Current Opinion in Gastroenterology最新文献

The alcohol-associated hepatitis treatment landscape. 酒精相关性肝炎治疗前景

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-02-13 DOI: 10.1097/MOG.0000000000001158

Hanna Blaney, Amon Asgharpour

{"title":"The alcohol-associated hepatitis treatment landscape.","authors":"Hanna Blaney, Amon Asgharpour","doi":"10.1097/MOG.0000000000001158","DOIUrl":"10.1097/MOG.0000000000001158","url":null,"abstract":"Purpose of review: Alcohol-associated hepatitis is a severe form of alcohol-associated liver disease and is associated with a high mortality. Treatment of alcohol-associated hepatitis has historically been limited, with few therapies demonstrating survival benefit. However, multiple promising new therapies are on the horizon, with this review highlighting recent advances in alcohol-associated hepatitis treatment.Recent findings: Multiple new pharmacological agents targeting different mechanisms are under study for alcohol-associated hepatitis, including larsucosterol, F-652, and INT-787. Manipulation of the gut-brain axis has also been leveraged for alcohol-associated hepatitis, with use of fecal microbiota transplant and other modalities. Early liver transplantation, while not universally available, has offered improved survival with similar outcomes compared to other etiologies of liver disease. Living donor liver transplantation has also been investigated in alcohol-associated hepatitis, with promising results. While steroids still remain the mainstay of therapy, recent studies have offered nuances to their use, including use of a taper to reduce risk of infection without changing efficacy.Summary: Medical management of alcohol-associated hepatitis has remained largely unchanged since the 1970 s. However, promising therapies targeting multiple aspects of pathophysiology are on the horizon, including a planned phase 3 trial for larsucosterol, an active phase 2a study with INT-787 and a planned trial using F-652.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"107-113"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198204","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

Small bowel pathology - diet, pill or buzz? 小肠病理——节食、服药还是嗡嗡声？

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-03-31 DOI: 10.1097/MOG.0000000000001161

Reena Sidhu

引用次数: 0

Irritable bowel syndrome with diarrhea: time to change practice? 肠易激综合征伴腹泻：该改变做法了吗？

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-02-09 DOI: 10.1097/MOG.0000000000001157

Cristina Caranfil, Luisa Bertin, Fabiana Zingone

{"title":"Irritable bowel syndrome with diarrhea: time to change practice?","authors":"Cristina Caranfil, Luisa Bertin, Fabiana Zingone","doi":"10.1097/MOG.0000000000001157","DOIUrl":"10.1097/MOG.0000000000001157","url":null,"abstract":"Purpose of review: Traditional approaches to irritable bowel syndrome with diarrhea (IBS-D) relied on extensive exclusionary testing and empiric symptom management. Recent advances in understanding neuroimmune pathophysiology, refined diagnostic algorithms, emergence of novel biomarkers, and clarification of comparative treatment efficacy through systematic reviews necessitate evaluation of whether accumulated evidence warrants substantive changes to contemporary diagnostic and therapeutic practice in IBS-D management.Recent findings: Diagnostic paradigms have shifted toward symptom-based approaches utilizing judicious testing informed by alarm features, with emerging biomarkers including neutrophil-to-albumin ratio, microRNA-148, and bile acid malabsorption markers showing promise. Therapeutically, tricyclic antidepressants demonstrate robust efficacy as neuromodulators, while selective serotonin reuptake inhibitors show limited benefit. Emerging neuroimmune therapies targeting mast cell activation, including histamine receptor antagonists, represent promising avenues. Low FODMAP and Mediterranean diets demonstrate substantial efficacy, while brain-gut behavioral therapies achieve clinically meaningful improvements in refractory populations through accessible delivery modalities.Summary: Contemporary evidence supports fundamental practice shifts from exclusionary testing toward targeted investigation of treatable mimics and from empiric management toward mechanism-based multimodal interventions integrating neuromodulators, dietary modifications, and behavioral therapies. Optimal outcomes require individualized treatment selection informed by symptom phenotype and comorbidity profiles, ideally delivered through integrated care models combining gastroenterology, dietetic, and behavioral expertise.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"178-188"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144525","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

