsin may also offer adjunctive value. Management should include antireflux strategies for those with objectively-proven LPRD, alongside treatments targeting nonreflux mechanisms of LPS, such as voice therapy, neuromodulation, and behavioral therapy.Summary: An individualized, multidisciplinary approach is essential in managing LPS/LPRD. Objective reflux testing improves diagnostic accuracy, avoids unnecessary therapies, and enables tailored treatment. Future research should further refine diagnostic thresholds, validate risk stratification tools, and explore novel therapeutic targets to optimize outcomes.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128409","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

Avoiding the complications of endoscopic retrograde cholangiopancreatography. 内窥镜逆行胆管造影并发症的避免。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-05 DOI: 10.1097/MOG.0000000000001103

Syed Matthew Kodilinye, Yasutoshi Shiratori, Anthony N Kalloo

{"title":"Avoiding the complications of endoscopic retrograde cholangiopancreatography.","authors":"Syed Matthew Kodilinye, Yasutoshi Shiratori, Anthony N Kalloo","doi":"10.1097/MOG.0000000000001103","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001103","url":null,"abstract":"Purpose of review: To review the literature within the past 5 years on risk factors and prophylactic measures for avoiding the complications of endoscopic retrograde cholangiopancreatography (ERCP), including post-ERCP pancreatitis (PEP), post-ERCP cholangitis, bleeding, and perforation.Recent findings: Despite advances in endoscopic technique and numerous clinical trials, complications of ERCP still occur frequently, particularly PEP. Recent findings are concentrated in the PEP domain and include the following: the discovery of pancreatic steatosis as a potential novel risk factor, machine learning models to predict PEP, combination prophylactic strategies including rectal NSAIDs, aggressive intravenous fluid hydration and pancreatic duct stents, potential novel pharmacotherapies, and enhanced endoscopic techniques for difficult biliary cannulation.Summary: Endoscopists should be familiar with the complications of ERCP and prophylactic strategies. PEP carries a significant morbidity and economic burden, but its occurrence is par for the course when performing ERCP. Future studies should concentrate on elucidating further the pathophysiology of PEP and predicting cases that result in severe complications (severe if hospitalization was greater than 10 days along with the presence of pseudocyst, pancreatic necrosis, need for percutaneous drainage or surgery, or death).","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129487","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

Noncirrhotic portal hypertension: current trends and future directions. 非肝硬化门静脉高压：当前趋势和未来方向。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-05 DOI: 10.1097/MOG.0000000000001106

Babu Lal Meena, Omkar S Rudra, Deepti Sharma, Shiv Kumar Sarin

{"title":"Noncirrhotic portal hypertension: current trends and future directions.","authors":"Babu Lal Meena, Omkar S Rudra, Deepti Sharma, Shiv Kumar Sarin","doi":"10.1097/MOG.0000000000001106","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001106","url":null,"abstract":"Purpose of review: Noncirrhotic portal hypertension (NCPH) comprises a diverse group of vascular liver disorders characterized by elevated portal pressure without cirrhosis. Due to overlapping clinical features, distinguishing NCPH from cirrhosis and porto-sinusoidal vascular disorder (PSVD) remains challenging. This review explores recent advancements in diagnosis, differentiation, and evolving treatment strategies.Recent findings: NCPH is characterized by preserved liver function and near-normal hepatic venous pressure gradients (HVPG). It shares risk factors with PSVD, including infections, drugs, toxins, and prothrombotic conditions. Diagnostic advancements, such as liver stiffness measurement (LSM) and splenic stiffness measurement (SSM), offer noninvasive differentiation from cirrhosis, while liver biopsy remains crucial for confirming PSVD and noncirrhotic portal fibrosis (NCPF). Imaging is reliable for diagnosing extrahepatic portal vein obstruction (EHPVO). Transjugular intrahepatic portosystemic shunts (TIPS) for refractory variceal bleeding or ascites, achieving rebleeding control in 72-80% of cases. Surgical shunts and splenectomy remain essential for uncontrolled bleeding and portal biliopathy, demonstrating excellent variceal control (93-95%).Summary: NCPH requires a high index of suspicion for diagnosis. Differentiation from cirrhosis and PSVD relies on clinical, histological, and hemodynamic assessments. Management focuses on endoscopic, interventional, and surgical strategies tailored to disease severity. Future research should standardize diagnostic criteria, explore targeted therapies, and refine prognostic tools to improve outcomes.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112334","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

Key updates in Crohn's disease surgery for the gastroenterologist in 2025. 2025年胃肠病学家克罗恩病手术的关键更新。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-02 DOI: 10.1097/MOG.0000000000001102

