Curr. Opin. Gastroenterol. [JOURNAL]
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200 papers
A review of techniques of third space endoscopy for gastrointestinal tumors.
Nabi Z, Reddy DN
Curr Opin Gastroenterol · 2025 Sep · PMID 40493453 · Publisher ↗
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, th...
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.
Emerging role of peroxisome proliferator-activated receptor agonists in the treatment of cholestatic liver disease.
Bhushan S, Kowdley KV
Curr Opin Gastroenterol · 2025 Jul · PMID 40470994 · Publisher ↗
PURPOSE OF REVIEW: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, chronic cholestatic diseases associated with significant morbidity. While previously approved therapies for PBC, inc...
PURPOSE OF REVIEW: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, chronic cholestatic diseases associated with significant morbidity. While previously approved therapies for PBC, including ursodeoxycholic acid (UDCA) and obeticholic acid (OCA) have substantially altered the natural course of the disease and improved patient survival, they have several limitations including an incomplete therapeutic response, patient intolerance and a lack of symptom relief. RECENT FINDINGS: Peroxisome proliferator-activated receptor (PPAR) agonists have emerged as promising therapeutic agents capable of achieving biochemical remission and alleviating debilitating symptoms such as pruritus. Elafibranor and Seladelpar were recently granted accelerated approval by the FDA as second-line treatment option for PBC. Although no treatment has yet received approval for PSC, several PPAR agonists have been evaluated in clinical trials. SUMMARY: This review highlights the evolving role of PPAR agonists as second-line agents for PBC and investigational treatments for PSC.
My approach to managing the acute endoscopic perforation.
Tiankanon K, Ngamruengphong S
Curr Opin Gastroenterol · 2025 Sep · PMID 40464833 · Publisher ↗
PURPOSE OF REVIEW: Acute endoscopic gastrointestinal perforation, a rare but potentially life-threatening complication of endoscopic procedures, presents a significant management challenge. While surgical repair has been...
PURPOSE OF REVIEW: Acute endoscopic gastrointestinal perforation, a rare but potentially life-threatening complication of endoscopic procedures, presents a significant management challenge. While surgical repair has been the traditional approach, endoscopic closure offers a highly successful, less invasive alternative in select cases. RECENT FINDINGS: Successful endoscopic management hinges on prompt perforation detection, the early initiation of appropriate antibiotic therapy, and the achievement of a secure and adequate endoscopic closure utilizing well honed technical skills. We comprehensively review various endoscopic closure techniques, including standard through-the-scope clips, over-the-scope clips, dual-action clips, Mantis clips, the Overstitch system, endoscopic through-the-scope suturing systems, and the use of covered metal stents. SUMMARY: This review aims to equip gastroenterologists with a practical framework for the timely and effective management of acute endoscopic gastrointestinal perforations.
The current state of esophageal lichen planus.
Ghai MB, Parsa N, Sloan JA
Curr Opin Gastroenterol · 2025 Jul · PMID 40402848 · Publisher ↗
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 histop...
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.
Management of paraesophageal hernia 2025.
Rieder E, Schoppmann SF
Curr Opin Gastroenterol · 2025 Jul · PMID 40402847 · Publisher ↗
PURPOSE OF REVIEW: A paraesophageal hernia (PEH) is the condition in which the fundus of the stomach protrudes through the diaphragmatic hiatus into the chest adjacent to the esophagus. Such hernias can result in serious...
PURPOSE OF REVIEW: A paraesophageal hernia (PEH) is the condition in which the fundus of the stomach protrudes through the diaphragmatic hiatus into the chest adjacent to the esophagus. Such hernias can result in serious complications such as bleeding, obstruction, ischemia, and perforation. There is considerable controversy regarding the optimal management of PEH and, in this report, we review recent publications that address this issue. RECENT FINDINGS: After surgical repair of PEH, the rate of recurrence remains high, and recent data do not document a clear advantage for the use of a mesh for crural buttressing in preventing recurrence. There also appears to be no significant difference among different types of mesh for preventing recurrence in the long term. The optimal shape, positioning, and material for mesh remain controversial topics. Recent reports suggest benefit for performing gastropexy routinely during PEH repair, and the addition of a fundoplication does not seem to reduce rates of recurrence or gastroesophageal reflux. Promising early results have been described for new techniques of PEH repair such as the use of posterior rectus sheath fascia for hiatal augmentation, and anterior crural reconstruction. SUMMARY: This report summarizes the most recent data on key issues in the management of PEH such as the use of mesh, gastropexy, fundoplication, the role of age, and novel techniques for PEH repair.
