Current Opinion in Gastroenterology最新文献_第2页

Gut-directed therapeutics in inflammatory bowel disease. 炎症性肠病的肠道定向治疗。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-04-25 DOI: 10.1097/MOG.0000000000001099

Christina Kratschmer, David T Curiel, Matthew A Ciorba

{"title":"Gut-directed therapeutics in inflammatory bowel disease.","authors":"Christina Kratschmer, David T Curiel, Matthew A Ciorba","doi":"10.1097/MOG.0000000000001099","DOIUrl":"10.1097/MOG.0000000000001099","url":null,"abstract":"Purpose of review: Tissue-directed therapies (TDTs) provide potential advantages, including improved tolerance, safety, and efficacy. This review provides a conceptual framework for understanding intestinal TDT and summarizes the current landscape of TDT in inflammatory bowel disease (IBD).Recent findings: Vedolizumab, a mAb targeting the gut homing α4β7 integrin, served as revolutionary proof-of-principle for the power of advanced TDT in IBD. The development of other monoclonal antibodies targeting cell adhesion molecules followed including abrilumab (α4β7), etrolizumab (β7), and ontamalimab (MAdCAM-1). MORF-057, an oral small molecule inhibitor of α4β7, is now in development for ulcerative colitis. Efforts have also been made toward gut specific JAK inhibitors. Microbiome-based therapies, including engineered probiotics, bacteriophages, and postbiotics, are gaining interest. There are also a number of innovative drug delivery methods, including engineered yeast, hydrogels, and nanoparticles, and viral-based gene therapy.Summary: Gut-targeted therapies range from novel variations on traditional drugs (i.e., mAbs and small molecules) to microbiome-based therapeutics and engineered delivery systems. They can be used alone or in combination with currently available therapies. Future directions should focus on the development of tried-and-true modalities (mAbs, small molecules) as well as the microbiome and more innovative delivery systems.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"201-207"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056806","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

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 : 2025-07-01 Epub 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":"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":"229-233"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","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

Chromatin profiling to identify biomarkers in inflammatory bowel diseases. 鉴定炎症性肠病生物标志物的染色质谱分析。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-05-02 DOI: 10.1097/MOG.0000000000001104

Ayesh Awad, Aaron J Alcala, Martis W Cowles, Shehzad Z Sheikh

{"title":"Chromatin profiling to identify biomarkers in inflammatory bowel diseases.","authors":"Ayesh Awad, Aaron J Alcala, Martis W Cowles, Shehzad Z Sheikh","doi":"10.1097/MOG.0000000000001104","DOIUrl":"10.1097/MOG.0000000000001104","url":null,"abstract":"Purpose of review: Chromatin plays a critical role in gene regulation and disease pathogenesis. In inflammatory bowel disease (IBD), alterations in chromatin structure contribute to disease heterogeneity and impact treatment responses. This review explores chromatin accessibility and chromatin-associated proteins as biomarkers for IBD and highlights recent technological advancements enabling targeted biomarker discovery and novel therapies.Recent findings: Advancements in high-throughput sequencing have enabled genome-wide profiling of chromatin interactions in IBD. Studies have identified distinct chromatin landscapes in Crohn's disease (CD) and ulcerative colitis (UC), revealing stable regulatory shifts independent of inflammation.Summary: Chromatin profiling offers a novel approach for identifying biomarkers and therapeutic targets in IBD. Integrating chromatin accessibility data with transcriptomic and epigenomic analyses can refine disease classification and guide personalized treatment strategies. Emerging techniques compatible with formalin-fixed paraffin-embedded (FFPE) samples enhance clinical applicability, bridging the gap between molecular research and precision gastroenterology.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"216-222"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996837","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

Emerging role of peroxisome proliferator-activated receptor agonists in the treatment of cholestatic liver disease. 过氧化物酶体增殖物激活受体激动剂在治疗胆汁淤积性肝病中的新作用。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-06-05 DOI: 10.1097/MOG.0000000000001109