Gassan Kassim, Stefan D Holubar, Benjamin L Cohen

{"title":"Key updates in Crohn's disease surgery for the gastroenterologist in 2025.","authors":"Gassan Kassim, Stefan D Holubar, Benjamin L Cohen","doi":"10.1097/MOG.0000000000001102","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001102","url":null,"abstract":"Purpose of review: The field of inflammatory bowel disease (IBD) has been evolving at an unprecedented rate. Not only does this apply to the medical management of IBD but also to its surgical management. This review aims to highlight the major updates in the current surgical approach in Crohn's disease.Recent findings: Surgery for Crohn's disease is no longer considered only for medically refractory disease or for disease-related complications but can rather be considered as an effective first-line treatment option. The concept of multimodal prehabilitation is becoming more solidified in Crohn's disease, as strong evidence continues to indicate its positive impact on surgical outcomes. The impact of the mesentery as well as the type of surgical anastomosis on postsurgical Crohn's disease recurrence is being closely reexamined. The optimal approach for surgical management of perianal Crohn's disease is also being redefined.Summary: Surgery is an integral part of the care of Crohn's disease patients and keeping up with the evolving paradigm of surgery in Crohn's disease is critical for all providers taking care of Crohn's disease patients to ensure patients are getting the best care possible.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129388","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

Startups and the next frontier of inflammatory bowel disease therapy: a guide for the brave. 初创公司和炎症性肠病治疗的下一个前沿：勇敢的指南。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-02 DOI: 10.1097/MOG.0000000000001100

Vladimir Lamm

{"title":"Startups and the next frontier of inflammatory bowel disease therapy: a guide for the brave.","authors":"Vladimir Lamm","doi":"10.1097/MOG.0000000000001100","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001100","url":null,"abstract":"Purpose of review: This review explores the evolving landscape of inflammatory bowel disease (IBD) therapy, particularly through the lens of startups that are pushing the boundaries of current treatment paradigms. By discussing the challenges and opportunities faced by startups, this review seeks to provide insights for aspiring entrepreneurs and innovators in the IBD space.Recent findings: The landscape of IBD is rapidly evolving, with innovative solutions ranging from novel therapeutics to digital health platforms. An analysis of recent SBIR award winners highlights emerging trends, including microbiome-based therapies, targeted small molecules, and advanced drug delivery systems like hydrogels. Digital health solutions, such as smart monitoring tools and AI-assisted treatment selection are gaining traction. IBD startups are playing a crucial role in cost reduction through competition, streamlining drug development, and treatment personalization. Despite regulatory, financial, and funding challenges, startups are driving the next phase of IBD innovation.Summary: The future of IBD therapy is being driven by innovative start-ups that are challenging the status quo in IBD treatment. These companies are addressing critical gaps in therapy by focusing on novel drug targets, improved drug delivery, and precision medicine. While startups face many challenges including high research and development (R&D) costs, regulatory hurdles, and funding, they continue to be at the forefront of IBD innovation. Their success could potentially lead to more affordable and effective therapies. By drawing on examples like the nutraceutical company, Evinature, my own personal experience as technical lead of Edulis, a startup focused on localized IBD therapy, and perspective from the head of the Crohn's and Colitis Foundation's IBD Ventures, this review aims to provide insights for those looking to innovate in IBD.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128092","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

Next pit stop-small bowel: a myriad of pathology. 下一个进站，小肠：无数的病理。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-04-03 DOI: 10.1097/MOG.0000000000001089

Reena Sidhu

引用次数: 0

New therapies in celiac disease. 乳糜泻的新疗法

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-01-27 DOI: 10.1097/MOG.0000000000001080

Antonella Santonicola, Carlo Soldaini, Carolina Ciacci

{"title":"New therapies in celiac disease.","authors":"Antonella Santonicola, Carlo Soldaini, Carolina Ciacci","doi":"10.1097/MOG.0000000000001080","DOIUrl":"10.1097/MOG.0000000000001080","url":null,"abstract":"Purpose of review: Celiac disease (CeD) is a chronic autoimmune disorder of the small intestine triggered by gluten ingestion in genetically predisposed individuals. The cornerstone of CeD management remains a strict adherence to a lifelong gluten-free diet (GFD), although such a dietary restriction can lead to an altered quality of life and may not be easy to follow for many patients. These challenges highlighted the need for alternative therapies. This review aims to explore the latest advancements in these therapeutic avenues, emphasizing mechanisms of action, clinical efficacy, and safety profiles of drugs currently in advanced stages of clinical testing.Recent findings: Recent advances in the understanding of CeD pathophysiology have catalyzed the development of new therapeutic approaches, which include strategies to modify gluten processing in the gut, block gluten-triggered immune responses, or restore immune tolerance to gluten.Summary: While these therapies are not poised to take the place of GFD, they represent promising treatment alternatives that could enhance the quality of life and minimize long-term consequences in CeD patients. Further research, as well as phase III clinical trials of those already conducted, are needed to establish the feasibility of integrating these novel drugs in the clinical management of CeD.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"124-131"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0