Curr. Opin. Gastroenterol. [JOURNAL]
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200 papers
Updates on therapeutic endoscopic ultrasound.
Wahba G, Lee JH
Curr Opin Gastroenterol · 2025 Jan · PMID 39560626 · Publisher ↗
PURPOSE OF REVIEW: Multiple endoscopic ultrasound (EUS) guided therapeutic interventions have been developed for the management of benign and malignant pancreaticobiliary and gastrointestinal luminal pathology. Recent hi...
PURPOSE OF REVIEW: Multiple endoscopic ultrasound (EUS) guided therapeutic interventions have been developed for the management of benign and malignant pancreaticobiliary and gastrointestinal luminal pathology. Recent high-quality evidence is increasingly validating these interventions and positioning them within evidence-based therapeutic algorithms. RECENT FINDINGS: Here we review therapeutic EUS-guided interventions including pancreatic fluid collection drainage, gastroenterostomy, biliary drainage, pancreatic duct drainage and gallbladder drainage. The most up-to-date high-quality evidence supporting these interventions is presented including comparative data with other conventional treatment options. Newer emerging interventions such as tumor ablation are also reviewed. Current controversies and future avenues for research are discussed. The key role of EUS-guided interventions in managing pancreaticobiliary pathology in patients with a surgically altered anatomy is highlighted. SUMMARY: Multiple EUS therapeutic interventions have evolved from experimental or rescue options to now well established first- and second-line interventions over other endoscopic, percutaneous and surgical alternatives with the support of high-quality data. Further research is needed to better optimize patient selection and guide long term postintervention follow-up.
Tight junction regulation, intestinal permeability, and mucosal immunity in gastrointestinal health and disease.
Saha K, Zhou Y, Turner JR
Curr Opin Gastroenterol · 2025 Jan · PMID 39560621 · Full text
PURPOSE OF REVIEW: The contributions of intestinal barrier loss, that is, increased permeability, to multiple disorders, including inflammatory bowel disease (IBD), have been a topic of speculation for many years, and th...
PURPOSE OF REVIEW: The contributions of intestinal barrier loss, that is, increased permeability, to multiple disorders, including inflammatory bowel disease (IBD), have been a topic of speculation for many years, and the literature is replete with conclusions based on correlation and speculation. The goal of this article is to critically review recent advances in mechanistic understanding of barrier regulation and the evidence for and against contributions of intestinal barrier loss to disease pathogenesis. RECENT FINDINGS: It is now recognized that intestinal permeability reflects the combined effects of two distinct routes across tight junctions, which form selectively permeable seals between adjacent epithelial cells, and mucosal damage that leads to nonselective barrier loss. These are referred to as pore and leak pathways across the tight junction and an unrestricted pathway at sites of damage. Despite advances in phenotypic and mechanistic characterization of three distinct permeability pathways, development of experimental agents that specifically target these pathways, and remarkable efficacy in preclinical models, pathway-targeted therapies have not been tested in human subjects. SUMMARY: After decades of speculation, therapeutic interventions that target the intestinal barrier are nearly within reach. More widespread use of available tools and development of new tools that discriminate between pore, leak, and unrestricted pathway permeabilities and underlying regulatory mechanisms will be essential to understanding the local and systemic consequences of intestinal barrier loss.
The use of artificial intelligence in colonoscopic evaluations.
Khalaf K, Rizkala T, Repici A
Curr Opin Gastroenterol · 2025 Jan · PMID 39480883 · Publisher ↗
PURPOSE OF REVIEW: This review aims to highlight the transformative impact of artificial intelligence in the field of gastrointestinal endoscopy, particularly in the detection and characterization of colorectal polyps. R...
