Current Opinion in Gastroenterology最新文献_第2页

Demystifying Meckel's diverticulum - a guide for the gastroenterologist. 揭开梅克尔憩室的神秘面纱——胃肠病学家指南。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-03-06 DOI: 10.1097/MOG.0000000000001085

Kimberley Butler, Thomas Peachey, Reena Sidhu, Foong Way David Tai

{"title":"Demystifying Meckel's diverticulum - a guide for the gastroenterologist.","authors":"Kimberley Butler, Thomas Peachey, Reena Sidhu, Foong Way David Tai","doi":"10.1097/MOG.0000000000001085","DOIUrl":"10.1097/MOG.0000000000001085","url":null,"abstract":"Purpose of review: Meckel's diverticulum (MD) is a common congenital ileal diverticulum. Whilst mostly asymptomatic, 4-9% develop complications, such as small bowel obstruction, diverticulitis or bleeding. In 1933, Charles Mayo wrote that MD is 'frequently suspected, often looked for and seldom found', and it continues to pose a diagnostic challenge today. With advancements in small bowel imaging and endoscopy, this review outlines the gastroenterologist's approach to MD.Recent findings: There are a number of strategies for diagnosing MD. Meckel's scan has a sensitivity of 80-92% in children but 62-88% in adults. The diagnostic yield of small bowel capsule endoscopy (SBCE) is only up to 50%. Device-assisted enteroscopy (DAE) has a sensitivity of 84-100% for MD but is invasive. The definitive treatment for symptomatic MD is surgical resection, but the management of asymptomatic cases are controversial. A recent systematic review favoured resection of incidental MD.Summary: A high index of suspicion and a multimodality combination of SBCE, Meckel's scan, CT and DAE is often required to diagnose MD. Complicated MD is treated by surgical resection. Management of incidental MD remains debated, although current evidence appears to favour resection.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"146-153"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607108","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

Contemporary management of portal vein thromboses in patients with and without cirrhosis. 肝硬化和非肝硬化患者门静脉血栓形成的当代处理。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-14 DOI: 10.1097/MOG.0000000000001086

Abhishek Shenoy, Jessica P E Davis

{"title":"Contemporary management of portal vein thromboses in patients with and without cirrhosis.","authors":"Abhishek Shenoy, Jessica P E Davis","doi":"10.1097/MOG.0000000000001086","DOIUrl":"10.1097/MOG.0000000000001086","url":null,"abstract":"Purpose of review: Portal vein thromboses (PVT) is a common clotting disorder that can be seen in patients with and without cirrhosis. There are no current clinical guidelines on management of portal vein thromboses in these two distinct populations given most studies are retrospective and comprised of heterogenous cohorts.Recent findings: When evaluating PVT, patients must first be stratified into those with cirrhosis and those without cirrhosis. In addition, a novel nomenclature can help categorize specific PVT types and determine the need and response to anticoagulation. The management of PVT in patients with cirrhosis varies and is primarily dependent on whether the PVT is recent or chronic. In contrast, patients without cirrhosis are almost always anticoagulated to avoid complications of PVT. Direct oral anticoagulants, low-molecular weight heparin, and vitamin-K antagonists have all been used in patients with and without cirrhosis, without clear guidance on optimal treatment duration and surveillance.Summary: Direct oral anticoagulants are increasingly used for patients with PVT though there is limited data on the safety and efficacy of these medications. The risk/benefit profiles of various anticoagulants must be considered when choosing a therapeutic anticoagulant. There are ongoing studies evaluating outcome measures of different anticoagulants in patients with PVT. Large, multicenter, randomized controlled trials may help elucidate the efficacy of anticoagulants on various outcome measures in PVT, including recanalization, bleeding, and survival.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"97-103"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505757","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 clinical challenge of managing patients after sustained virological response with direct-acting antivirals for Hepatitis C. 使用直接作用的丙型肝炎抗病毒药物治疗持续病毒学反应后患者的临床挑战。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-12 DOI: 10.1097/MOG.0000000000001084

