Best Practice & Research Clinical Gastroenterology最新文献_第5页

Clinical updates in bowel preparation for colonoscopy 结肠镜检查前肠道准备的临床进展。

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2026-02-01 Epub Date: 2025-08-14 DOI: 10.1016/j.bpg.2025.102046

Marcello Maida , Alexander D. Grieme , Yizhong Wu , Alessandro Vitello , Federico Bonomo , Carlo D. Maida , Vassallo Roberto , Antonio Facciorusso , Daryl Ramai

{"title":"Clinical updates in bowel preparation for colonoscopy","authors":"Marcello Maida , Alexander D. Grieme , Yizhong Wu , Alessandro Vitello , Federico Bonomo , Carlo D. Maida , Vassallo Roberto , Antonio Facciorusso , Daryl Ramai","doi":"10.1016/j.bpg.2025.102046","DOIUrl":"10.1016/j.bpg.2025.102046","url":null,"abstract":"<div><div>Colonoscopy is essential for colorectal cancer (CRC) screening, but its effectiveness depends on adequate bowel preparation (BP), which remains suboptimal in up to 44 % of cases. Poor BP reduces lesion detection, particularly in the proximal colon, and increases procedure time, repeat exams, and healthcare costs. This narrative review summarizes evidence-based strategies to improve BP, highlighting high- and low-volume polyethylene glycol (PEG) regimens, including newer very-low-volume options with better patient tolerance. Adjunctive agents like simethicone and 5-HT4 agonists benefit select groups, especially those with constipation. Split-dose and same-day regimens, particularly with a <5-h interval before the procedure, enhance cleansing and adenoma detection. A 1-day low-fiber diet is now preferred for better compliance. Risk factors for poor BP include age, comorbidities, and socioeconomic barriers. Emerging tools, such as predictive models and AI-enabled apps, support personalized care. A patient-centered, risk-adapted approach is vital to optimize colonoscopy quality and reduce CRC incidence.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102046"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273769","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

To CADe or not to CADe – evidence for the benefit of CAD for increased yield of colonoscopy 加或不加冠心病-冠心病对提高结肠镜检查成功率有利的证据。

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2026-02-01 Epub Date: 2026-01-23 DOI: 10.1016/j.bpg.2026.102091

Rungsun Rerknimitr

{"title":"To CADe or not to CADe – evidence for the benefit of CAD for increased yield of colonoscopy","authors":"Rungsun Rerknimitr","doi":"10.1016/j.bpg.2026.102091","DOIUrl":"10.1016/j.bpg.2026.102091","url":null,"abstract":"<div><div>Computer -Aided Detection (CADe) has emerged as a promising tool for enhancing colonoscopy during colorectal cancer screening. This manuscript critically examines the evidence supporting CADe's role in improving the yield of colonoscopy, focusing on its impact on lesion detection, miss rates, and real-time decision-making, especially for less experienced endoscopists. We review relevant clinical trials, studies, and meta-analyses to provide a comprehensive assessment of CADe's impact on detection rates, diagnostic accuracy, cost-effectiveness, colonoscopy training, reimbursement and patient outcomes. Despite challenges such as the need for adequate bowel preparation, a degree of false-positive rate, and potential lower sensitivity in detecting sessile serrated lesions (SSL), CADe holds significant promise for improving colonoscopy outcomes by enabling constant detection of colorectal neoplasia and contributing to lower adenoma miss rate. This review also covers the factors influencing the decision to use or not use CADe in various clinical contexts. Further development of AI-powered tools can potentially extend the benefits of CADe by enabling polyp characterization and automated quality control during colonoscopy, addressing factors such as withdrawal time and bowel preparation adequacy.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102091"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273893","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

Re-evaluating post-polypectomy surveillance: The role of non-invasive modalities in colorectal cancer prevention 再评估息肉切除术后监测：非侵入性模式在结直肠癌预防中的作用。

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2026-02-01 Epub Date: 2026-02-05 DOI: 10.1016/j.bpg.2026.102092

Ethna McFerran , Damian McKay , Maurice B. Loughrey , Mark Lawler , Stephen T. McSorley

