Current Opinion in Gastroenterology最新文献_第9页

The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis. 结肠炎可能是显微镜下的，但腹泻不是：显微镜下结肠炎和免疫检查点抑制剂结肠炎治疗的最新进展。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2024-01-01 Epub Date: 2023-10-20 DOI: 10.1097/MOG.0000000000000986

Ngozi Y Enwerem, Eugene F Yen

{"title":"The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis.","authors":"Ngozi Y Enwerem, Eugene F Yen","doi":"10.1097/MOG.0000000000000986","DOIUrl":"10.1097/MOG.0000000000000986","url":null,"abstract":"Purpose of review: Microscopic colitis is an inflammatory disease of the colon that presents as watery diarrhea with minimal to normal endoscopic changes on colonoscopy. It encompasses two common subtypes, lymphocytic colitis and collagenous colitis, which are both treated similarly.Immune checkpoint inhibitor colitis is among the most common immune-related adverse events. Endoscopic and histological findings range from normal colonic mucosa to inflammatory bowel like changes. This review article provides update in treatment and management of microscopic colitis and immune checkpoint inhibitor colitis (ICPi colitis).Recent findings: Recent studies on microscopic colitis have focused on the successful use of immunomodulators such as biologics for treatment of budesonide refractory microscopic colitis cases. Microscopic colitis does not confer an added risk for colorectal cancer.With the increasing usage of immunotherapy agents, immune checkpoint inhibitor colitis is becoming more common. ICPi colitis can be successfully managed with steroids, with treatment stepped up to biologics for moderate to severe cases or for mild cases that do not respond to steroids. Immunotherapy agents can be carefully re-introduced in mild cases, after treatment of ICPi colitis.Summary: Biologics can be used to treat budesonide refractory microscopic colitis. ICPi colitis can be managed with steroids and biologics in moderate to severe cases.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"50-59"},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693554","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

Clostridioides difficile infections; new treatments and future perspectives. 艰难梭菌感染；新的治疗方法和未来的展望。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2024-01-01 Epub Date: 2023-11-09 DOI: 10.1097/MOG.0000000000000989

Charmaine Normington, Caroline H Chilton, Anthony M Buckley

{"title":"Clostridioides difficile infections; new treatments and future perspectives.","authors":"Charmaine Normington, Caroline H Chilton, Anthony M Buckley","doi":"10.1097/MOG.0000000000000989","DOIUrl":"10.1097/MOG.0000000000000989","url":null,"abstract":"Purpose of review: As a significant cause of global morbidity and mortality, Clostridioides difficile infections (CDIs) are listed by the Centres for Disease Control and prevention as one of the top 5 urgent threats in the USA. CDI occurs from gut microbiome dysbiosis, typically through antibiotic-mediated disruption; however, antibiotics are the treatment of choice, which can result in recurrent infections. Here, we highlight new treatments available and provide a perspective on different classes of future treatments.Recent findings: Due to the reduced risk of disease recurrence, the microbiome-sparing antibiotic Fidaxomicin has been recommended as the first-line treatment for C. difficile infection. Based on the success of faecal microbiota transplantations (FMT) in treating CDI recurrence, defined microbiome biotherapeutics offer a safer and more tightly controlled alterative as an adjunct to antibiotic therapy. Given the association between antibiotic-mediated dysbiosis of the intestinal microbiota and the recurrence of CDI, future prospective therapies aim to reduce the dependence on antibiotics for the treatment of CDI.Summary: With current first-in-line antibiotic therapy options associated with high levels of recurrent CDI, the availability of new generation targeted therapeutics can really impact treatment success. There are still unknowns about the long-term implications of these new CDI therapeutics, but efforts to expand the CDI treatment toolbox can offer multiple solutions for clinicians to treat this multifaceted infectious disease to reduce patient suffering.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"7-13"},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523267","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

Step on the accelerator: modern treatment of constipation. 踩下油门：便秘的现代治疗方法。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2024-01-01 Epub Date: 2023-09-01 DOI: 10.1097/MOG.0000000000000982