PURPOSE OF REVIEW: This review aims to highlight the transformative impact of artificial intelligence in the field of gastrointestinal endoscopy, particularly in the detection and characterization of colorectal polyps. RECENT FINDINGS: Over the past decade, artificial intelligence has significantly advanced the medical industry, including gastrointestinal endoscopy. Computer aided diagnosis - detection (CADe) systems have shown notable success in increasing ADR. Recent meta-analyses of RCTs have demonstrated that patients undergoing colonoscopy with CADe assistance had a higher ADR compared with conventional methods. Similarly, computer aided diagnosis - characterization (CADx) systems have proven effective in distinguishing between adenomatous and nonadenomatous polyps, enhancing diagnostic confidence and supporting cost-saving measures like the resect-and-discard strategy. Despite the high performance of these systems, the variability in real-world adoption highlights the importance of integrating artificial intelligence as an assistive tool rather than a replacement for human expertise. SUMMARY: Artificial intelligence integration in colonoscopy, through CADe and CADx systems, marks a significant advancement in gastroenterology. These systems enhance lesion detection and characterization, leading to improved diagnostic accuracy, training outcomes, and clinical workflow efficiency. While artificial intelligence offers substantial benefits, the optimal approach involves using artificial intelligence to augment the expertise of endoscopists, ensuring that clinical decisions remain under human oversight.
Neuro-immune cell interactions in the regulation of intestinal immune homeostasis.
Hou X, Artis D
Curr Opin Gastroenterol · 2025 Jan · PMID 39417780 · Full text
PURPOSE OF REVIEW: Bidirectional regulation between neurons and immune cells in the intestine governs essential physiological processes, including digestion, metabolism and motility, while also controlling intestinal inf...
PURPOSE OF REVIEW: Bidirectional regulation between neurons and immune cells in the intestine governs essential physiological processes, including digestion, metabolism and motility, while also controlling intestinal inflammation and maintaining tissue homeostasis. This review covers recent advances and future research challenges focused on the regulatory molecules and potential therapeutic targets in neuron-immune interactions within the intestine. RECENT FINDINGS: Recently identified molecular and cellular pathways have been shown to regulate neuron-immune cell cross talk in the context of maintaining tissue homeostasis, modulating inflammation, and promoting intestinal repair. Additionally, behaviors governed by the central nervous system, including feeding and stress responses, can play key roles in regulating intestinal immunity and inflammation. SUMMARY: This review emphasizes recent progress in understanding the complex interplay between the nervous system and intestinal immune system and outlines future research directions. These advances have the potential to lead to innovative therapies targeting gastrointestinal disorders including inflammatory bowel diseases, allergic responses and cancer.
Current opinion: functional dyspepsia.
Olson CG, Travers P, Lacy BE
Curr Opin Gastroenterol · 2024 Nov · PMID 39360697 · Publisher ↗
PURPOSE OF REVIEW: Functional dyspepsia is a common gastrointestinal disease that is under-recognized and under-diagnosed. It is a complex disorder of gut-brain interaction with no FDA-approved treatment options. The pur...
PURPOSE OF REVIEW: Functional dyspepsia is a common gastrointestinal disease that is under-recognized and under-diagnosed. It is a complex disorder of gut-brain interaction with no FDA-approved treatment options. The purpose of this review is to highlight updates in the proposed pathophysiology and present new data regarding potential therapies for functional dyspepsia. RECENT FINDINGS: Alterations in the intestinal microbiome and integrity of the intestinal membrane may play a crucial role in the pathogenesis of functional dyspepsia. The low FODMAP diet, in addition to modulating the microbiome with antibiotics and probiotics, are targets for large future studies. Novel methods of delivery of gut-brain therapies have shown promising results, especially virtual reality. SUMMARY: The pathophysiology and management of functional dyspepsia is complex and there is still much unknown; however, continued research is identifying new targets for treatment. New and more targeted treatment options provide clinicians a variety of tools to offer patients with functional dyspepsia.
Celiac disease and nonceliac enteropathies.
Doyle JB, Lebwohl B
Curr Opin Gastroenterol · 2024 Nov · PMID 39360696 · Full text
PURPOSE OF REVIEW: This review highlights recent research in the field of celiac disease. RECENT FINDINGS: Epidemiological studies continue to identify celiac disease-associated diseases such as inflammatory arthritis, i...
