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Current Opinion in Gastroenterology最新文献

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Diagnosis and management of immune mediated liver injury from checkpoint inhibitors. 检查点抑制剂引起的免疫介导的肝损伤的诊断和管理。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-05-01 Epub Date: 2024-02-15 DOI: 10.1097/MOG.0000000000001015
Alisa Likhitsup, Robert J Fontana
{"title":"Diagnosis and management of immune mediated liver injury from checkpoint inhibitors.","authors":"Alisa Likhitsup, Robert J Fontana","doi":"10.1097/MOG.0000000000001015","DOIUrl":"10.1097/MOG.0000000000001015","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim is to summarize the latest data on the incidence, clinical manifestations, and management of immune- mediated liver injury from checkpoint inhibitors (ILICI).</p><p><strong>Recent findings: </strong>ILICI develops in 10-15% of oncology patients receiving immunotherapy with most having asymptomatic serum aminotransferase and/or alkaline phosphatase elevations. Most grade 1-2 ILICI patients improve with drug discontinuation and/or short-term oral corticosteroids. In contrast, the 2-3% with grade 3/4 hepatotoxicity frequently require oral or intravenous corticosteroids and some are hospitalized to initiate further immunosuppression with mycophenolate mofetil or azathioprine. Liver biopsy is generally reserved for patients with atypical features or those with severe hepatotoxicity who fail to respond to treatment. Up to 3% of ILICI patients with a cholestatic profile have MRI evidence of intra or extrahepatic cholangitis that responds poorly to immunosuppression. Most ILICI patients improve during follow-up and liver-related death is very uncommon (<1%). Up to 30% of rechallenged ILICI patients develop recurrent hepatotoxicity with a shorter latency.</p><p><strong>Summary: </strong>ILICI is increasingly encountered by gastroenterologists evaluating oncology patients with abnormal liver biochemistries. A stepwise approach to exclude viral hepatitis, alcohol, hepatic metastases, and pancreaticobiliary disease is recommended. The majority of ILICI patients fully recover with ICI discontinuation and short-term corticosteroids or a second line immunosuppressant.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"164-171"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906820","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
Mast cell activation and nutritional disorders in patients with hypermobility. 过度活动症患者的肥大细胞活化和营养失调。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI: 10.1097/MOG.0000000000001008
Hugo A Penny, Imran Aziz, Ching Lam
{"title":"Mast cell activation and nutritional disorders in patients with hypermobility.","authors":"Hugo A Penny, Imran Aziz, Ching Lam","doi":"10.1097/MOG.0000000000001008","DOIUrl":"10.1097/MOG.0000000000001008","url":null,"abstract":"<p><strong>Purpose of review: </strong>Individuals with joint hypermobility disorders are increasingly referred to gastroenterology services for support with the investigation and management of gastrointestinal complaints. Individuals can present with a myriad of complex coexisting diagnoses, the inter-relationship of which is unclear. This review discusses the proposed association between hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) with disorders of mast cell activation and provides an overview of gastrointestinal symptoms and nutritional outcomes in this patient cohort.</p><p><strong>Recent findings: </strong>It is unclear whether a true association between hEDS/HSD and mast cell activation disorders exists. There is a high prevalence of nonspecific gastrointestinal symptoms in individuals with hEDS/HSD and patients may be at risk of macro-nutrient and micro-nutrient deficiencies, although the current evidence base is limited.</p><p><strong>Summary: </strong>We advocate a pragmatic approach to the investigation and management of gastrointestinal symptoms in patients with hEDS/HSD. This centres on excluding organic pathology, discussing the overlap with disorders of gut-brain interactions, trialling evidence-based therapies targeting individual symptoms, and supporting nutritional deficiencies where present via the least invasive approach. Engagement with a broad multidisciplinary team is also important to support the holistic needs of this patient cohort.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"225-232"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933995","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
Monitoring coeliac disease in 2024, time to change practice? 2024 年监测乳糜泻，是时候改变做法了吗？
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-05-01 Epub Date: 2024-03-13 DOI: 10.1097/MOG.0000000000001009
Suneil A Raju, Mohamed G Shiha, Hugo A Penny