Avoiding the complications of endoscopic retrograde cholangiopancreatography.
Kodilinye SM, Shiratori Y, Kalloo AN
Curr Opin Gastroenterol · 2025 Sep · PMID 40402845 · Publisher ↗
PURPOSE OF REVIEW: To review the literature within the past 5 years on risk factors and prophylactic measures for avoiding the complications of endoscopic retrograde cholangiopancreatography (ERCP), including post-ERCP p...
PURPOSE OF REVIEW: To review the literature within the past 5 years on risk factors and prophylactic measures for avoiding the complications of endoscopic retrograde cholangiopancreatography (ERCP), including post-ERCP pancreatitis (PEP), post-ERCP cholangitis, bleeding, and perforation. RECENT FINDINGS: Despite advances in endoscopic technique and numerous clinical trials, complications of ERCP still occur frequently, particularly PEP. Recent findings are concentrated in the PEP domain and include the following: the discovery of pancreatic steatosis as a potential novel risk factor, machine learning models to predict PEP, combination prophylactic strategies including rectal NSAIDs, aggressive intravenous fluid hydration and pancreatic duct stents, potential novel pharmacotherapies, and enhanced endoscopic techniques for difficult biliary cannulation. SUMMARY: Endoscopists should be familiar with the complications of ERCP and prophylactic strategies. PEP carries a significant morbidity and economic burden, but its occurrence is par for the course when performing ERCP. Future studies should concentrate on elucidating further the pathophysiology of PEP and predicting cases that result in severe complications (severe if hospitalization was greater than 10 days along with the presence of pseudocyst, pancreatic necrosis, need for percutaneous drainage or surgery, or death).
Management of reflux hypersensitivity.
Achalu S, Elmi AN, Kamal AN
Curr Opin Gastroenterol · 2025 Jul · PMID 40402844 · Publisher ↗
PURPOSE OF REVIEW: The challenges in distinguishing reflux hypersensitivity (RH) from other functional esophageal disorders demand a comprehensive understanding of RH. This review aims to discuss the latest practices in...
PURPOSE OF REVIEW: The challenges in distinguishing reflux hypersensitivity (RH) from other functional esophageal disorders demand a comprehensive understanding of RH. This review aims to discuss the latest practices in diagnosis and management of RH, examining the pathophysiology, diagnostic criteria, and evolving treatment strategies for RH, with an emphasis on the role of effective patient-physician communication. RECENT FINDINGS: Esophageal hypersensitivity appears to play a significant role in symptoms generation for RH patients. Diagnostic algorithms have improved with updates from the Lyon consensus. Management strategies including treatments with neuromodulators, proton-pump inhibitors, behavioral interventions, and antireflux surgery are potential therapeutic options for patients with RH. SUMMARY: Effective RH management requires a patient-centered approach that considers possible pharmacologic, behavioral, and surgical strategies. Effective patient-physician communication is essential to educate patients and address their concerns about neuromodulators, and to reframe treatment strategies to target esophageal hypersensitivity rather than a psychiatric disorder.
Key updates in Crohn's disease surgery for the gastroenterologist in 2025.
Kassim G, Holubar SD, Cohen BL
Curr Opin Gastroenterol · 2025 Jul · PMID 40402838 · Publisher ↗
PURPOSE OF REVIEW: The field of inflammatory bowel disease (IBD) has been evolving at an unprecedented rate. Not only does this apply to the medical management of IBD but also to its surgical management. This review aims...