{"title":"Re-evaluating post-polypectomy surveillance: The role of non-invasive modalities in colorectal cancer prevention","authors":"Ethna McFerran , Damian McKay , Maurice B. Loughrey , Mark Lawler , Stephen T. McSorley","doi":"10.1016/j.bpg.2026.102092","DOIUrl":"10.1016/j.bpg.2026.102092","url":null,"abstract":"<div><div>Post-polypectomy surveillance is a cornerstone of colorectal cancer (CRC) prevention, yet current reliance on colonoscopy poses challenges related to capacity, patient burden, and adherence.</div><div>Amid growing interest in non-invasive strategies, this review evaluates the diagnostic performance, clinical applicability, and limitations of emerging alternatives, including faecal immunochemical testing (FIT), multitarget stool DNA (mt-sDNA), CT colonography (CTC), circulating tumour DNA (ctDNA), and colon capsule endoscopy (CCE), in the context of post-polypectomy surveillance. While FIT remains widely endorsed for low-risk populations, its limited sensitivity for flat adenomas and serrated lesions constrains its utility. mt-sDNA and CTC offer incremental improvements in detection but face cost-effectiveness, false-positive, and guideline limitations in surveillance. ctDNA holds promise for recurrence monitoring in high-risk CRC but remains investigational for adenoma surveillance. Evidence for CCE as a triage tool is emerging, though concerns persist regarding incomplete examinations, cost, and residual risk.</div><div>Importantly, substantial heterogeneity in surveillance guidelines and suboptimal real-world adherence complicate evaluation and implementation of these modalities. Integration of molecular biomarkers and risk-adaptive strategies may support more personalised follow-up. However, robust comparative effectiveness studies that account for system-level and behavioural factors are essential to guide appropriate adoption. Non-invasive tools remain complementary, not yet replacements, for colonoscopy in post-polypectomy care.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102092"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273905","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

How many minutes should we take for withdrawal - guideline recommendations and upcoming evidence 我们应该花多少分钟来进行退出-指南建议和即将到来的证据。

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2026-02-01 Epub Date: 2025-05-28 DOI: 10.1016/j.bpg.2025.102019

Kjetil Kjeldstad Garborg

引用次数: 0

Nutritional approach to dumping syndrome 营养法治疗倾倒综合症

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-12-01 Epub Date: 2025-12-09 DOI: 10.1016/j.bpg.2025.102075

E. Scarpellini , W. Siquini

{"title":"Nutritional approach to dumping syndrome","authors":"E. Scarpellini , W. Siquini","doi":"10.1016/j.bpg.2025.102075","DOIUrl":"10.1016/j.bpg.2025.102075","url":null,"abstract":"<div><h3>Background</h3><div>Dumping syndrome is defined by the occurrence of ‘dumping-like’ symptoms after surgery of the upper GI tract, triggered by food reaching the small bowel too rapidly or in too high quantity. There are two different subsets of symptoms and signs, classified as early and late dumping, respectively. Nutritional approach is recommended with different levels of evidence across the managing flow-chart of the syndrome.</div></div><div><h3>Methods</h3><div>We performed a narrative review of literature evidence on the nutritional approach to dumping syndrome. In detail, we made a search on main medical databases for publications using the following keywords, their acronyms and their associations (e.g., “and “): “Dumping syndrome”,” Treatment”, “Nutrition”, “Dietary supplements”, “Food viscosity”, “Artificial Nutrition”.</div></div><div><h3>Results</h3><div>Dietary adjustment remains the initial step in the management of dumping syndrome and can be maintained throughout the patients' natural history. In detail, in patients with late dumping, rapidly absorbable carbohydrates and lactose must be avoided. In case of insufficient response to diet alone, dietary supplements increasing food viscosity have successfully been used. Similarly, corn starch has shown efficacy for children suffering from dumping symptoms. Increased amount of dietary soluble fibers increases intestinal transit time, delays glucose absorption, and improves patients’ symptoms. In refractory patients, continuous enteral nutrition via a nasogastric tube or a feeding jejunostomy has been used, especially for late dumping hypoglycemia.</div></div><div><h3>Conclusions</h3><div>some data from literature supports the use of nutritional schemes and agents enhancing food viscosity for dumping symptoms management. In refractory cases, enteral nutrition can be attempted. Larger RCTs are needed to confirm these observations.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"79 ","pages":"Article 102075"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799821","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