Anna Pocurull, Sabela Lens

{"title":"The clinical challenge of managing patients after sustained virological response with direct-acting antivirals for Hepatitis C.","authors":"Anna Pocurull, Sabela Lens","doi":"10.1097/MOG.0000000000001084","DOIUrl":"10.1097/MOG.0000000000001084","url":null,"abstract":"Purpose of review: This review highlights the critical considerations for monitoring patients who achieve sustained virological response (SVR) after direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection. Despite the remarkable success of DAAs, challenges persist in managing long-term risks, including hepatocellular carcinoma (HCC), liver decompensation, and extrahepatic manifestations, necessitating a tailored follow-up approach.Recent findings: Recent studies emphasize that SVR does not eliminate risks for complications, particularly in patients with advanced fibrosis or cirrhosis. Advances in noninvasive tools, such as transient elastography and blood-based markers, have improved assessment of portal hypertension and liver function dynamics post-SVR. HCC surveillance remains critical for high-risk groups. Additionally, SVR improves extrahepatic conditions like mixed cryoglobulinemia and non-Hodgkin lymphoma, though careful monitoring for recurrence or associated risks is advised. Reinfection in high-risk populations underscores the importance of structured prevention and retreatment strategies.Summary: Tailored follow-up of post-SVR patients remains essential. Future research should focus on refining predictive tools for late complications and optimizing surveillance strategies, balancing cost-effectiveness with clinical outcomes.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"116-121"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494484","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 ultrasound: friend or foe? 小肠超声：是敌是友？

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-17 DOI: 10.1097/MOG.0000000000001081

James Wild, Nicoletta Nandi, Thean Soon Chew, Benjamin Rea, Reena Sidhu

{"title":"Small bowel ultrasound: friend or foe?","authors":"James Wild, Nicoletta Nandi, Thean Soon Chew, Benjamin Rea, Reena Sidhu","doi":"10.1097/MOG.0000000000001081","DOIUrl":"10.1097/MOG.0000000000001081","url":null,"abstract":"Purpose of review: Crohn's disease (CD), requires accurate diagnosis and regular monitoring to manage disease activity, prevent complications, and improve outcomes. Intestinal ultrasound (IUS) has emerged as a noninvasive, real-time imaging modality, offering a valuable alternative to traditional diagnostic techniques such as magnetic resonance enterography (MRE), endoscopy and capsule endoscopy (CE). This review examines recent advances in IUS for the diagnosis and monitoring of small bowel CD, with a focus on its applications, benefits, and limitations.Recent findings: Recent studies have demonstrated that IUS provides high sensitivity and specificity in detecting key markers of disease activity, including bowel wall thickness (BWT), bowel wall flow (BWF), and bowel wall stratification (BWS). Advances in IUS techniques, such as elastography and contrast-enhanced ultrasound (CEUS), have expanded its diagnostic and prognostic capabilities, potentially enabling differentiation between inflammation and fibrosis. However, challenges remain, including operator dependency, variability in scoring systems, and reduced sensitivity for superficial mucosal abnormalities. Efforts to standardize parameters and improve training have shown promise in addressing these limitations.Summary: IUS is a critical complementary tool for assessing disease activity, transmural healing, and postoperative recurrence in small bowel CD. Its noninvasiveness, cost-effectiveness, and real time assessment make it well suited for routine clinical use. Nonetheless, further multicentre studies are needed to validate scoring systems, optimize integration with other modalities, and improve consistency across clinical settings. IUS holds significant potential for advancing personalized care in small bowel CD, though ongoing research is required to refine its applications and maximize its clinical utility.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"154-163"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505759","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

Portal hypertension in pregnancy. 妊娠期门静脉高压。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-19 DOI: 10.1097/MOG.0000000000001091