PURPOSE OF REVIEW: This review highlights recent research in the field of celiac disease. RECENT FINDINGS: Epidemiological studies continue to identify celiac disease-associated diseases such as inflammatory arthritis, irritable bowel syndrome, and cardiovascular disease. Recently published consensus guidelines provide recommendations for the long-term management and monitoring of patients with celiac disease. There are multiple pharmaceutical therapies for celiac disease under investigation, and recent phase I and phase II trials are reviewed here. Finally, a recent trial of patients with nonceliac gluten sensitivity demonstrates a significant nocebo effect in this condition. SUMMARY: Recent advances in celiac disease include the development of new clinical guidelines as well as promising new therapeutics. Continued high-quality research is needed to improve the outcomes of patients with celiac disease and nonceliac enteropathies.
Stomach and duodenum: what's current in 2024.
Shah TU
Curr Opin Gastroenterol · 2024 Nov · PMID 39360695 · Publisher ↗
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Regurgitation, eructation, and supragastric belch: retrograde esophageal motility, disorders, and treatment.
Patel P, Layne S, Leiman DA
Curr Opin Gastroenterol · 2024 Nov · PMID 39150445 · Publisher ↗
PURPOSE OF REVIEW: This review describes pathologic conditions of retrograde flow into the esophagus along with recent therapeutic advances and treatment options. RECENT FINDINGS: The esophagus facilitates anterograde an...
PURPOSE OF REVIEW: This review describes pathologic conditions of retrograde flow into the esophagus along with recent therapeutic advances and treatment options. RECENT FINDINGS: The esophagus facilitates anterograde and retrograde movement of contents, the latter of which is mediated by transient lower esophageal sphincter relaxations (TLESRs). Gastroesophageal reflux disease (GERD) often includes esophageal-specific symptoms such as heartburn or regurgitation. Volume regurgitation responds less frequently to acid suppression with proton pump inhibitors (PPIs) than heartburn, given its relationship with incompetence of the esophagogastric junction (EGJ) and increased frequency of TLESRs. Therefore, although the refluxate pH can be altered with PPIs, the frequency of reflux episodes is generally not reduced and surgical and endoscopic treatments may be favored. Other instances of abnormal retrograde esophageal flow respond better to medical therapy, or lifestyle interventions. Compared to gastric belching because of increased stomach distension, supragastric belching is caused by intake of air from pharynx into the esophagus followed by rapid expulsion of air. These conditions can be distinguished on esophageal tests such as high-resolution manometry and are likely to respond to behavioral modifications. SUMMARY: Retrograde flow into the esophagus can be a normal occurrence, but diagnostic testing to distinguish causes can guide appropriate intervention.
Introduction to the issue: acute pancreatitis and related metabolic complications.
Yadav D, Hart PA, Bellin M
Curr Opin Gastroenterol · 2024 Sep · PMID 39110100 · Full text
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Selection of endoscopic resection technique for large colorectal lesion treatment.
Cronin O, Mandarino FV, Bourke MJ
Curr Opin Gastroenterol · 2024 Sep · PMID 39110099 · Publisher ↗
PURPOSE OF REVIEW: Large nonpedunculated colorectal polyps ≥ 20 mm (LNPCPs) comprise 1% of all colorectal lesions. LNPCPs are more likely to contain advanced histology such as high-grade dysplasia and submucosal invasive...