Nutritional management in functional dyspepsia and gastroparesis 功能性消化不良和胃轻瘫的营养管理

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-12-01 Epub Date: 2025-12-09 DOI: 10.1016/j.bpg.2025.102079

Stine Störsrud, Joost P. Algera, Hans Törnblom

引用次数: 0

Dietary approaches in functional bowel disorders 功能性肠病的饮食方法

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-12-01 Epub Date: 2025-12-07 DOI: 10.1016/j.bpg.2025.102077

Karen Van den Houte

{"title":"Dietary approaches in functional bowel disorders","authors":"Karen Van den Houte","doi":"10.1016/j.bpg.2025.102077","DOIUrl":"10.1016/j.bpg.2025.102077","url":null,"abstract":"<div><div>Functional bowel disorders, classified as disorders of gut-brain interaction, are highly prevalent and characterized by chronic gastrointestinal symptoms in the absence of identifiable structural abnormalities. The pathophysiology of these disorders is multifactorial. Given this complexity, a symptom-directed treatment approach is essential<strong>.</strong> As the majority of these patients report food-related symptoms, first-line therapy typically involves the implementation of general dietary and lifestyle advice, as recommended by the British Dietetic Association's (BDA) evidence-based guidelines and U.K's National Institute of Health and Care Excellence (NICE) guidelines. For patients not achieving adequate symptom relief with general guidance, second-line interventions may include targeted exclusion diets, eliminating carbohydrates or proteins. This review focuses on the dietary approaches used in patients with functional bowel disorders, particularly in irritable bowel syndrome (IBS), the most studied disorder. Special attention is given to the low fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet is well studied, including its rationale, pathophysiology, effect on gastrointestinal symptoms, and limitations of the diet. Additional dietary strategies are explored, including the starch and sucrose reduced diet, the gluten-free diet or a diet focusing on dietary proteins. Overall, this review synthesizes the current evidence supporting dietary therapies in functional bowel disorders and highlights the need for personalized, multidisciplinary approaches to optimize patient outcomes.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"79 ","pages":"Article 102077"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799714","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

Persistent symptoms and enteropathy in coeliac disease: clinical considerations and therapeutic opportunities 乳糜泻的持续症状和肠病：临床考虑和治疗机会

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-12-01 Epub Date: 2025-12-09 DOI: 10.1016/j.bpg.2025.102081

Maxim D'heedene , Jason A. Tye-Din , Lucas Wauters

{"title":"Persistent symptoms and enteropathy in coeliac disease: clinical considerations and therapeutic opportunities","authors":"Maxim D'heedene , Jason A. Tye-Din , Lucas Wauters","doi":"10.1016/j.bpg.2025.102081","DOIUrl":"10.1016/j.bpg.2025.102081","url":null,"abstract":"<div><div>Coeliac disease is an immune-mediated enteropathy triggered by gluten ingestion. While a strict gluten-free diet remains the basis of treatment, a sizeable proportion of patients continue to experience symptoms or histological abnormalities despite adherence. This clinical entity of non-responsive coeliac disease imposes diagnostic and therapeutic challenges. Inadvertent gluten intake is a leading cause and can be difficult to detect, but measuring gluten immunogenic peptides in the urine or stool can provide objective evidence of exposure. Persistent symptoms or enteropathy can also originate from coexisting gastrointestinal disorders or the rare complication of refractory coeliac disease, which requires specialized treatment. Several novel therapies, including intestinal gluten neutralization, intestinal permeability modulation, HLA-gluten or cytokine blockade, transglutaminase inhibition and induction of gluten tolerance have reached Phase 1b/2 clinical trials. While coeliac drug development still faces several hurdles, these advances offer hope for more personalized, effective management beyond the gluten-free diet.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"79 ","pages":"Article 102081"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799825","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

Non-pharmacological approaches in gastroesophageal reflux disease: Evidence-based dietary and lifestyle interventions 胃食管反流病的非药物治疗：循证饮食和生活方式干预

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-12-01 Epub Date: 2025-12-09 DOI: 10.1016/j.bpg.2025.102083