Dorien Pint, Yooyun Chung, Michael A Heneghan

{"title":"Portal hypertension in pregnancy.","authors":"Dorien Pint, Yooyun Chung, Michael A Heneghan","doi":"10.1097/MOG.0000000000001091","DOIUrl":"10.1097/MOG.0000000000001091","url":null,"abstract":"Purpose of review: This review highlights the management, maternal and fetal outcomes, and the critical role of prepregnancy counseling for women with portal hypertension (PHT), a topic of growing clinical relevance as pregnancies in women with PHT have increased over the last two decades.Recent findings: Pregnancy exacerbates PHT due to physiological changes that increase blood flow and vascular resistance, raising the risk of life-threatening complications like variceal bleeding. The distinction between noncirrhotic (NCPH) and cirrhotic portal hypertension (CPH) is essential, as maternal risks vary significantly.Summary: Optimal care for women with PHT requires preconception counseling to assess risks, adjust medications, and plan necessary investigations such as variceal and splenic artery aneurysm screening and, if necessary, plan additional interventions. A multidisciplinary team - including hepatologists, obstetricians, anesthetists, and radiologists - is crucial for personalized management, addressing both the mode of delivery and peripartum care. While PHT complicates pregnancy, favorable outcomes are achievable with proactive planning and close follow-up during pregnancy.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"110-115"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505758","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-1 receptor agonists as a promising therapeutic option of metabolic dysfunction associated steatotic liver disease and obesity: hitting two targets with one shot. 胰高血糖素样肽-1受体激动剂作为代谢功能障碍相关的脂肪变性肝病和肥胖的有希望的治疗选择：一次击中两个目标

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-13 DOI: 10.1097/MOG.0000000000001083

Eda Kaya, Wing-Kin Syn, Paul Manka

{"title":"Glucagon like peptide-1 receptor agonists as a promising therapeutic option of metabolic dysfunction associated steatotic liver disease and obesity: hitting two targets with one shot.","authors":"Eda Kaya, Wing-Kin Syn, Paul Manka","doi":"10.1097/MOG.0000000000001083","DOIUrl":"10.1097/MOG.0000000000001083","url":null,"abstract":"Purpose of review: Obesity and type 2 diabetes mellitus (T2DM) are significant global health challenges, closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown promise in treating T2DM and obesity, but their potential for managing MASLD is still being explored. This review aims to examine the current progress in using GLP-1RAs for MASLD treatment and evaluate emerging dual and triple hormonal agonists as future therapeutic options.Recent findings: GLP-1RAs have been effective in controlling blood sugar levels, promoting weight loss, and improving cardiovascular and kidney function. Furthermore, they have shown potential benefits for liver function in patients with MASLD. GLP-1, a key incretin hormone, influences glucose metabolism, appetite, and insulin sensitivity while affecting gastric emptying and potentially reducing fat deposition in the liver. Recent developments in GLP-1RAs include various formulations with different administration and dosing options, expanding their therapeutic use.Summary: GLP-1RAs have become central to the management of T2DM, obesity, and possibly MASLD due to their ability to lower HbA1c, aid in weight reduction, and provide cardiovascular protection. As research continues, dual and triple hormonal agonists are emerging as the next evolution of incretin-based therapies, offering promising new strategies for addressing MASLD in the future.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"104-109"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494480","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 vasculitis? what a gastroenterologist should know - from diagnosis to management. 小肠血管炎？胃肠病医生应知的知识--从诊断到治疗。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-10 DOI: 10.1097/MOG.0000000000001087

João Carlos Gonçalves, Bruno Rosa, José Cotter

{"title":"Small bowel vasculitis? what a gastroenterologist should know - from diagnosis to management.","authors":"João Carlos Gonçalves, Bruno Rosa, José Cotter","doi":"10.1097/MOG.0000000000001087","DOIUrl":"10.1097/MOG.0000000000001087","url":null,"abstract":"Purpose of review: This article provides gastroenterologists with an overview of small bowel involvement in systemic vasculitis. Though various vasculitides can impact the small bowel, we highlight those with a more frequent and clinically significant GI involvement.Recent findings: Recent advances, including increased accessibility to cross-sectional imaging, capsule endoscopy and device-assisted enteroscopy, have improved detection of gastrointestinal manifestations in systemic vasculitis. Studies have also explored the genetic and inflammatory pathways involved in these diseases, although high-quality evidence on diagnosis and treatment remains limited, leading to reliance on expert consensus.Summary: Small bowel involvement is common in Behçet's disease and small vessel vasculitis, presenting with symptoms ranging from mild to severe, including massive bleeding, ischemia, and perforation, often indicating a poorer prognosis. Diagnosis is challenging, but in patients with a known or suspected history of vasculitis, it should prompt contrast-enhanced abdominal imaging and endoscopic evaluation. Treatment decisions should be made collaboratively by a multidisciplinary team, with immunosuppressive therapy remaining the cornerstone.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"132-138"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494483","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