PURPOSE OF REVIEW: Large nonpedunculated colorectal polyps ≥ 20 mm (LNPCPs) comprise 1% of all colorectal lesions. LNPCPs are more likely to contain advanced histology such as high-grade dysplasia and submucosal invasive cancer (SMIC). Endoscopic resection is the first-line approach for management of these lesions. Endoscopic resection options include endoscopic mucosal resection (EMR), cold-snare EMR (EMR), endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). This review aimed to critically evaluate current endoscopic resection techniques. RECENT FINDINGS: Evidence-based selective resection algorithms should inform the most appropriate endoscopic resection technique. Most LNPCPs are removed by conventional EMR but there has been a trend toward C-EMR for endoscopic resection of LNPCPs. More high-quality trials are required to better define the limitations of C-EMR. Advances in our understanding of ESD technique, has clarified its role within the colorectum. More recently, the development of a full thickness resection device (FTRD) has allowed the curative endoscopic resection of select lesions. SUMMARY: Endoscopic resection should be regarded as the principle approach for all LNPCPs. Underpinned by high-quality research, endoscopic resection has become more nuanced, leading to improved patient outcomes.
Updates and innovations in therapeutic endoscopy.
Kalloo AN
Curr Opin Gastroenterol · 2024 Sep · PMID 39110098 · Publisher ↗
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Immune markers of severe acute pancreatitis.
Lee PJ, Papachristou GI, Speake C … +1 more , Lacy-Hulbert A
Curr Opin Gastroenterol · 2024 Sep · PMID 38967941 · Full text
PURPOSE OF REVIEW: Acute pancreatitis is a common acute inflammatory disorder of the pancreas, and its incidence has been increasing worldwide. Approximately 10% of acute pancreatitis progresses to severe acute pancreati...
PURPOSE OF REVIEW: Acute pancreatitis is a common acute inflammatory disorder of the pancreas, and its incidence has been increasing worldwide. Approximately 10% of acute pancreatitis progresses to severe acute pancreatitis (SAP), which carries significant morbidity and mortality. Disordered immune response to pancreatic injury is regarded as a key event that mediates systemic injury in SAP. In this article, we review recent developments in immune biomarkers of SAP and future directions for research. RECENT FINDINGS: Given the importance of the NLRP3-inflammasome pathway in mediating systemic inflammatory response syndrome and systemic injury, recent studies have investigated associations of SAP with systemic levels of activators of NLRP3, such as the damage associated molecular patterns (DAMPs) for the first time in human SAP. For example, circulating levels of histones, mitochondrial DNAs, and cell free DNAs have been associated with SAP. A panel of mechanistically relevant immune markers (e.g., panel of Angiopoeitin-2, hepatocyte growth factor, interleukin-8 (IL-8), resistin and sTNF-α R1) carried higher predictive accuracies than existing clinical scores and individual immune markers. Of the cytokines with established relevance to SAP pathogenesis, phase 2 trials of immunotherapies, including tumor necrosis factor (TNF)-alpha inhibition and stimulation of IL-10 production, are underway to determine if altering the immunologic response can reduce the severity of acute pancreatitis (AP). SUMMARY: Circulating systemic levels of various DAMPs and a panel of immune markers that possibly reflect activities of different pathways that drive SAP appear promising as predictive biomarkers for SAP. But larger multicenter studies are needed for external validation. Studies investigating immune cellular pathways driving SAP using immunophenotyping techniques are scarce. Interdisciplinary efforts are also needed to bring some of the promising biomarkers to the bedside for validation and testing for clinical utility. Studies investigating the role of and characterization of altered gut-lymph and gut-microbiota in severe AP are needed.
Imaging abnormalities of the pancreas in diabetes: implications for diagnosis and treatment.
Spilseth B, Fogel EL, Toledo FGS … +1 more , Campbell-Thompson M
Curr Opin Gastroenterol · 2024 Sep · PMID 38967933 · Full text
PURPOSE OF REVIEW: Radiographic imaging of the pancreas has drawn recent interest as pancreas volume may serve as a biomarker in identifying the likelihood of diabetes development, subtyping diabetes, and identifying pro...
