Filipe Rodolfo Moreira Borges Oliveira, Paul Kubes
{"title":"Kupffer cells are central to mitigating intravascular infections.","authors":"Filipe Rodolfo Moreira Borges Oliveira, Paul Kubes","doi":"10.1097/MOG.0000000000001128","DOIUrl":"10.1097/MOG.0000000000001128","url":null,"abstract":"<p><strong>Purpose of review: </strong>Kupffer cells (KCs), the resident liver macrophages, are absolutely critical in immune surveillance and intravascular pathogen eradication. This mini-review highlights KCs' contributions to host protection of intravascular infections.</p><p><strong>Recent findings: </strong>KCs, uniquely originated and self-renewing, demonstrate remarkable functional plasticity and trained immunity. KCs are frontline responders in infections: they phagocytose microorganisms but can succumb to certain infections. We highlight some of the recent findings in this regard.</p><p><strong>Summary: </strong>Understanding KCs' complex interactions with diverse pathogens is key to improving treatment modalities in infection. Future research, needs to focus on how certain pathogens evade KCs and how we can aid these macrophages in eradicating microbes. A move towards humanized KC models in vivo and in vitro incorporating key environmental factors such as shear flow and unique sinusoidal components will be essential to unravel their comprehensive roles.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"432-435"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132386","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":"Endobariatrics in the era of glucagon-like peptide-1 receptor agonists: evolving roles, evidence, and integration.","authors":"Farnoosh Vahedi, Meghna Yalamanchi, Danny Issa","doi":"10.1097/MOG.0000000000001134","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001134","url":null,"abstract":"<p><strong>Purpose of review: </strong>We review and summarize current evidence-based management strategies in the field of endobariatrics (EBT) for the management of obesity during a time of rapidly expanding pharmacologic options, particularly with rising popularity of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs).</p><p><strong>Recent findings: </strong>National trends show increased use of GLP-1 RAs in obesity management. EBT are minimally invasive endoscopic therapies that offer durable weight loss with low complications rates. Patient comorbidities, socioeconomic factors, and adherence are critical considerations in treatment selection. Emerging data suggest that combining GLP-1 RAs with EBTs may yield synergistic effects.</p><p><strong>Summary: </strong>A growing array of treatment options are available in the management of obesity. Personalized, combination therapy that integrates mechanism-based interventions with pharmacotherapy may optimize long-term outcomes for sustained weight loss. Multidisciplinary approach remains essential for delivering comprehensive multidisciplinary care.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"41 6","pages":"380-388"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193920","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":"Advances in diagnosis and therapy for upper gastrointestinal Crohn's disease.","authors":"Laura Sahyoun, Jill K J Gaidos","doi":"10.1097/MOG.0000000000001129","DOIUrl":"10.1097/MOG.0000000000001129","url":null,"abstract":"<p><strong>Purpose of review: </strong>Crohn's disease is a chronic, relapsing and remitting inflammatory process that can involve the entire length of the gastrointestinal tract. Upper gastrointestinal involvement (UGI) in Crohn's disease is present in up to 15% of patients and can present as a diagnostic challenge given nonspecific symptoms and overlapping disease entities. This review provides an update on diagnosing and risk stratifying UGI-CD.</p><p><strong>Recent findings: </strong>Literature suggests the use of imaging modalities (such as video capsule endoscopy, cross-sectional imaging and intestinal ultrasound) to help identify proximal inflammation when clinical suspicion for UGI involvement exists based on symptoms and patient factors. Additionally, proximal disease involvement has been associated with increased disease severity, a higher prevalence of strictures and an increased risk for surgery. First-line therapies are corticosteroids and antitumor necrosis factor therapies if systemic treatment is needed based on disease severity. For stricturing disease, endoscopic balloon dilation, strictureplasty, surgical resection or bypass can be considered for medically refractory or recurrent disease.</p><p><strong>Summary: </strong>As the prevalence and progression of UGI-CD is still understudied due to its variable definition, presentation and incidence, the development of a standardized approach to diagnosis could aid in determining the overall prevalence and most effective treatments.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"426-431"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024652","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":"Advancing care in malignant gastric outlet obstruction: a contemporary review of management strategies.","authors":"Adrianna Wierzbicka, Tilak Shah","doi":"10.1097/MOG.0000000000001101","DOIUrl":"10.1097/MOG.0000000000001101","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review is to summarize the most pertinent data on management of malignant gastric outlet obstruction (MGOO), with an emphasis on recent updates.