Luisa Bertin , Federico Caldart , Edoardo Vincenzo Savarino

{"title":"Non-pharmacological approaches in gastroesophageal reflux disease: Evidence-based dietary and lifestyle interventions","authors":"Luisa Bertin , Federico Caldart , Edoardo Vincenzo Savarino","doi":"10.1016/j.bpg.2025.102083","DOIUrl":"10.1016/j.bpg.2025.102083","url":null,"abstract":"<div><div>Gastroesophageal reflux disease (GERD) affects 18–28 % of Western populations, with 10–40 % experiencing refractory symptoms despite proton pump inhibitor therapy. We conducted a comprehensive narrative review of dietary interventions in GERD, analyzing studies that measured clinical efficacy through validated symptom scores (GERD-Q, RDQ) and objective reflux parameters (24-h pH-impedance monitoring, acid exposure time). We examined pathophysiological mechanisms, intervention efficacy, and clinical implementation strategies across diverse patient populations. Structured dietary interventions demonstrate clinically meaningful outcomes with robust mechanistic rationale. Low-carbohydrate approaches achieved significant reductions in esophageal acid exposure time (mean difference −2.83 %, 95 % CI: −4.554 to −1.114, p < 0.001), while systematic trigger food elimination protocols achieved 23 % improvement in GERD-Q scores, enabling 45 % of patients to discontinue pharmacological therapy. Plant-based dietary patterns showed remarkable protective effects with 50 % reduction in GERD prevalence (OR = 1.96, 95 % CI 1.22–3.17 for animal food consumption). Weight management interventions demonstrated exceptional efficacy in overweight patients, with GERD prevalence decreasing from 37 % to 15 % (p < 0.01) and 65 % achieving complete symptom resolution. Individual dietary trigger identification achieved high success rates with standardized protocols. Evidence-based dietary interventions offer clinically meaningful alternatives or adjuncts to pharmacological therapy. However, significant study heterogeneity and predominance of short-term trials limit definitive clinical recommendations. Future research should prioritize developing validated precision medicine algorithms integrating clinical phenotyping, genetic markers, and microbiome profiling to optimize personalized dietary prescriptions and investigate long-term sustainability of dietary modifications.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"79 ","pages":"Article 102083"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799861","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 dietary fiber in the gastrointestinal tract: when, how and why? 膳食纤维在胃肠道中的作用：何时，如何以及为什么？

IF 4 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-12-01 Epub Date: 2025-12-08 DOI: 10.1016/j.bpg.2025.102080

Christian von Muhlenbrock , Federico Aronsohn , Rodrigo Quera , Ana María Madrid

{"title":"The role of dietary fiber in the gastrointestinal tract: when, how and why?","authors":"Christian von Muhlenbrock , Federico Aronsohn , Rodrigo Quera , Ana María Madrid","doi":"10.1016/j.bpg.2025.102080","DOIUrl":"10.1016/j.bpg.2025.102080","url":null,"abstract":"<div><div>Dietary fiber (DF) used to be seen merely as an indigestible component, but it is now recognized as essential for both gut and overall metabolic health. Historically, humans consumed between 70 and 120 g of fiber per day, far more than the less than 20 g typically eaten today, despite WHO recommendations of 25–35 g daily. The physiological effects of dietary fibers depend on a complex interplay of their physicochemical properties (solubility, viscosity, and fermentability) rather than on a single characteristic. These properties determine how fibers interact with different segments of the gastrointestinal tract, influencing motility, fermentation, and barrier function. This review examines how distinct types and combinations of dietary fibers modulate gastrointestinal physiology and symptoms in various disorders, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease. For example, fibers such as psyllium, which combine solubility with moderate viscosity and fermentability, can improve bowel habits and reduce symptom burden in IBS, though responses vary among individuals. In IBD, high-fiber diets, particularly Mediterranean-style ones, appear safe and may even confer protection. Similarly, fiber from fruits and cereals is associated with a reduced risk of diverticular disease. Overall, understanding how multiple fiber properties interact to influence gastrointestinal function may allow more targeted dietary recommendations according to specific clinical contexts. Further research is needed to define the optimal types and amounts of fiber for different conditions and individuals.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"79 ","pages":"Article 102080"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799820","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