PURPOSE OF REVIEW: Radiographic imaging of the pancreas has drawn recent interest as pancreas volume may serve as a biomarker in identifying the likelihood of diabetes development, subtyping diabetes, and identifying prognostic indicators of poor ultimate outcomes. In this review, the role of pancreas imaging is discussed in various forms of diabetes including type 1 diabetes (T1D), type 2 diabetes (T2D), and diabetes of the exocrine pancreas, particularly diabetes following acute or chronic pancreatitis. RECENT FINDINGS: Recent literature of quantitative pancreatic imaging correlating with various forms of diabetes was reviewed. Imaging-derived pancreas volumes are lower in individuals with diabetes, in particular those with T1D. Additionally, morphologic changes, enhancement characteristics, fat content, and MRI signal changes have been observed in different diabetes subtypes. These characteristics, as well as potential confounding variables, are reviewed. Additionally, future areas of research in MRI, CT radiomics, and pancreatitis-related imaging predictors of diabetes are discussed. SUMMARY: Increased understanding of pancreas imaging features which predict diabetes and gauge prognosis has the potential to identify at-risk individuals and will become increasingly important in diabetes care. This article reviews the current knowledge of common pancreas imaging features as well as future directions of ongoing research in diabetes imaging.
Healthcare disparities in pancreatitis: knowledge gaps and next steps.
Choate R, Bradley D, Conwell D … +1 more , Yazici C
Curr Opin Gastroenterol · 2024 Sep · PMID 38967932 · Full text
PURPOSE OF REVIEW: This review examines current research on healthcare disparities in pancreatitis, identifies knowledge gaps, and proposes strategies to develop targeted multilevel interventions to address inequities in...
PURPOSE OF REVIEW: This review examines current research on healthcare disparities in pancreatitis, identifies knowledge gaps, and proposes strategies to develop targeted multilevel interventions to address inequities in pancreatitis care. RECENT FINDINGS: Current literature has identified patient, disease, and healthcare-level factors contributing to disparities in risk factors and health outcomes of pancreatitis. Moreover, social structures, economic systems, social vulnerability, and policy significantly influence the pancreatitis care continuum. SUMMARY: Understanding the root causes of health inequities is critical to developing effective approaches for the prevention, early detection, and management of pancreatitis.
Ideal strategy for nonvariceal upper gastrointestinal bleeding.
Kavitt RT, Gralnek IM
Curr Opin Gastroenterol · 2024 Sep · PMID 38967918 · Publisher ↗
PURPOSE OF REVIEW: Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosa...
PURPOSE OF REVIEW: Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosal erosions of the esophagus, stomach or duodenum, Mallory-Weiss tears, Dieulafoy lesions, upper GI tract malignancy, or other etiology. RECENT FINDINGS: Peptic ulcers classified as Forrest Ia, Ib, or IIa require endoscopic hemostasis, while IIb ulcers may be considered for endoscopic clot removal with endoscopic treatment of any underlying major stigmata. Endoscopic hemostasis for ulcers classified as Forrest IIc or III is not advised due to the low risk of recurrent bleeding. Endoscopic hemostasis in ulcer bleeding can be achieved using injection, thermal, and/or mechanical modalities. SUMMARY: This review focuses on the currently recommended endoscopic therapies of patients presenting with acute nonvariceal upper gastrointestinal hemorrhage.
Incretin mimetics and acute pancreatitis: enemy or innocent bystander?
Pratley R, Saeed ZI, Casu A
Curr Opin Gastroenterol · 2024 Sep · PMID 38967917 · Publisher ↗
PURPOSE OF REVIEW: The incretin enhancers and mimetics, including dipeptidyl peptidase-4 (DPP-4) inhibitors, GLP-1 receptor agonists (GLP-1RA) and GLP-1/GIP co-agonists, have become mainstays in the treatment of type 2 d...