Sheena Bhushan, Kris V Kowdley

{"title":"Emerging role of peroxisome proliferator-activated receptor agonists in the treatment of cholestatic liver disease.","authors":"Sheena Bhushan, Kris V Kowdley","doi":"10.1097/MOG.0000000000001109","DOIUrl":"10.1097/MOG.0000000000001109","url":null,"abstract":"Purpose of review: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, chronic cholestatic diseases associated with significant morbidity. While previously approved therapies for PBC, including ursodeoxycholic acid (UDCA) and obeticholic acid (OCA) have substantially altered the natural course of the disease and improved patient survival, they have several limitations including an incomplete therapeutic response, patient intolerance and a lack of symptom relief.Recent findings: Peroxisome proliferator-activated receptor (PPAR) agonists have emerged as promising therapeutic agents capable of achieving biochemical remission and alleviating debilitating symptoms such as pruritus. Elafibranor and Seladelpar were recently granted accelerated approval by the FDA as second-line treatment option for PBC. Although no treatment has yet received approval for PSC, several PPAR agonists have been evaluated in clinical trials.Summary: This review highlights the evolving role of PPAR agonists as second-line agents for PBC and investigational treatments for PSC.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"41 4","pages":"281-288"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227466","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

Surgical versus endoscopic management of esophageal perforation. 食管穿孔的手术与内镜治疗。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-04-23 DOI: 10.1097/MOG.0000000000001095

Kevin J Wang, Evelyn V Alexander, Stephanie G Worrell

{"title":"Surgical versus endoscopic management of esophageal perforation.","authors":"Kevin J Wang, Evelyn V Alexander, Stephanie G Worrell","doi":"10.1097/MOG.0000000000001095","DOIUrl":"10.1097/MOG.0000000000001095","url":null,"abstract":"Purpose of review: The management of esophageal perforation is a topic of debate, as there now are viable surgical and endoscopic options. Historically, surgical management had been considered the standard of care for these perforations, but such surgical management can be associated with considerable morbidity. In this report, we explore contemporary options for the care of patients with esophageal perforations.Recent findings: Innovations in endoscopic therapies, including self-expanding metal and plastic stents, over-the-scope clips, vacuum therapy, and endoscopic suturing have expanded treatment options for esophageal perforations. These approaches are particularly beneficial for selected patients with early, contained perforations, offering reduced morbidity and shorter hospital stays. However, surgical intervention remains essential in cases of extensive contamination, necrosis, or delayed diagnosis. A growing body of evidence supports a patient-specific approach, integrating both traditional and emerging interventions.Summary: The management of esophageal perforation is evolving with the increasing use of minimally invasive endoscopic techniques. However, surgical repair remains the definitive treatment in patients with hemodynamic instability or extensive contamination. Timely intervention is critical, as delayed diagnosis significantly increases morbidity and mortality. A tailored approach, incorporating patient-specific factors and nature of the disease, ensures optimal outcomes.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"239-244"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056266","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

Hematopoietic stem cell transplantation in Crohn's disease: a comprehensive review. 造血干细胞移植治疗克罗恩病的综述

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-04-14 DOI: 10.1097/MOG.0000000000001096

Akshita Gupta, Elena Ricart, Louis Cohen

{"title":"Hematopoietic stem cell transplantation in Crohn's disease: a comprehensive review.","authors":"Akshita Gupta, Elena Ricart, Louis Cohen","doi":"10.1097/MOG.0000000000001096","DOIUrl":"10.1097/MOG.0000000000001096","url":null,"abstract":"Purpose of review: Despite advances in medical therapies for the treatment of Crohn's disease (CD), 20-30% of patients fail to respond to these therapies (i.e. refractory CD). Medically refractory CD leads to significant disability increasing morbidity and mortality. To prevent the disability of refractory CD, hematopoietic stem cell transplantation (SCT) has emerged as a therapeutic strategy.Recent findings: Autologous (auto-SCT) and allogeneic SCT (allo-SCT) have been explored in clinical trials for refractory CD patients. We will review the stem cell transplant process, how each part of stem cell transplantation affects clinical efficacy and safety, and how specific clinical trials advanced our understanding of the role of stem cell transplant in the treatment of refractory CD.Summary: As multiple clinical trials using the same auto-SCT protocol demonstrated auto-SCT as clinically efficacious for refractory CD it supports that this treatment may be adopted as standard of care for select patients with refractory CD. To establish auto-SCT as a standard therapy will require the creation of international registries to track long-term SCT outcomes and translational studies to refine SCT protocols for CD patients as a cellular therapy that truly restores healthy intestinal immune cell populations from hematopoietic stem cells.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"175-181"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057237","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

Aminotransferase levels in clinical practice - what is normal? 临床实践中的转氨酶水平-什么是正常的？

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-04-09 DOI: 10.1097/MOG.0000000000001094