</p><p><strong>Recent findings: </strong>Traditionally, options to restore luminal patency in patients with MGOO were surgical gastrojejunostomy (SGJ) and endoscopic insertion of an enteral stent. The latter was reserved for patients with poor performance status or anticipated survival less than 2 months. Endoscopic gastroenterostomy (EUS-GE) is a newer technique that aims to mimic a SGJ and involves placement of a lumen apposing metal stent (LAMS) from the stomach directly into the jejunum. In a recent randomized trial of EUS-GE vs. enteral stent, the former was associated with reduced re-interventions, improved stent patency, and improved patient reported eating habits. Recent publications suggest that EUS-GE may offer substantial advantages over S-GJ; a randomized trial is currently underway. Venting gastrostomy may be the most suitable option for patients with markedly impaired gastric motility or with multiple luminal obstructions.</p><p><strong>Summary: </strong>MGOO is a debilitating late complication of advanced upper gastrointestinal malignancies, resulting from blockage or mechanical compression of the distal stomach, pyloric antrum or duodenum. Various modalities are currently available, and should be tailored to patient's expectations, underlying cause, life expectancy, and functional status.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"409-415"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041852","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":"Modern concepts of small intestinal bacterial overgrowth.","authors":"Gillian M Barlow, Mark Pimentel","doi":"10.1097/MOG.0000000000001135","DOIUrl":"10.1097/MOG.0000000000001135","url":null,"abstract":"<p><strong>Purpose of review: </strong>Small intestinal bacterial overgrowth (SIBO) has been a recognized condition for more than half a century. Early descriptions of SIBO were based on the concept of colonic bacteria \"backing up\" into the small intestine. This was based on techniques using unprotected aspiration catheters and earlier culture techniques. Recent advances in breath testing, small bowel sampling, culture techniques, and next generation sequencing have helped expand our understanding of SIBO.</p><p><strong>Recent findings: </strong>\"SIBO\" is now understood to encompass at least three different types of overgrowth including SIBO, intestinal methanogen overgrowth (IMO) and intestinal sulfide overproduction (ISO). Each has their own unique microbial profile. In addition, next generation sequencing has revealed that SIBO is not a migration of colonic flora into the small intestine, but rather overgrowth of two predominant species/strains from phylum Proteobacteria ( Escherichia coli and Klebsiella ). Lastly, results from next generation sequencing of the stool and small intestinal microbiomes have validated breath testing as a diagnostic tool.</p><p><strong>Summary: </strong>Together, these advances have allowed the identification of key microbes in overgrowth syndromes, uncovering their relationships to conditions such as irritable bowel syndrome, and paving the way for the development of novel customized treatment options in the future.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"399-408"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076504","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}
{"title":"Potassium-competitive acid blockers.","authors":"Trevor A Davis, C Prakash Gyawali","doi":"10.1097/MOG.0000000000001127","DOIUrl":"10.1097/MOG.0000000000001127","url":null,"abstract":"<p><strong>Purpose of review: </strong>Acid suppression is the mainstay of management of common foregut disorders, including gastroesophageal reflux disease (GERD), peptic ulcer disease and Helicobacter pylori infection. Drawbacks of standard management with proton pump inhibitors (PPIs) include acid lability requiring enteric coating, slow onset of effect, lack of suppression of nocturnal acid breakthrough, and need for administration before meals.</p><p><strong>Recent findings: </strong>Potassium-competitive acid blockers (PCABs) are a novel class of acid suppressants that are effective in the management of symptomatic and erosive GERD, peptic ulcer disease and H. pylori infection. Administration before meals is not needed, and these agents achieve profound acid suppression right from the first dose, with control of daytime as well as nocturnal acid. In randomized controlled trials, PCABs are noninferior and often superior to PPIs, especially in healing of advanced grade esophagitis and eradication of treatment-naive as well as refractory H. pylori. The safety profile of PCABs over 10 years of use is reassuring, although profound acid suppression may contribute to hypergastrinemia and increased risk of gastrointestinal infections.</p><p><strong>Summary: </strong>As PCABs become available in many countries around the globe, real-world use will allow further research to determine the clinical niche of these acid-suppressive agents.