{"title":"Monitoring coeliac disease in 2024, time to change practice?","authors":"Suneil A Raju, Mohamed G Shiha, Hugo A Penny","doi":"10.1097/MOG.0000000000001009","DOIUrl":"10.1097/MOG.0000000000001009","url":null,"abstract":"<p><strong>Purpose of review: </strong>Persistent villous atrophy is associated with morbidity in coeliac disease and most commonly due to ongoing gluten ingestion. Current methods for assessing gluten exposure and persisting villous atrophy include dietary questionnaires and repeat duodenal biopsy, which have limited accuracy or are invasive. This review discusses adjunctive and/or novel tests that could be used to overcome these challenges.</p><p><strong>Recent findings: </strong>Small bowel capsule endoscopy is well tolerated and helps to evaluate for persisting villous atrophy and importantly, complications associated with coeliac disease. Testing for urinary and/or stool gluten immunogenic peptides may help identify recent gluten exposure, but further studies are still warranted to evaluate the accuracy and applicability of this approach. Measuring spikes in circulating Interleukin-2 following gluten challenge has shown promise for coeliac disease diagnosis, and thus may serve as a useful confirmatory test in those with persisting symptoms but provides no information on mucosal inflammation. No specific gut microbial signature has been identified in coeliac disease; however, studies have shown a reduced microbial diversity in active disease, which with future refinement may prove clinically useful.</p><p><strong>Summary: </strong>There is no evidence to support alternative methods for assessing persisting villous atrophy in coeliac disease over performing an up-to-date duodenal biopsy. Monitoring for adherence to a gluten-free diet remains clinically challenging and should be a priority for future research.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"190-195"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319852","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
COVID-19 vaccine-induced liver injury. COVID-19 疫苗诱发的肝损伤。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-05-01 Epub Date: 2024-02-14 DOI: 10.1097/MOG.0000000000001012
Hersh Shroff
{"title":"COVID-19 vaccine-induced liver injury.","authors":"Hersh Shroff","doi":"10.1097/MOG.0000000000001012","DOIUrl":"10.1097/MOG.0000000000001012","url":null,"abstract":"<p><strong>Purpose of review: </strong>The rapid rollout and uptake of novel coronavirus disease 2019 (COVID-19) vaccines has been accompanied by a small yet noticeable accumulation of reports of liver injury occurring after vaccination. This review describes the present evidence surrounding COVID-19 vaccine-induced liver injury (VILI).</p><p><strong>Recent findings: </strong>Liver injury occurring after the COVID-19 vaccine often presents clinically similar to autoimmune hepatitis, with positive autoantibodies and a portal and lobular inflammatory infiltrate and varying degrees of necrosis on biopsy. The overwhelming majority of patients recover, often spontaneously or with a limited course of immunosuppression. The overall incidence of this phenomenon appears to be exceedingly low.</p><p><strong>Summary: </strong>Providers should remain vigilant for ongoing reports of VILI after COVID-19 and yet feel reassured by the low incidence and high likelihood of recovery. Ongoing genetic and histological study, as well as longer-term follow-up of presently identified cases, will shed further light on the clinical entity of VILI.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"119-125"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730864","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
Idiopathic terminal ileitis: myth or true entity? 特发性末端回肠炎：传说还是真实存在？
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-05-01 Epub Date: 2024-02-14 DOI: 10.1097/MOG.0000000000001011
Nicoletta Nandi, Foong Way David Tai, Mark McAlindon, Reena Sidhu
{"title":"Idiopathic terminal ileitis: myth or true entity?","authors":"Nicoletta Nandi, Foong Way David Tai, Mark McAlindon, Reena Sidhu","doi":"10.1097/MOG.0000000000001011","DOIUrl":"10.1097/MOG.0000000000001011","url":null,"abstract":"<p><strong>Purpose of review: </strong>Isolated terminal ileitis is an increasing phenomenon identified during colonoscopy. Idiopathic terminal ileitis (IDTI) is a diagnosis of exclusion, representing a significant challenge from a diagnostic and management point of view. This review provides an overview of the most recent and relevant evidence on idiopathic IDTI, focusing on its evolution, the natural history and the management strategies proposed in the literature.</p><p><strong>Recent findings: </strong>IDTI is uncommon, with a reported prevalence between 0.5 and 7%. The main differential is with Crohn's disease and intestinal tuberculosis in endemic countries. A proportion of patients (0-50%) can progress and develop Crohn's disease; however, there are no reliable predictive factors to stratify IDTI patients.</p><p><strong>Summary: </strong>IDTI is a challenging entity, with a small proportion of patients progressing to Crohn's disease over time thus requiring follow-up. Noninvasive modalities such as capsule endoscopy are useful for follow-up, but further research is required to better understand this entity.</p>","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"217-224"},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730865","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 practical guide to selecting and using new ulcerative colitis therapies. 溃疡性结肠炎新疗法的选择和使用实用指南。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-04-12 DOI: 10.1097/mog.0000000000001023
