A ramble through the small bowel
Current Opinion in Gastroenterology
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2w ago
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Editorial introductions
Current Opinion in Gastroenterology
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2w ago
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Noninvasive assessment of liver fibrosis and portal hypertension
Current Opinion in Gastroenterology
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2w ago
Purpose of review The result of ongoing liver injury – and disease, regardless of cause – is fibrosis, and fibrosis appears to be a critically important result of ongoing injury. Further, in a number of different liver diseases, the presence of fibrosis has prognostic value. Therefore, the assessment of fibrosis is of critical clinical importance. Given the importance of fibrosis, there has been a rapid evolution in the use of noninvasive liver tests. This review highlights a number of the core principles surrounding. Recent findings The use of noninvasive test has progressed rapidly over the ..read more
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Biologics, small molecule therapies and surgery in small bowel Crohn's disease
Current Opinion in Gastroenterology
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2w ago
Purpose of review The terminal ileum and small bowel (SB) are involved in 30–45% of patients with Crohn's disease, while 20% have both small and large bowel involvement. Ileal Crohn's is associated with higher risk of progression to stricturing and penetrating disease1, hence it's imperative to utilize effective therapies to induce and maintain clinical and endoscopic remission and prevent intestinal complications. We review the available data of biologics and upadacitinib in small bowel disease, and the emerging data on the role of surgery as first line therapy for isolated Crohn's ileitis. R ..read more
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Update on ischemic hepatitis
Current Opinion in Gastroenterology
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2w ago
Purpose of review Ischemic hepatitis (IH) refers to diffuse liver injury secondary to hypoperfusion. The condition is usually seen in the critical care setting and is associated with significant mortality. IH typically occurs in the setting of systemic hypotension superimposed on some form of underlying cardiac dysfunction. This review aims to report what is known and what is new about the etiology, pathophysiology, and clinical features associated with IH. Recent findings In recent years, studies on IH have largely confirmed earlier reports regarding etiologies, comorbid conditions, and assoc ..read more
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Monitoring coeliac disease in 2024, time to change practice?
Current Opinion in Gastroenterology
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2w ago
Purpose of review Persistent villous atrophy is associated with morbidity in coeliac disease and most commonly due to ongoing gluten ingestion. Current methods for assessing gluten exposure and persisting villous atrophy include dietary questionnaires and repeat duodenal biopsy, which have limited accuracy or are invasive. This review discusses adjunctive and/or novel tests that could be used to overcome these challenges. Recent findings Small bowel capsule endoscopy is well tolerated and helps to evaluate for persisting villous atrophy and importantly, complications associated with coeliac di ..read more
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Terlipressin for hepatorenal syndrome
Current Opinion in Gastroenterology
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2w ago
Purpose of review The definition and diagnostic criteria of hepatorenal syndrome-acute kidney injury (HRS-AKI) has undergone recent changes. A major vasoconstrictor, terlipressin, has recently been approved as pharmacotherapy for HRS-AKI in the United States. The purpose of this review is to familiarize the readers with these new diagnostic criteria of HRS-AKI, and how best to use terlipressin. Recent findings Terlipressin is effective either as bolus dosing or continuous infusion and can achieve reversal of HRS-AKI in approximately 40% of patients. Continuous infusion allows lower daily dose ..read more
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Small bowel intussusception – aetiology & management
Current Opinion in Gastroenterology
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2w ago
Purpose of review Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. Recent findings There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. Summary A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical featur ..read more
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Mast cell activation and nutritional disorders in patients with hypermobility
Current Opinion in Gastroenterology
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2w ago
Purpose of review Individuals with joint hypermobility disorders are increasingly referred to gastroenterology services for support with the investigation and management of gastrointestinal complaints. Individuals can present with a myriad of complex coexisting diagnoses, the inter-relationship of which is unclear. This review discusses the proposed association between hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) with disorders of mast cell activation and provides an overview of gastrointestinal symptoms and nutritional outcomes in this patient cohort. Re ..read more
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The role of the microbiome in liver disease
Current Opinion in Gastroenterology
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2w ago
Purpose of review The intestinal microbiome and the gut-liver axis play a major role in health and disease. The human gut harbors trillions of microbes and a disruption of the gut homeostasis can contribute to liver disease. In this review, the progress in the field within the last 3 years is summarized, focusing on metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), autoimmune liver disease (AILD), and hepatocellular carcinoma (HCC). Recent findings Changes in the fecal virome and fungal mycobiome have been described in patients with vario ..read more
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