PURPOSE OF REVIEW: The incretin enhancers and mimetics, including dipeptidyl peptidase-4 (DPP-4) inhibitors, GLP-1 receptor agonists (GLP-1RA) and GLP-1/GIP co-agonists, have become mainstays in the treatment of type 2 diabetes (T2D). Recently, the approval of certain GLP-1RA and GLP-1/GIP co-agonists for the treatment of obesity has broadened their popularity and use. In this review, we summarize the evidence for an association of these drugs with acute pancreatitis and other adverse events of special interest to gastroenterologists. RECENT FINDINGS: In addition to pancreatic islets, GLP-1 receptors are expressed in the exocrine cells of the pancreas. There is inconsistent evidence for an association of DPP-4 inhibitors, GLP-1RA and co-agonists with risk for acute pancreatitis in individual trials. Meta-analyses of long-term randomized controlled trials indicate a small risk of acute pancreatitis associated with DPP-4 inhibitors but not GLP-1RA or co-agonists. Cholecystitis and cholelithiasis may be more common among those treated with GLP-1RA and GLP-1/GIP co-agonists. There is no evidence that any of these drugs are associated with an increased risk of pancreatic cancer. SUMMARY: While drugs that leverage the incretin system are increasingly being used for patients with T2D and obesity, caution in warranted in those with a history of pancreatitis and gallbladder disease.
Risk and factors determining diabetes after mild, nonnecrotizing acute pancreatitis.
Pichardo-Lowden A, Goodarzi MO, Trikudanathan G … +2 more , Serrano J, Dungan KM
Curr Opin Gastroenterol · 2024 Sep · PMID 38935336 · Full text
PURPOSE OF REVIEW: Diabetes mellitus (DM) is relatively common following acute pancreatitis (AP), even after mild acute pancreatitis (MAP), the most frequent AP presentation, in which there is no overt beta cell injury....
PURPOSE OF REVIEW: Diabetes mellitus (DM) is relatively common following acute pancreatitis (AP), even after mild acute pancreatitis (MAP), the most frequent AP presentation, in which there is no overt beta cell injury. Post-AP related diabetes is widely misdiagnosed, resulting in potentially inappropriate treatment and worse outcomes than type 2 diabetes (T2D). Thus, it is important to understand risk across the spectrum of AP severity. RECENT FINDINGS: Biological mechanisms are unclear and may include local and systemic inflammation leading to beta cell dysfunction and insulin resistance, altered gut barrier and/or gut peptides and possibly islet autoimmunity, though no studies have specifically focused on MAP. While studies examining clinical risk factors on MAP exclusively are lacking, there are studies which include MAP. These studies vary in scientific rigor, approaches to rule out preexisting diabetes, variable AP severity, diagnostic testing methods, and duration of follow-up. Overall, disease related factors, including AP severity, as well as established T2D risk factors are reported to contribute to the risk for DM following AP. SUMMARY: Though numerous studies have explored risk factors for DM after AP, few studies specifically focused on MAP, highlighting a key knowledge gap that is relevant to the majority of patients with AP.
Gastroduodenal injury and repair mechanisms.
Hagen SJ
Curr Opin Gastroenterol · 2024 Nov · PMID 38935320 · Publisher ↗
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 hea...
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: Studies on acute superficial lesions have been sparse in the past year, with more focus given to novel mechanisms of mucosal protection, and the way in which mature epithelial cells or committed stem cells dedifferentiate, reprogram, proliferate, and then regenerate the gastroduodenal mucosa after injury. For this, adenoviral therapy showed organ specific targeting with mRNA and protein expression of effectors to protect against mucosal injury and ulceration. A large database of plant-based agents known to protect against injury and ulceration was published, along with studies using plant-based compounds delivered with alginates, polysaccharide/gel floating rafts, or incorporated into nanoparticles or green carbon dots to improve targeting and retention at the ulcerated lesion. With RNA technology developing rapidly, particularly single-cell RNA sequencing, important and novel data was forthcoming on mucosal regeneration. In particular, the role of interleukin-17 hub proteins in mucosal healing was highlighted. The presence and role of injury reserve cells was determined, as was the composition of ligand gradients for cell differentiation in both stomach and duodenum. The role of amphiregulin in parietal cell differentiation from lineage-restricted stem cells and the Yap1 gene signature in metaplasia vs. healing ulcers were of particular importance. Additionally, studies unveiled the important role of mesenchymal stromal cells in differentiation and repair mechanisms, in Muse cells as an exciting new therapy for mucosal repair after injury, and the role of sympathetic neurons in activating the immune system to regulate mucosal repair mechanisms. SUMMARY: Recent studies highlight novel mechanisms that promote mucosal regeneration after injury of the gastroduodenal mucosa.