PURPOSE OF REVIEW: The field of inflammatory bowel disease (IBD) has been evolving at an unprecedented rate. Not only does this apply to the medical management of IBD but also to its surgical management. This review aims to highlight the major updates in the current surgical approach in Crohn's disease. RECENT FINDINGS: Surgery for Crohn's disease is no longer considered only for medically refractory disease or for disease-related complications but can rather be considered as an effective first-line treatment option. The concept of multimodal prehabilitation is becoming more solidified in Crohn's disease, as strong evidence continues to indicate its positive impact on surgical outcomes. The impact of the mesentery as well as the type of surgical anastomosis on postsurgical Crohn's disease recurrence is being closely reexamined. The optimal approach for surgical management of perianal Crohn's disease is also being redefined. SUMMARY: Surgery is an integral part of the care of Crohn's disease patients and keeping up with the evolving paradigm of surgery in Crohn's disease is critical for all providers taking care of Crohn's disease patients to ensure patients are getting the best care possible.
Startups and the next frontier of inflammatory bowel disease therapy: a guide for the brave.
Lamm V
Curr Opin Gastroenterol · 2025 Jul · PMID 40402837 · Publisher ↗
PURPOSE OF REVIEW: This review explores the evolving landscape of inflammatory bowel disease (IBD) therapy, particularly through the lens of startups that are pushing the boundaries of current treatment paradigms. By dis...
PURPOSE OF REVIEW: This review explores the evolving landscape of inflammatory bowel disease (IBD) therapy, particularly through the lens of startups that are pushing the boundaries of current treatment paradigms. By discussing the challenges and opportunities faced by startups, this review seeks to provide insights for aspiring entrepreneurs and innovators in the IBD space. RECENT FINDINGS: The landscape of IBD is rapidly evolving, with innovative solutions ranging from novel therapeutics to digital health platforms. An analysis of recent SBIR award winners highlights emerging trends, including microbiome-based therapies, targeted small molecules, and advanced drug delivery systems like hydrogels. Digital health solutions, such as smart monitoring tools and AI-assisted treatment selection are gaining traction. IBD startups are playing a crucial role in cost reduction through competition, streamlining drug development, and treatment personalization. Despite regulatory, financial, and funding challenges, startups are driving the next phase of IBD innovation. SUMMARY: The future of IBD therapy is being driven by innovative start-ups that are challenging the status quo in IBD treatment. These companies are addressing critical gaps in therapy by focusing on novel drug targets, improved drug delivery, and precision medicine. While startups face many challenges including high research and development (R&D) costs, regulatory hurdles, and funding, they continue to be at the forefront of IBD innovation. Their success could potentially lead to more affordable and effective therapies. By drawing on examples like the nutraceutical company, Evinature, my own personal experience as technical lead of Edulis, a startup focused on localized IBD therapy, and perspective from the head of the Crohn's and Colitis Foundation's IBD Ventures, this review aims to provide insights for those looking to innovate in IBD.
Update on laryngopharyngeal reflux disease.
Algara MA, Chan WW
Curr Opin Gastroenterol · 2025 Jul · PMID 40402835 · Publisher ↗
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...
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.
Noncirrhotic portal hypertension: current trends and future directions.
Meena BL, Rudra OS, Sharma D … +1 more , Sarin SK
Curr Opin Gastroenterol · 2025 Jul · PMID 40396916 · Publisher ↗
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, distingu...
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.
Gut-directed therapeutics in inflammatory bowel disease.
Kratschmer C, Curiel DT, Ciorba MA
Curr Opin Gastroenterol · 2025 Jul · PMID 40305008 · Full text
PURPOSE OF REVIEW: Tissue-directed therapies (TDTs) provide potential advantages, including improved tolerance, safety, and efficacy. This review provides a conceptual framework for understanding intestinal TDT and summa...
