Current Opinion in Gastroenterology最新文献_第2页

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

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

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-05-14 DOI: 10.1097/MOG.0000000000001108

Miguel A Algara, Walter W Chan

{"title":"Update on laryngopharyngeal reflux disease.","authors":"Miguel A Algara, Walter W Chan","doi":"10.1097/MOG.0000000000001108","DOIUrl":"10.1097/MOG.0000000000001108","url":null,"abstract":"Purpose of review: Chronic laryngopharyngeal symptoms (LPS) are increasingly prevalent presentations to gastroenterologists' offices, and clinicians often make a presumptive diagnosis of laryngopharyngeal reflux disease (LPRD) based on LPS symptoms or laryngoscopic findings alone. Such presumptive diagnoses of LPRD often are incorrect, and establishing the correct diagnosis poses significant challenges for clinicians. This review addresses the timely need for advances in evaluating and managing LPS/LPRD, given their diagnostic complexity and the healthcare burden of ineffective empiric treatments.Recent findings: Recent evidence emphasizes the diverse etiologies of LPS including LPRD, oropharyngeal or other airway pathologies, allergic conditions, and cognitive-affective processes or altered brain-larynx interaction. The diagnostic approach should be individualized and multimodal, including upfront reflux testing over empiric acid suppression trials for possible LPRD, given the poor correlation between LPS and objective evidence of reflux. Predictive models and risk stratification tools such as the COuGH RefluX score show promise to help guide testing and therapeutic strategies. Reflux testing modalities include wireless pH monitoring and impedance-based testing (traditional impedance-pH or combined hypopharyngeal-esophageal reflux monitoring). Biochemical testing for salivary pepsin may also offer adjunctive value. Management should include antireflux strategies for those with objectively-proven LPRD, alongside treatments targeting nonreflux mechanisms of LPS, such as voice therapy, neuromodulation, and behavioral therapy.Summary: An individualized, multidisciplinary approach is essential in managing LPS/LPRD. Objective reflux testing improves diagnostic accuracy, avoids unnecessary therapies, and enables tailored treatment. Future research should further refine diagnostic thresholds, validate risk stratification tools, and explore novel therapeutic targets to optimize outcomes.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"251-259"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial introductions. 编辑介绍。

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.0000000000001105

引用次数: 0

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

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-07-01 Epub Date: 2025-05-02 DOI: 10.1097/MOG.0000000000001106

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

{"title":"Noncirrhotic portal hypertension: current trends and future directions.","authors":"Babu Lal Meena, Omkar S Rudra, Deepti Sharma, Shiv Kumar Sarin","doi":"10.1097/MOG.0000000000001106","DOIUrl":"10.1097/MOG.0000000000001106","url":null,"abstract":"Purpose of review: Noncirrhotic portal hypertension (NCPH) comprises a diverse group of vascular liver disorders characterized by elevated portal pressure without cirrhosis. Due to overlapping clinical features, distinguishing NCPH from cirrhosis and porto-sinusoidal vascular disorder (PSVD) remains challenging. This review explores recent advancements in diagnosis, differentiation, and evolving treatment strategies.Recent findings: NCPH is characterized by preserved liver function and near-normal hepatic venous pressure gradients (HVPG). It shares risk factors with PSVD, including infections, drugs, toxins, and prothrombotic conditions. Diagnostic advancements, such as liver stiffness measurement (LSM) and splenic stiffness measurement (SSM), offer noninvasive differentiation from cirrhosis, while liver biopsy remains crucial for confirming PSVD and noncirrhotic portal fibrosis (NCPF). Imaging is reliable for diagnosing extrahepatic portal vein obstruction (EHPVO). Transjugular intrahepatic portosystemic shunts (TIPS) for refractory variceal bleeding or ascites, achieving rebleeding control in 72-80% of cases. Surgical shunts and splenectomy remain essential for uncontrolled bleeding and portal biliopathy, demonstrating excellent variceal control (93-95%).Summary: NCPH requires a high index of suspicion for diagnosis. Differentiation from cirrhosis and PSVD relies on clinical, histological, and hemodynamic assessments. Management focuses on endoscopic, interventional, and surgical strategies tailored to disease severity. Future research should standardize diagnostic criteria, explore targeted therapies, and refine prognostic tools to improve outcomes.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"271-280"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A review of techniques of third space endoscopy for gastrointestinal tumors. 胃肠肿瘤第三空间内镜检查技术综述。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-06-06 DOI: 10.1097/MOG.0000000000001113