Implementation science: a primer for hepatology research. 实施科学：肝病学研究入门。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-03-18 DOI: 10.1097/MOG.0000000000001164

Manisha Verma, Hamza Tahir, Richard Kalman

{"title":"Implementation science: a primer for hepatology research.","authors":"Manisha Verma, Hamza Tahir, Richard Kalman","doi":"10.1097/MOG.0000000000001164","DOIUrl":"10.1097/MOG.0000000000001164","url":null,"abstract":"Purpose of review: Despite significant progress in evidence-based therapies and models of care, hepatology continues to face challenges in translating proven interventions into routine clinical practice. Variability in adoption has contributed to ongoing gaps in quality, outcomes, and equity of care across diverse settings. Implementation science offers a systematic approach to understanding and improving how evidence-based interventions are delivered, adapted, and sustained in real-world environments. This review provides an overview of implementation science and discusses its increasing importance for advancing hepatology research and practice.Recent findings: Recent studies in hepatology have applied implementation science frameworks to better understand why effective interventions fail to reach patients and how those barriers can be addressed. Work in areas such as viral hepatitis elimination, cirrhosis management, palliative care integration, hepatocellular cancer surveillance, and alcohol use disorder treatment illustrates the value of focusing on context, stakeholder engagement, and strategy selection. These studies commonly use established frameworks, pragmatic trial designs, and mixed methods to assess outcomes such as adoption, fidelity, and sustainability alongside clinical impact.Summary: Implementation science offers a practical bridge between discovery and routine care in hepatology. Integrating implementation principles into research, quality improvement initiatives, and trainee education can accelerate the translation of evidence into practice, reduce unwarranted variation in care, and promote more equitable delivery of liver-related services.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"136-142"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475879","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

Glucagon-like peptide agonists and use in short bowel syndrome - what about the side effects? 胰高血糖素样肽激动剂及其在短肠综合征中的应用——副作用如何？

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-03-20 DOI: 10.1097/MOG.0000000000001169

Lucy Gorard, Megan Boucher, Charlotte Rutter

{"title":"Glucagon-like peptide agonists and use in short bowel syndrome - what about the side effects?","authors":"Lucy Gorard, Megan Boucher, Charlotte Rutter","doi":"10.1097/MOG.0000000000001169","DOIUrl":"10.1097/MOG.0000000000001169","url":null,"abstract":"Purpose of review: This review summarizes recent evidence on the use of glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2) agonists in the management of short bowel syndrome (SBS), with a focus on emerging therapies and real-world experience. It evaluates their impact on intestinal adaptation, safety, and future clinical potential.Recent findings: GLP-2 agonists such as teduglutide continue to demonstrate improvements in intestinal absorption resulting in reductions in parenteral support (PS) requirements and improved quality of life. Clinical trials report that newer long-acting agents, such as apraglutide and glepaglutide, allow less frequent dosing with a reduction in PS and structural intestinal changes on imaging. Safety profiles remain favourable, with gastrointestinal symptoms, fluid balance issues, gallbladder events and injection-site reactions reported most frequently. GLP-1 agonists show promise in slowing transit time and offer an area for further research.Summary: While GLP-2 agonists shape the current landscape of SBS management, GLP-1 based therapies may complement future treatment strategies offering the potential to reduce or even eliminate dependence on PS. Continued long-term studies and registry data are essential to optimize patient selection, safety monitoring, and personalized use of GLP agonists.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"201-207"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500287","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 utility of albumin in cirrhosis: established benefits and unanswered questions. 白蛋白在肝硬化中的应用：已确定的益处和未解决的问题。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-01-29 DOI: 10.1097/MOG.0000000000001155