PURPOSE OF REVIEW: Tissue-directed therapies (TDTs) provide potential advantages, including improved tolerance, safety, and efficacy. This review provides a conceptual framework for understanding intestinal TDT and summarizes the current landscape of TDT in inflammatory bowel disease (IBD). RECENT FINDINGS: Vedolizumab, a mAb targeting the gut homing α4β7 integrin, served as revolutionary proof-of-principle for the power of advanced TDT in IBD. The development of other monoclonal antibodies targeting cell adhesion molecules followed including abrilumab (α4β7), etrolizumab (β7), and ontamalimab (MAdCAM-1). MORF-057, an oral small molecule inhibitor of α4β7, is now in development for ulcerative colitis. Efforts have also been made toward gut specific JAK inhibitors. Microbiome-based therapies, including engineered probiotics, bacteriophages, and postbiotics, are gaining interest. There are also a number of innovative drug delivery methods, including engineered yeast, hydrogels, and nanoparticles, and viral-based gene therapy. SUMMARY: Gut-targeted therapies range from novel variations on traditional drugs (i.e., mAbs and small molecules) to microbiome-based therapeutics and engineered delivery systems. They can be used alone or in combination with currently available therapies. Future directions should focus on the development of tried-and-true modalities (mAbs, small molecules) as well as the microbiome and more innovative delivery systems.
Chromatin profiling to identify biomarkers in inflammatory bowel diseases.
Awad A, Alcala AJ, Cowles MW … +1 more , Sheikh SZ
Curr Opin Gastroenterol · 2025 Jul · PMID 40304726 · Full text
PURPOSE OF REVIEW: Chromatin plays a critical role in gene regulation and disease pathogenesis. In inflammatory bowel disease (IBD), alterations in chromatin structure contribute to disease heterogeneity and impact treat...
PURPOSE OF REVIEW: Chromatin plays a critical role in gene regulation and disease pathogenesis. In inflammatory bowel disease (IBD), alterations in chromatin structure contribute to disease heterogeneity and impact treatment responses. This review explores chromatin accessibility and chromatin-associated proteins as biomarkers for IBD and highlights recent technological advancements enabling targeted biomarker discovery and novel therapies. RECENT FINDINGS: Advancements in high-throughput sequencing have enabled genome-wide profiling of chromatin interactions in IBD. Studies have identified distinct chromatin landscapes in Crohn's disease (CD) and ulcerative colitis (UC), revealing stable regulatory shifts independent of inflammation. SUMMARY: Chromatin profiling offers a novel approach for identifying biomarkers and therapeutic targets in IBD. Integrating chromatin accessibility data with transcriptomic and epigenomic analyses can refine disease classification and guide personalized treatment strategies. Emerging techniques compatible with formalin-fixed paraffin-embedded (FFPE) samples enhance clinical applicability, bridging the gap between molecular research and precision gastroenterology.
Advancing care in malignant gastric outlet obstruction: a contemporary review of management strategies.
Wierzbicka A, Shah T
Curr Opin Gastroenterol · 2025 Nov · PMID 40304723 · Publisher ↗
PURPOSE OF REVIEW: The aim of this review is to summarize the most pertinent data on management of malignant gastric outlet obstruction (MGOO), with an emphasis on recent updates. RECENT FINDINGS: Traditionally, options...
PURPOSE OF REVIEW: The aim of this review is to summarize the most pertinent data on management of malignant gastric outlet obstruction (MGOO), with an emphasis on recent updates. RECENT FINDINGS: Traditionally, options to restore luminal patency in patients with MGOO were surgical gastrojejunostomy (SGJ) and endoscopic insertion of an enteral stent. The latter was reserved for patients with poor performance status or anticipated survival less than 2 months. Endoscopic gastroenterostomy (EUS-GE) is a newer technique that aims to mimic a SGJ and involves placement of a lumen apposing metal stent (LAMS) from the stomach directly into the jejunum. In a recent randomized trial of EUS-GE vs. enteral stent, the former was associated with reduced re-interventions, improved stent patency, and improved patient reported eating habits. Recent publications suggest that EUS-GE may offer substantial advantages over S-GJ; a randomized trial is currently underway. Venting gastrostomy may be the most suitable option for patients with markedly impaired gastric motility or with multiple luminal obstructions. SUMMARY: MGOO is a debilitating late complication of advanced upper gastrointestinal malignancies, resulting from blockage or mechanical compression of the distal stomach, pyloric antrum or duodenum. Various modalities are currently available, and should be tailored to patient's expectations, underlying cause, life expectancy, and functional status.