Editorial introductions. 编辑介绍。

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.0000000000001093

引用次数: 0

Panenteric capsule endoscopy in gastrointestinal bleeding - time to change old habits? 泛肠胶囊内镜下消化道出血——该改旧习惯了吗？

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-12 DOI: 10.1097/MOG.0000000000001088

Francesco Segatta, Silvia Paggi, Franco Radaelli, Emanuele Rondonotti

{"title":"Panenteric capsule endoscopy in gastrointestinal bleeding - time to change old habits?","authors":"Francesco Segatta, Silvia Paggi, Franco Radaelli, Emanuele Rondonotti","doi":"10.1097/MOG.0000000000001088","DOIUrl":"10.1097/MOG.0000000000001088","url":null,"abstract":"Purpose of review: Capsule endoscopy (CE) is an effective tool for small bowel evaluation. Recent technical advancements, including long-lasting batteries and enhanced optics, have enabled featured capsules (panenteric capsules, PCs) to potentially assess the entire gastrointestinal (GI) tract. The PC provides a potential easy-to-use, comprehensive, single-device approach for evaluating GI bleeding patients. This review critically examines the potential role of PC in patients with GI bleeding by highlighting benefits, limitations, open issues, and future challenges.Recent findings: Evidence on PC for GI bleeding patients remains limited. Two retrospective studies and one recent prospective trial consistently show that when used in the workup of GI bleeding patients, PC is safe, feasible, achieves high diagnostic yield (both in the small and large bowel), and potentially reduces the need for unnecessary colonoscopies. Nevertheless, current challenges include the need for extensive bowel preparation, incomplete colon evaluation, and limited access to trained readers.Summary: The PC holds promise for optimizing the diagnostic workup of GI bleeding patients. However, significant challenges remain. Robust clinical trials comparing standard diagnostic methods to PC-based workup are needed before the adoption of PC in managing bleeding patients in clinical practice.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"139-145"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494481","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 role of gluten and wheat in irritable bowel syndrome and noncoeliac gluten or wheat sensitivity. 麸质和小麦在肠易激综合征和非乳糜泻麸质或小麦敏感性中的作用。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-05-01 Epub Date: 2025-02-17 DOI: 10.1097/MOG.0000000000001090

Tom van Gils, Magnus Simrén

{"title":"The role of gluten and wheat in irritable bowel syndrome and noncoeliac gluten or wheat sensitivity.","authors":"Tom van Gils, Magnus Simrén","doi":"10.1097/MOG.0000000000001090","DOIUrl":"10.1097/MOG.0000000000001090","url":null,"abstract":"Purpose of review: The role of gluten and wheat in irritable bowel syndrome (IBS) is unclear, whereas it plays a key-role in the diagnosis and treatment of noncoeliac gluten or wheat sensitivity (NCGWS). This review aims to provide the most recent insights in pathophysiological mechanisms and to summarize the evidence for a gluten- or wheat-free diet in IBS and NCGWS.Recent findings: The exact role of gluten and wheat in IBS and NCGWS pathophysiological mechanisms remains complex. However, recent findings suggest a role for antigliadin antibodies to identify those IBS patients who may benefit from a gluten-free diet and low levels of fecal calprotectin to differentiate IBS and NCGWS. The importance of gut-brain interactions in self-reported gluten sensitive individuals was shown by a strong nocebo effect, although a role of gluten could not be excluded. Evidence for a gluten-free diet remains debatable in both conditions, whereas a wheat-free diet may have more potential, especially in NCGWS.Summary: IBS and NCGWS are two closely related conditions with a complex and largely unrevealed pathophysiology. The role of gluten may have been overestimated in the past, but it is likely that certain wheat components, along with gut-brain interactions, play a role in both conditions.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"164-174"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505760","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