Tara Nagaraj, John Shinn, Kara De Felice
{"title":"A practical guide to selecting and using new ulcerative colitis therapies.","authors":"Tara Nagaraj, John Shinn, Kara De Felice","doi":"10.1097/mog.0000000000001023","DOIUrl":"https://doi.org/10.1097/mog.0000000000001023","url":null,"abstract":"Several new biologics (mirizikizumab) and small molecules (upadacitinib, ozanimod, etrasimod) are approved for the treatment of moderate-to-severe ulcerative colitis. To date, there are no head-to-head trials to guide positioning and use of these newer agents.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562087","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 Practical guide to selecting and using new Crohn's disease therapies. 选择和使用克罗恩病新疗法实用指南》。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-04-12 DOI: 10.1097/mog.0000000000001029
Elizabeth A Scoville, Sara N Horst
{"title":"A Practical guide to selecting and using new Crohn's disease therapies.","authors":"Elizabeth A Scoville, Sara N Horst","doi":"10.1097/mog.0000000000001029","DOIUrl":"https://doi.org/10.1097/mog.0000000000001029","url":null,"abstract":"This review details the three new agents, including two novel mechanisms of action, approved to treat Crohn's disease in recent years. We review efficacy, safety, prescribing information, and available data on positioning these new therapies.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"183 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562407","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
Towards personalized management of early esophageal adenocarcinoma. 实现早期食管腺癌的个性化治疗。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-04-12 DOI: 10.1097/mog.0000000000001030
Vincent Bos, Man Wai Chan, Roos E Pouw
{"title":"Towards personalized management of early esophageal adenocarcinoma.","authors":"Vincent Bos, Man Wai Chan, Roos E Pouw","doi":"10.1097/mog.0000000000001030","DOIUrl":"https://doi.org/10.1097/mog.0000000000001030","url":null,"abstract":"This review aims to discuss recent advancements in the endoscopic management of early esophageal adenocarcinoma (T1 EAC).","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"47 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562383","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 the fibroblast in Barrett's esophagus and esophageal adenocarcinoma. 成纤维细胞在巴雷特食管和食管腺癌中的作用。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-04-12 DOI: 10.1097/mog.0000000000001032
Huili Zhu, Ramon U Jin
{"title":"The role of the fibroblast in Barrett's esophagus and esophageal adenocarcinoma.","authors":"Huili Zhu, Ramon U Jin","doi":"10.1097/mog.0000000000001032","DOIUrl":"https://doi.org/10.1097/mog.0000000000001032","url":null,"abstract":"Barrett's esophagus (BE) is the number one risk factor for developing esophageal adenocarcinoma (EAC), a deadly cancer with limited treatment options that has been increasing in incidence in the US. In this report, we discuss current studies on the role of mesenchyme and cancer-associated fibroblasts (CAFs) in BE and EAC, and we highlight translational prospects of targeting these cells.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"75 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140614031","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
Advances in endoscopic management of colonic diverticular bleeding. 结肠憩室出血的内窥镜治疗进展。
IF 2.5 3区 医学
Current Opinion in Gastroenterology Pub Date : 2024-04-11 DOI: 10.1097/mog.0000000000001021
Yasutoshi Shiratori, Syed Matthew Kodilinye, Ahmed E Salem
{"title":"Advances in endoscopic management of colonic diverticular bleeding.","authors":"Yasutoshi Shiratori, Syed Matthew Kodilinye, Ahmed E Salem","doi":"10.1097/mog.0000000000001021","DOIUrl":"https://doi.org/10.1097/mog.0000000000001021","url":null,"abstract":"This review is focused on diagnostic and management strategies for colonic diverticular bleeding (CDB). It aims to present the current state of the field, highlighting the available techniques, and emphasizing findings that influence the choice of therapy.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"46 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140562404","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
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