Surgical versus endoscopic management of esophageal perforation.
Wang KJ, Alexander EV, Worrell SG
Curr Opin Gastroenterol · 2025 Jul · PMID 40304698 · Publisher ↗
PURPOSE OF REVIEW: The management of esophageal perforation is a topic of debate, as there now are viable surgical and endoscopic options. Historically, surgical management had been considered the standard of care for th...
PURPOSE OF REVIEW: The management of esophageal perforation is a topic of debate, as there now are viable surgical and endoscopic options. Historically, surgical management had been considered the standard of care for these perforations, but such surgical management can be associated with considerable morbidity. In this report, we explore contemporary options for the care of patients with esophageal perforations. RECENT FINDINGS: Innovations in endoscopic therapies, including self-expanding metal and plastic stents, over-the-scope clips, vacuum therapy, and endoscopic suturing have expanded treatment options for esophageal perforations. These approaches are particularly beneficial for selected patients with early, contained perforations, offering reduced morbidity and shorter hospital stays. However, surgical intervention remains essential in cases of extensive contamination, necrosis, or delayed diagnosis. A growing body of evidence supports a patient-specific approach, integrating both traditional and emerging interventions. SUMMARY: The management of esophageal perforation is evolving with the increasing use of minimally invasive endoscopic techniques. However, surgical repair remains the definitive treatment in patients with hemodynamic instability or extensive contamination. Timely intervention is critical, as delayed diagnosis significantly increases morbidity and mortality. A tailored approach, incorporating patient-specific factors and nature of the disease, ensures optimal outcomes.
Hematopoietic stem cell transplantation in Crohn's disease: a comprehensive review.
Gupta A, Ricart E, Cohen L
Curr Opin Gastroenterol · 2025 Jul · PMID 40232992 · Full text
PURPOSE OF REVIEW: Despite advances in medical therapies for the treatment of Crohn's disease (CD), 20-30% of patients fail to respond to these therapies (i.e. refractory CD). Medically refractory CD leads to significant...
PURPOSE OF REVIEW: Despite advances in medical therapies for the treatment of Crohn's disease (CD), 20-30% of patients fail to respond to these therapies (i.e. refractory CD). Medically refractory CD leads to significant disability increasing morbidity and mortality. To prevent the disability of refractory CD, hematopoietic stem cell transplantation (SCT) has emerged as a therapeutic strategy. RECENT FINDINGS: Autologous (auto-SCT) and allogeneic SCT (allo-SCT) have been explored in clinical trials for refractory CD patients. We will review the stem cell transplant process, how each part of stem cell transplantation affects clinical efficacy and safety, and how specific clinical trials advanced our understanding of the role of stem cell transplant in the treatment of refractory CD. SUMMARY: As multiple clinical trials using the same auto-SCT protocol demonstrated auto-SCT as clinically efficacious for refractory CD it supports that this treatment may be adopted as standard of care for select patients with refractory CD. To establish auto-SCT as a standard therapy will require the creation of international registries to track long-term SCT outcomes and translational studies to refine SCT protocols for CD patients as a cellular therapy that truly restores healthy intestinal immune cell populations from hematopoietic stem cells.
Aminotransferase levels in clinical practice - what is normal?
Allam J, Rockey DC
Curr Opin Gastroenterol · 2025 Jul · PMID 40227983 · Publisher ↗
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 limi...
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.
Update on hepatitis C virus management.
Peer AD, Price JC
Curr Opin Gastroenterol · 2025 Jul · PMID 40227981 · Publisher ↗
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...
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.
Who and how to choose combination therapy for inflammatory bowel disease: a comprehensive expert review.
David A, Rekkabi C, Fournier A … +1 more , Battat R
Curr Opin Gastroenterol · 2025 Jul · PMID 40183312 · Publisher ↗
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...
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.
Next pit stop-small bowel: a myriad of pathology.
Sidhu R
Curr Opin Gastroenterol · 2025 May · PMID 40178083 · Publisher ↗
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