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"389-398"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024698","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":"Updates in endoscopic hemostasis for nonvariceal gastroduodenal bleeding.","authors":"Himesh B Zaver, Mary S McGrath, Andrew Y Wang","doi":"10.1097/MOG.0000000000001133","DOIUrl":"10.1097/MOG.0000000000001133","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide an updated overview of the management of nonvariceal upper gastrointestinal bleeding, focusing on recent advancements in endoscopic hemostasis techniques and evidence-based clinical practices.</p><p><strong>Recent findings: </strong>Recent studies and societal guidance emphasize the importance of early triage, restrictive transfusion strategies, and the integration of risk stratification tools for management of nonvariceal upper gastrointestinal bleeding. Notable advancements in endoscopic modalities for hemostasis include cap-assisted clips, noncontact thermal therapies, and the expansion of available topical hemostatic agents.</p><p><strong>Summary: </strong>Effective nonvariceal upper gastrointestinal bleeding management requires a multidisciplinary approach that prioritizes early resuscitation, risk assessment, and the use of evolving endoscopic technologies to achieve optimal hemostasis.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"416-425"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132407","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":"Stomach and duodenum: what's current in 2025.","authors":"Tilak U Shah","doi":"10.1097/MOG.0000000000001130","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001130","url":null,"abstract":"","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"41 6","pages":"377-379"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193926","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}
Amy T Woods, Alexander C Ford, Christopher J Black
{"title":"All in my head or all in my gut? An update on irritable bowel syndrome.","authors":"Amy T Woods, Alexander C Ford, Christopher J Black","doi":"10.1097/MOG.0000000000001141","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001141","url":null,"abstract":"<p><strong>Purpose of review: </strong>Irritable bowel syndrome (IBS) has a considerable impact on patients and healthcare systems. IBS is a disorder of brain-gut interaction with numerous biopsychosocial factors involved, including early life experiences, previous gastrointestinal infections, and coexisting mood disorders. An understanding of the role of the gut-brain axis in symptom generation is vital to enable delivery of holistic care.</p><p><strong>Recent findings: </strong>We explore psychological mechanisms, such as coexisting anxiety and depression, adverse life experiences, and somatisation and how these impact symptom severity. There is evidence for psychological therapies, such as cognitive behavioural therapy or gut-directed hypnotherapy, in IBS. We go on to summarise gut-based mechanisms, such as abnormal motility, visceral hypersensitivity, inflammation, and dysbiosis. Efficacious treatments targeting these include antidiarrhoeals, laxatives, antispasmodics, drugs acting on ion channels or serotonin, gut-brain neuromodulators, and treatments targeting the microbiota or inflammation. Finally, we consider emerging evidence from models describing distinct IBS phenotypes and their potential to facilitate a more integrated approach to identify best treatment options.</p><p><strong>Summary: </strong>For many patients with IBS, both brain and gut mechanisms must be considered within the context of the biopsychosocial model to enable effective delivery of holistic and personalised care.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349685","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 mucosal resection or endoscopic submucosal dissection: choosing the right tool to a polyp-free colon.","authors":"George M Wahba, Fredy Nehme, Phillip S Ge","doi":"10.1097/MOG.0000000000001140","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001140","url":null,"abstract":"<p><strong>Purpose of review: </strong>Endoscopic resection is now the standard of care for the management of colorectal polyps. With increased training and expertise in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), it is important to recognize their complementary roles, as well as their individual strengths and limitations.</p><p><strong>Recent findings: </strong>Here, we draw upon the experience of a real patient scenario to provide a case-based review on EMR and ESD. We will review evidence-based technical refinements to EMR which have improved procedural safety and decreased recurrence rates, as well as how expanded access to ESD and enhanced training has resulted in improvements in outcomes and adverse events. Finally, we will discuss how lesion, patient, and endoscopist factors influence the overall endoscopic resection strategy.</p><p><strong>Summary: </strong>EMR and ESD are complementary tools in the modern endoscopic resection toolkit, and the correct resection strategy draws upon a deep understanding of the tools available and is individualized based upon patient, endoscopist, and lesion characteristics.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294299","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}