Daniel Staursky, Dhanush Shimoga, Amol Sharma

{"title":"Step on the accelerator: modern treatment of constipation.","authors":"Daniel Staursky, Dhanush Shimoga, Amol Sharma","doi":"10.1097/MOG.0000000000000982","DOIUrl":"10.1097/MOG.0000000000000982","url":null,"abstract":"Purpose of review: This review aims to explore effective management of constipation, examine challenges in making a positive diagnosis, and highlights the significance of a positive patient-provider relationship and emerging treatments.Recent findings: Less than one-fifth of patients feel satisfied with treatment of their constipation. Sixty percent of patients with functional dyspepsia and gastroparesis have severe to very severe constipation that correlates with their upper gastrointestinal symptom severity. Two gold kiwifruits are noninferior to 10 g of psyllium in the treatment of constipation. More than 40% of patients undergoing lumbar fusion continue to fill opioid prescriptions 90 days after surgery, contributing to 80 000 chronic opioid users annually. Most patients are using over-the-counter (OTC) treatments for constipation with greater than 60% dissatisfied. Pharmacologic management involves the use of GCC agonists and emerging drug classes such as bile acid transport inhibitors and sodium hydrogen exchanger isoform 3 (NHE3) inhibitors. Nonpharmacologic treatments, including neuromodulation and FDA-approved vibrating capsule, show promise in improving symptoms and quality of life.Summary: Constipation significantly impacts patients' quality of life and well being and the majority of patients are refractory to conservative measures and OTC treatments. Both pharmacologic and nonpharmacologic treatments hold promise for improving constipation and quality of life.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"43-49"},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534695","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 Rosetta Stone of interactions of mucosa and associated bacteria in the gastrointestinal tract. 胃肠道粘膜和相关细菌相互作用的罗塞塔石碑。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2024-01-01 Epub Date: 2023-11-20 DOI: 10.1097/MOG.0000000000000992

Serena Berberolli, Mengqi Wu, Francisco M Goycoolea

{"title":"The Rosetta Stone of interactions of mucosa and associated bacteria in the gastrointestinal tract.","authors":"Serena Berberolli, Mengqi Wu, Francisco M Goycoolea","doi":"10.1097/MOG.0000000000000992","DOIUrl":"10.1097/MOG.0000000000000992","url":null,"abstract":"Purpose of review: Gut microbiota-mucosa-epithelial cells co-exist in an intricate three-way relationship that underpins gut homeostasis, and ultimately influences health and disease conditions. The O-glycans of mucin glycoproteins have been uncovered as a centrepiece of this system, although understanding the phenomena at play at the molecular level has been challenging and subject to significant traction over the last years. The purpose of this review is to discuss the recent advances in the phenomena that mediate microbiota and mucus multidirectional interactions in the human gut.Recent findings: The mucus biosynthesis and degradation by both commensal and pathogenic bacteria is under tight regulation and involves hundreds of carbohydrate-active enzymes (CAZy) and transporters. The fucosylation of O-glycans from mucin-2 seems to dictate binding by pathogenic species and to influence their virulence. Less clear is the influence of O-glycans in quorum sensing and biofilm formation. We have reviewed the advances in the in vitro models available to recreate the phenomena that capture the physiological context of the intestinal environment, emphasising models that include mucus and other aspects relevant to the physiological context.Summary: The recent findings highlight the importance of merging advances in analytical (glycans analysis) and omics techniques along with original robust in vitro models that enable to deconstruct part of the high complexity of the living gut and expand our understanding of the microbes-mucosa relationships and their significance in health and disease.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"1-6"},"PeriodicalIF":2.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177800","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

Intestinal proteases. 肠道蛋白酶。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-11-01 Epub Date: 2023-08-29 DOI: 10.1097/MOG.0000000000000972