Zaheer Nabi, D Nageshwar Reddy

{"title":"A review of techniques of third space endoscopy for gastrointestinal tumors.","authors":"Zaheer Nabi, D Nageshwar Reddy","doi":"10.1097/MOG.0000000000001113","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001113","url":null,"abstract":"Purpose of review: This review explores the evolving landscape of third-space endoscopy (TSE) techniques for the management of gastrointestinal (GI) tumors. With rapid technological advances and accumulating evidence, there is a pressing need to synthesize current knowledge and clarify the comparative utility of approaches like submucosal tunneling endoscopic resection (STER) and tunneling endoscopic submucosal dissection (ESD).Recent findings: STER is safe and effective for resection of subepithelial lesions, offering mucosal preservation, high en bloc resection rates, and reduced recovery time compared to ESE, ESD, and endoscopic full-thickness resection. Piecemeal STER is a potential alternative to surgery in managing large esophageal sub-epithelial lesions without compromising outcomes. For early epithelial neoplasms, pocket-creation and tunneling variants of ESD improve dissection speed and reduce adverse events, especially in large lesions. Comparative studies across esophagus, stomach, and colon confirm these benefits. Additionally, risk scoring systems and resection algorithms may guide personalized technique selection.Summary: STER and tunneling ESD represent significant advances in minimally invasive management of GI tumors. Incorporating these techniques into practice can enhance safety and efficacy, especially when guided by risk stratification tools. Ongoing innovation, including artificial intelligence and robotics, is likely to further refine third-space interventions in near future.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267808","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

Endoscopic ultrasound in hepatology: ushering a new era in liver disease management. 内窥镜超声在肝病中的应用：引领肝病治疗的新时代。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-06-06 DOI: 10.1097/MOG.0000000000001115

Andrada Seicean, Irina Dragomir, Bogdan Procopet

{"title":"Endoscopic ultrasound in hepatology: ushering a new era in liver disease management.","authors":"Andrada Seicean, Irina Dragomir, Bogdan Procopet","doi":"10.1097/MOG.0000000000001115","DOIUrl":"https://doi.org/10.1097/MOG.0000000000001115","url":null,"abstract":"Purpose of review: This review aims to provide an up-to-date overview of the expanding role of endoscopic ultrasound (EUS) in endohepatology, highlighting its potential to transform the diagnostic and therapeutic landscape for liver diseases. Given the increasing complexity of liver disease management, this review discusses both established and emerging applications of EUS in liver parenchyma assessment, portal hypertension diagnosis and related complications treatment and liver biopsy techniques.Recent findings: Recent studies demonstrate that EUS can accurately assess liver fibrosis, detect focal lesions, and evaluate portal hypertension, with significant advancements in EUS-guided liver biopsy and treatment of gastric varices. Key findings include improved diagnostic accuracy with EUS-FNB over traditional methods and the potential for endoscopic ultrasound portal pressure gradient (EUS-PPG) in portal pressure measurements.Summary: EUS holds significant promise in diagnosing and treating liver diseases, with applications in assessing liver fibrosis, identifying focal liver lesions, and managing portal hypertension. Future research will likely focus on enhancing EUS's role in therapeutic procedures, such as managing portal vein thrombosis and creating intrahepatic portosystemic shunts, offering a new avenue for minimally invasive treatment options.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267809","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

My approach to managing the acute endoscopic perforation. 我处理急性内窥镜穿孔的方法。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2025-06-05 DOI: 10.1097/MOG.0000000000001114

Kasenee Tiankanon, Saowanee Ngamruengphong

引用次数: 0