Jad Allam, Don C Rockey

{"title":"Aminotransferase levels in clinical practice - what is normal?","authors":"Jad Allam, Don C Rockey","doi":"10.1097/MOG.0000000000001094","DOIUrl":"10.1097/MOG.0000000000001094","url":null,"abstract":"Purpose of review: No universal consensus exists as to what the upper limit of normal for alanine aminotransferase (ALT) should be. The purpose of this review is to provide insight on the wide variation in the upper limit of normal for ALT, and to highlight key elements resulting in these differences. We also wish to point to potential solutions for standardizing the upper limit of normal.Recent findings: There are considerable differences in the values for what constitutes a 'normal' ALT serum concentration set by laboratories, and reference values may vary two-fold between different institutions (from 30 to 60 U/l). Key reasons for this include using markedly different reference populations to establish the bounds of normal, and differences in analyzers and assays used to quantify ALT levels. A number of studies have attempted to re-evaluate the upper limit of normal and propose new cut-offs that would allow better detection of liver disease.Summary: The upper limit of normal for ALT continues to vary from one laboratory to another. Despite ongoing efforts, there is still an unmet demand to standardize ALT reference ranges, which is critical for clinical practice. More rigorous inclusion criteria for reference population studies and harmonization in analyzer differences is required to standardize ALT reference ranges universally.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"260-264"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006522","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 : 2025-07-01 Epub Date: 2025-05-14 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":"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":"223-228"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","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

Who and how to choose combination therapy for inflammatory bowel disease: a comprehensive expert review. 炎症性肠病的联合疗法由谁来选择、如何选择：专家综述。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-04-03 DOI: 10.1097/MOG.0000000000001097

Alessandro David, Chakib Rekkabi, Annissa Fournier, Robert Battat

{"title":"Who and how to choose combination therapy for inflammatory bowel disease: a comprehensive expert review.","authors":"Alessandro David, Chakib Rekkabi, Annissa Fournier, Robert Battat","doi":"10.1097/MOG.0000000000001097","DOIUrl":"10.1097/MOG.0000000000001097","url":null,"abstract":"Purpose of review: Therapeutic options in inflammatory bowel disease (IBD) have expanded significantly. Patients often experience primary or secondary loss of response to biologics or small molecules therapy. Determining which patients may benefit from combination of two therapies remains a key question.Recent findings: Combination therapy leverages complementary mechanisms of action, conventionally using tumor necrosis factor antagonists simultaneously with immunosuppressive agents, and more recently using two advanced therapies together. Combination of two advanced therapies has shown promise in two recent randomized trials for improving clinical and endoscopic outcomes while maintaining acceptable safety profiles. Observational studies highlight its potential for refractory disease and complex phenotypes. Guidelines still conservatively recommend monotherapy for IBD patients, even for those at high risk for complications.Summary: Advanced combination therapy (ACT) represents a potential significant advancement in managing IBD, offering treatment options for refractory cases, concomitant immune-mediated diseases and high-risk populations. Nonetheless, further randomized trials and registry data are needed to generate evidence to support broader adoption of this approach. Future research should focus on cost-effectiveness, longer-term treatment strategies and safety to refine its application in clinical practice.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"182-189"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781738","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 hepatitis C virus management. 丙型肝炎病毒管理的最新情况。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-04-11 DOI: 10.1097/MOG.0000000000001098

Austin D Peer, Jennifer C Price

{"title":"Update on hepatitis C virus management.","authors":"Austin D Peer, Jennifer C Price","doi":"10.1097/MOG.0000000000001098","DOIUrl":"10.1097/MOG.0000000000001098","url":null,"abstract":"Purpose of review: Despite the efficacy of direct-acting antiviral (DAA) therapy, hepatitis C virus (HCV) remains a significant contributor to liver-related morbidity and mortality. This review summarizes the approach to HCV treatment, the simplified treatment algorithm for most patients, the management of special populations, and future directions for HCV interventions.Recent findings: Pan genotypic DAA regimens have high cure rates and can be managed by nonspecialist providers, and the simplified treatment approach provides a clear algorithm for workup and treatment decisions among treatment-naive patients without decompensated cirrhosis. Additionally, advancements in point of care diagnostics have the potential to further expand access to screening and linkage to care. Despite these breakthroughs, barriers to accessing care and the stigmatization of high-risk populations continue to undercut progress towards HCV elimination. Continued implementation of innovative screening and treatment strategies are required to overcome rising HCV prevalence.Summary: HCV cure is achievable for nearly all patients, but reaching HCV elimination goals will require a comprehensive approach that increases screening, expands access to simplified treatment, and avoids stigmatization of at-risk populations. Targeting healthcare disparities and removing barriers to treatment uptake are crucial to achieving elimination targets.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"265-270"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058869","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