Sameer Rao, Madhusudan Grover

{"title":"Intestinal proteases.","authors":"Sameer Rao, Madhusudan Grover","doi":"10.1097/MOG.0000000000000972","DOIUrl":"10.1097/MOG.0000000000000972","url":null,"abstract":"Purpose of review: Proteases constitute a group of enzymes that hydrolyze peptide bonds. Intestinal proteases are an integral part of gut homeostasis and digestion. This review discusses the broader classification of proteases, regulation of proteolytic activity (PA) in the intestinal tract, and how dysregulation of intestinal proteases contributes to the pathophysiology of conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. We also discuss recent advancements in therapeutic modulation that directly or indirectly target intestinal proteases and can be utilized to treat these illnesses.Recent findings: Host and microbiota derived proteases have been associated with symptoms in subsets of patients with IBS, IBD and celiac disease. Elevated PA mediates barrier dysfunction, visceral hypersensitivity as well as immune activation and inflammation. Recent mechanistic studies have revealed the nature of disease-associated proteases and mechanisms regulating their activity, particularly those driven by the microbiota. Advancements in activity-based probes have allowed novel ways of in vivo imaging of PA. Newer strategies targeting proteases include monoclonal antibodies, engineered microbiota as well as specific protease inhibitors.Summary: Significant progresses made in the detection as well as regulation of PA is likely to provide therapeutic advancements for gastrointestinal diseases.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"472-478"},"PeriodicalIF":2.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237835","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

Updates in endoscopic management of ampullary and duodenal adenomas. 壶腹和十二指肠腺瘤内镜治疗的最新进展。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-11-01 Epub Date: 2023-10-05 DOI: 10.1097/MOG.0000000000000976

Pravallika Chadalavada, Tilak Upendra Shah

{"title":"Updates in endoscopic management of ampullary and duodenal adenomas.","authors":"Pravallika Chadalavada, Tilak Upendra Shah","doi":"10.1097/MOG.0000000000000976","DOIUrl":"10.1097/MOG.0000000000000976","url":null,"abstract":"Purpose of review: Adenomas are the most common benign lesions of the gastrointestinal tract. The current review aims to summarize recent literature regarding risk factors, natural history, diagnostic and staging technique, and management strategies for ampullary and nonampullary duodenal adenomas.Recent findings: Recent studies identified several possible risks factors for duodenal adenomas (e.g., cholecystectomy, proton pump inhibitor use), although these associations require corroboration. Chromoendoscopy and endocystoscopy may offer accuracy comparable to biopsies in expert hands. Recent publications underscore the reduction in morbidity with endoscopic resection for lesions without signs of malignancy with submucosal invasion. Submucosal injection did not improve safety of endoscopic ampullectomy.Summary: Surveillance may be a reasonable strategy for sub-centimeter ampullary adenomas occurring in familial adenomatous polyposis, as they carry a relatively low risk of malignancy. Endoscopic resection is the preferred strategy over surgery in patients without lesions suggestive of invasive malignancy. For nonampullary duodenal adenomas, several endoscopic resection techniques are available, each with their unique advantages and trade-offs. In patients who are not operative candidates but have intraductal extension, endoscopic ablation is an emerging option.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 6","pages":"496-502"},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41138876","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

Gastroparesis: time for a paradigm change. 胃轻瘫：是时候改变模式了。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-11-01 Epub Date: 2023-09-05 DOI: 10.1097/MOG.0000000000000978

Brian E Lacy, Journey L Wise, David J Cangemi

{"title":"Gastroparesis: time for a paradigm change.","authors":"Brian E Lacy, Journey L Wise, David J Cangemi","doi":"10.1097/MOG.0000000000000978","DOIUrl":"10.1097/MOG.0000000000000978","url":null,"abstract":"Purpose of review: Gastroparesis (GP) is a syndrome defined by symptoms and delayed gastric emptying in the absence of mechanical obstruction. Typical symptoms include nausea, vomiting, abdominal pain, and early satiety. Only one medication is currently FDA-approved for the treatment of GP. This review highlights recent research findings pertaining to GP and provides evidence to support a change in the current GP diagnostic and treatment paradigm.Recent findings: An analysis of GP trials over the past four decades demonstrates the power of placebo and the need to perform longer studies with clearly defined patient populations. Two studies highlight the need to evaluate patients with suspected GP carefully and to perform gastric emptying studies properly. The misdiagnosis of GP symptoms is reviewed, preceded by a discussion of whether GP should be considered a disorder of gut-brain interaction. Finally, new data on therapies that target the pylorus are highlighted.Summary: Gastroparesis is frequently over-diagnosed and incorrectly diagnosed. Performing a proper gastric emptying study which adheres to standard protocol, and accurately interpreting the results in the context of the individual patient, are critical to making an accurate diagnosis of GP. The treatment paradigm needs to shift from simply aiming to accelerate gastric emptying to treating global symptoms of a chronic syndrome that may represent gut-brain dysfunction in many patients.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"503-511"},"PeriodicalIF":2.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534694","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