Karim Besir, Don C Rockey

{"title":"The utility of albumin in cirrhosis: established benefits and unanswered questions.","authors":"Karim Besir, Don C Rockey","doi":"10.1097/MOG.0000000000001155","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001155","url":null,"abstract":"Purpose of review: Albumin plays a central role in maintaining circulatory and endothelial homeostasis through its oncotic and nononcotic effects. In cirrhosis, reduced concentration and impaired function of albumin contribute to circulatory derangements, renal dysfunction, and infection risk. While albumin is firmly established in certain settings such as spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), and large-volume paracentesis (LVP), its broader use in cirrhosis remains controversial and incompletely defined. We aim to integrate up to date guidance on the use of albumin in cirrhosis, and to highlight areas where evidence remains limited or evolving.Recent findings: Evidence from randomized trials and meta-analyses highlights both established and emerging roles of albumin in cirrhosis. Albumin has demonstrated clear benefit after LVP, where it reduces postprocedural circulatory dysfunction, renal impairment, and hyponatremia compared with other plasma expanders. In HRS, albumin serves as an indispensable therapeutic backbone, enhancing the efficacy of vasoconstrictors and improving rates of renal reversal, yet its independent role remains incompletely defined. In SBP, co-administration of albumin with antibiotics reduces renal failure and improves short-term survival, establishing it as standard of care. In acute kidney injury (AKI) outside of HRS, current guidelines recommend the use of albumin as part of an initial volume challenge in many forms of AKI to aid diagnosis and potentially promote renal recovery, although the timing of its use differs among guidelines.Summary: Albumin is a cornerstone therapy in the management of decompensated cirrhosis and its clinical complications. While its role is well defined in HRS, SBP, and post-LVP, higher-quality evidence is needed to refine its use in other settings, particularly in AKI.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 3","pages":"114-120"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583029","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

Antithrombotic and management of small bowel bleeding - time to throw caution into the wind? 抗血栓治疗和小肠出血的处理——是时候不顾一切了吗？

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-02-10 DOI: 10.1097/MOG.0000000000001160

Lucia Scaramella, Agostino Cosenza, Cristina Romero-Mascarell, Luca Elli

{"title":"Antithrombotic and management of small bowel bleeding - time to throw caution into the wind?","authors":"Lucia Scaramella, Agostino Cosenza, Cristina Romero-Mascarell, Luca Elli","doi":"10.1097/MOG.0000000000001160","DOIUrl":"10.1097/MOG.0000000000001160","url":null,"abstract":"Purpose of review: Small bowel bleeding (SBB) represents a significant diagnostic and therapeutic challenge. The use of antithrombotic therapy (oral anticoagulants and antiplatelet agents) has led to an increase in gastrointestinal bleeding events, particularly in the small bowel. The endoscopic management of SBB in patients receiving antithrombotic therapy remains a clinical dilemma . This review explores the current perspectives on the endoscopic management of SBB in patients receiving antithrombotic therapy and discusses whether the traditional cautions approach should be reconsidered.Recent findings: Recent studies confirmed a higher diagnostic yield of small bowel capsule endoscopy (SBCE) in patients administered with antithrombotic agents, and an increased prevalence of SBB from vascular lesions. Device-assisted enteroscopy (DAE) is the reference standard for endoscopic therapy; however, rebleeding rate remains high.Summary: Endoscopic management of SBB in patients receiving antithrombotic therapy remains suboptimal. Maintenance of therapy increases the diagnostic yield of SBCE; however, guidelines recommend to discontinue the therapy before DAE. This mismatch highlights a substantial disconnection between evidence and clinical practice. Prospective studies and expert consensus are needed to optimize outcomes in this population.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"146-153"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214888","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

Immune-related enteropathy. 几种肠病。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-03-05 DOI: 10.1097/MOG.0000000000001162

Kimberley Butler, Hugo A Penny, Foong Way David Tai

{"title":"Immune-related enteropathy.","authors":"Kimberley Butler, Hugo A Penny, Foong Way David Tai","doi":"10.1097/MOG.0000000000001162","DOIUrl":"10.1097/MOG.0000000000001162","url":null,"abstract":"Purpose of review: Immune-related enteropathies (IREs) represent a heterogeneous group of disorders characterised by immune-mediated small bowel injury. While coeliac disease is the most common cause, widespread use of small bowel endoscopy has expanded the recognition of rarer causes. This review aims to summarise recent advances in diagnosis, classification and management of IRE.Recent findings: Significant overlap exists between coeliac disease, autoimmune enteropathy, collagenous sprue, drug-induced enteropathies, common variable immunodeficiency (CVID) associated enteropathy and other IRE. A recent meta-analysis supports a no-biopsy approach in selected adults with significantly elevated IgA tissue transglutaminase levels and suspected coeliac disease. Refractory coeliac disease type II is now recognised as a low-grade intraepithelial T-cell lymphoma with a high risk of progression to enteropathy-associated T-cell lymphoma (EATL). Drug-induced enteropathies, particularly olmesartan-associated enteropathy, are increasingly detected and may mimic autoimmune enteropathy histologically. Novel therapeutic approaches, including cladribine, JAK inhibitors and biologics, have shown promise in refractory disease, although evidence is limited to small studies.Summary: IREs present substantial diagnostic and therapeutic challenges due to overlapping characteristics and variable disease course. A structured approach integrating clinical, serological and histopathological data is essential for accurate diagnosis. Early recognition and tailored management are crucial to prevent long-term complications.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"189-200"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357088","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