Nutritional aspects in patients with gastroparesis.
Wierzbicka A, Ukleja A
Curr Opin Gastroenterol · 2024 Nov · PMID 38935298 · Publisher ↗
PURPOSE OF REVIEW: The purpose of this review was to highlight most recent updates on nutritional aspects in gastroparesis (GP) focusing on dietary recommendations, utilization of enteral and parenteral nutrition, endosc...
PURPOSE OF REVIEW: The purpose of this review was to highlight most recent updates on nutritional aspects in gastroparesis (GP) focusing on dietary recommendations, utilization of enteral and parenteral nutrition, endoscopic and surgical interventions. RECENT FINDINGS: Recent data addressed eating patterns, nutritional interventions, and clarifications on the role of endoscopic and surgical interventions underlying an impact on nutritional management of GP patients. They support the importance of gastroparesis-specific diet in addition to drug therapy, and confirm the benefits of a modified low-fat, low-fiber diet. Current guidelines suggest a new approach to GP management based on predominant symptoms. Gastric peroral endoscopic pyloromyotomy (G-POEM) and surgical gastric electrical stimulator (GES) placement may be considered in individuals with nausea and vomiting before the need for jejunostomy tube placement for enteral feeding or parenteral nutrition. SUMMARY: Current literature supports the importance of dietary interventions, focusing on low-fat and low-fiber diets, in addition to drug therapies. Severely fiber-restrictive diets may not be necessary. There is enhanced understanding when jejunal feeding should be incorporated for refractory cases with consideration of G-POEM or/and GES even before jejunal tube placement. This approach will require patient evaluation in specialized motility centers.
Bidirectional relationship between acute pancreatitis and pancreatic cancer.
Jeon CY, Arain MA, Korc M … +2 more , Kozarek RA, Phillips AE
Curr Opin Gastroenterol · 2024 Sep · PMID 38935270 · Full text
PURPOSE OF REVIEW: The burdens of pancreatic ductal adenocarcinoma (PDAC) and acute pancreatitis are increasing globally. We reviewed current literature on whether acute pancreatitis is a causal factor for PDAC and exami...
PURPOSE OF REVIEW: The burdens of pancreatic ductal adenocarcinoma (PDAC) and acute pancreatitis are increasing globally. We reviewed current literature on whether acute pancreatitis is a causal factor for PDAC and examined clinical manifestations of PDAC-associated acute pancreatitis. RECENT FINDINGS: Recent findings detail the timing of acute pancreatitis before and after PDAC occurrence, further solidifying the evidence for PDAC-associated acute pancreatitis and for acute pancreatitis as a causal risk factor for PDAC. The risk of PDAC remains elevated above the general population in patients with distant history of acute pancreatitis. PDAC risk also increases with recurrent acute pancreatitis episodes, independent of smoking and alcohol. Mechanisms linking acute pancreatitis to PDAC include inflammation and neutrophil infiltration, which can be attenuated by suppressing inflammation and/or epigenetic modulation, thus slowing the progression of acinar-to-ductal metaplasia. Clinical presentation and management of acute pancreatitis in the context of PDAC are discussed, including challenges acute pancreatitis poses in the diagnosis and treatment of PDAC, and novel interventions for PDAC-associated acute pancreatitis. SUMMARY: PDAC risk may be reduced with improved acute pancreatitis prevention and treatment, such as antiinflammatories or epigenetic modulators. Increased acute pancreatitis and PDAC burden warrant more research on better diagnosis and management of PDAC-associated acute pancreatitis.
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