Stomach and duodenum: what's current in 2023. 胃和十二指肠：2023年的现状。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-11-01 Epub Date: 2023-10-05 DOI: 10.1097/MOG.0000000000000975

Tilak U Shah

引用次数: 0

Controversies regarding management of Helicobacter pylori infections. 关于幽门螺杆菌感染管理的争议。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-11-01 Epub Date: 2023-09-05 DOI: 10.1097/MOG.0000000000000981

Alyssa Price, David Y Graham, Mimi C Tan

{"title":"Controversies regarding management of Helicobacter pylori infections.","authors":"Alyssa Price, David Y Graham, Mimi C Tan","doi":"10.1097/MOG.0000000000000981","DOIUrl":"10.1097/MOG.0000000000000981","url":null,"abstract":"Purpose of review: The recognition that Helicobacter pylori should be considered and treated as an infectious disease has yet to fundamentally change diagnostic and treatment practices and has resulted in many controversies.Recent findings: We discuss the following controversies: whether the current 'per-patient' approach to H. pylori testing based on symptoms should be expanded to include achieving population-level H. pylori eradication, whether H. pylori should be approached as an infectious gastrointestinal disease similar to that of other infectious diseases of similar severity and outcome, whether treatment of H. pylori should be primarily empiric or based on antibiotic susceptibility and locally proven successful therapies as are other infectious diseases, whether it is necessary to obtain confirmation of treatment success in every patient treated for H. pylori , and whether potassium-competitive acid blockers should replace proton pump inhibitors in H. pylori therapy.Summary: Available guidelines and meta-analyses do not yet address H. pylori as an infectious disease. The diagnosis and management and treatment success of H. pylori infections trails behind that of other important infectious diseases. We provide new insights and propose changes in the traditional understanding required to modernize the management of H. pylori infections.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"482-489"},"PeriodicalIF":2.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237836","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

Pathophysiology updates: gastroduodenal injury and repair mechanisms. 病理生理学更新：胃十二指肠损伤和修复机制。

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-11-01 Epub Date: 2023-08-29 DOI: 10.1097/MOG.0000000000000973

Susan J Hagen

{"title":"Pathophysiology updates: gastroduodenal injury and repair mechanisms.","authors":"Susan J Hagen","doi":"10.1097/MOG.0000000000000973","DOIUrl":"10.1097/MOG.0000000000000973","url":null,"abstract":"Purpose of review: Although the mucosal barrier serves as a primary interface between the environment and host, little is known about the repair of acute, superficial lesions or deeper, persistent lesions that if not healed, can be the site of increased permeability to luminal antigens, inflammation, and/or neoplasia development.Recent findings: Recent studies on acute superficial lesions have focused on calcium signaling and focal adhesion kinase, which regulate cell migration and controlled matrix adhesion during restitution. Microfluidic organ-on-a-chip and gut-on-a-chip models continued in development to support reductionist studies of epithelial-bacterial and/or epithelial-immune cell interactions during mucosal barrier disruption. In fact, these models may allow personalized medicine studies in the future using patient-derived cells to evaluate injury and repair mechanisms. Work done in the past year evaluated the safety and efficacy of acid blocking drugs on ulcer healing, with new animal studies providing evidence that each drug affects the microbiome in a different way that can be correlated with its efficacy in ulcer healing. Lastly, work to understand the way in which mature epithelial cells or committed stem cells dedifferentiate, reprogram, proliferate, and then regenerate the gastroduodenal mucosa after injury was a major focus of studies in the past year.Summary: Recent studies highlight novel mechanisms that promote restitution and mucosal regeneration after injury of the gastroduodenal mucosa.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":" ","pages":"512-516"},"PeriodicalIF":2.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237842","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