Precision medicine in steatotic liver disease. 脂肪变性肝病的精准医学。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-03-06 DOI: 10.1097/MOG.0000000000001165

Vitchapong Prasitsumrit, Vincent L Chen

{"title":"Precision medicine in steatotic liver disease.","authors":"Vitchapong Prasitsumrit, Vincent L Chen","doi":"10.1097/MOG.0000000000001165","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001165","url":null,"abstract":"Purpose of review: Discuss advances in genomics, metabolomics, and proteomics in steatotic liver disease.Recent findings: Common genetic variants in genes including PNPLA3, TM6SF2, and HSD17B13 are associated with risk of hepatic steatosis, metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) cirrhosis, and hepatocellular carcinoma. In contrast, variants in other genes such as GCKR are strongly associated with steatosis but much more weakly associated with advanced liver disease. The cirrhosis-associated variants typically drive steatosis through reduction of lipid export from the liver, potentially highlighting this mechanism as a driver of fibrosis though not ruling out alternative pathways. Alterations in amino acids, lipids, bile acids, and other metabolites have been observed in both MASLD and ALD reflecting insulin resistance, altered bile acid metabolism, and increased fatty acid flux and de novo lipogenesis (for MASLD) or mitochondrial dysfunction (for ALD). Also seen are characteristic changes in serum/plasma protein levels reflecting fibrosis, systemic inflammation, and hepatic synthetic function are also seen with MASLD and ALD. Predictive models incorporating genomics, metabolomic, and proteomic biomarkers may improve upon existing clinical models, but nearly all studies on this topic have been retrospective or post hoc.Summary: Genomics, metabolomics, proteomics, and multiomics may improve our understanding of disease pathophysiology. They may also have implications for clinical care, but further prospective studies are required to establish whether they provide sufficient benefit over clinical biomarkers to be routinely used.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"42 3","pages":"121-128"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583108","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

Plasma exchange in acute liver failure. 血浆置换治疗急性肝功能衰竭。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2026-05-01 Epub Date: 2026-03-05 DOI: 10.1097/MOG.0000000000001166

Hampton B Sasser, David G Koch

{"title":"Plasma exchange in acute liver failure.","authors":"Hampton B Sasser, David G Koch","doi":"10.1097/MOG.0000000000001166","DOIUrl":"10.1097/MOG.0000000000001166","url":null,"abstract":"Purpose of review: Acute liver failure is a life-threatening condition that requires intensive medical management or liver transplant for survival. Plasma exchange has been investigated as a supportive intervention to provide a bridge to hepatic recovery or to liver transplant. This review aims to explain the physiologic rationale, provide historical context, and review recent evidence on the use of plasma exchange in acute liver failure.Recent findings: Recent studies paint a mixed picture of plasma exchange's role in the current armamentarium for the management of acute liver failure. Although multiple meta-analyses have shown a survival benefit from plasma exchange, the results from original studies published in the interim are less consistent, with some showing a survival benefit and others not. Further, the literature on this topic is quite heterogeneous with respect to baseline patient characteristics, etiologies of acute liver failure, the dose of plasma exchange administered, and the outcomes assessed. The takeaways and limitations of recent evidence will be discussed.Summary: Plasma exchange has a clear physiologic basis for use in acute liver failure, and multiple prospective studies have shown its ability to improve survival. The effectiveness of plasma exchange, however, depends on appropriate patient selection and timely initiation.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"129-135"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357066","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