Expert Review of Gastroenterology & Hepatology

Recent developments in biomarker guided therapy for Crohn's disease
Bargas A, Torres J and Verstockt B
Crohn's disease (CD) is a chronic inflammatory condition with a highly variable course and unpredictable treatment response. As the therapeutic landscape expands, there is a growing need for biomarkers that can support earlier diagnosis, risk-stratification, treatment selection, and that can inform monitoring or discontinuation strategies.
Highlighting the relevance of a multidisciplinary approach in metabolic-associated steatotic liver disease (MASLD)
Lara-Romero C, Fernández-Gómez MA, Martín F, Castilla-Guerra L, Funuyet-Salas J, Berná G, Millán-Domínguez R and Romero-Gómez M
Metabolic-associated steatotic liver disease (MASLD) represents a prevalent and multifaceted systemic condition, characterized by its intricate interplay of obesity, type 2 diabetes, and various metabolic perturbations. Given its complexity, MASLD necessitates a comprehensive multidisciplinary strategy for both prevention and management.
From liver to gut: the hidden gastrointestinal impact of pediatric metabolic dysfunction-associated steatotic liver disease
Forcina G, Frattolillo V, De Cesare M, Floriano A, Palma R, Casamassima F, Bartiromo M, Marzuillo P, Miraglia Del Giudice E and Di Sessa A
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder in children and is increasingly recognized as a multisystem condition. Among its extrahepatic manifestations, gastrointestinal (GI) comorbidities significantly influence disease progression and long-term outcomes. A deeper understanding of the liver - gut pathophysiological interplay is essential for developing integrated, multidisciplinary management strategies.
Hepatocellular carcinoma: new insights into prevention and surveillance
Jarrah M, Bourque S, Choudhury A and Singal AG
Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is one of the few cancers with a 5-year survival below 25%, largely driven by frequent late-stage diagnoses. Historically, viral etiologies have been the leading causes of HCC; however, the rising prevalence of metabolic risk factors including obesity and diabetes, in parallel with increasing alcohol misuse, has resulted in increasing proportions of HCC due to non-viral etiologies.
Mistakes in the utilization of vibration-controlled transient elastography in the evaluation of liver fibrosis: a narrative review
Niriella MA, Dassanayake UB, Madurapperuma CP, Wijesingha IP, De Silva AP and de Silva HJ
The degree of fibrosis is the most significant indicator of clinical prognosis in chronic liver disease (CLD). While liver biopsy remains the gold standard for assessing liver disease activity and fibrosis, its invasive nature, potential complications, and high cost have spurred the development of alternative diagnostic methods. This has led to significant interest in noninvasive, cost-effective, and easily replicable techniques for evaluating liver fibrosis. Among these noninvasive tests, vibration-controlled transient elastography (VCTE) has emerged as the most extensively researched and validated imaging-based method for staging liver fibrosis.
High-dosage human albumin infusion may be superior for hypervolemic hyponatremia in cirrhosis with ascites
Zhang X, Chai L, Zhao H, Zhao H, Wang R, Bernardi M and Qi X
Human albumin (HA) infusion may be effective for improving hypervolemic hyponatremia in cirrhosis. However, it remains unclear about whether HA dosage can influence its efficacy.
Treatment optimization of subcutaneous infliximab in patients with inflammatory bowel disease
Gade A, Saraga A, Deyhim T, Geeganage G, Cheifetz AS and Papamichael K
Subcutaneous infliximab (SC-IFX) is an efficacious medication for inflammatory bowel disease (IBD). However, there is limited information about treatment optimization following loss of response (LOR), the role of therapeutic drug monitoring (TDM), and combination therapy with an immunomodulator (IMM) and efficacy of SC-IFX in perianal fistulizing Crohn's disease (CD).
Treatment of pediatric abdominal pain: what is the evidence?
Saps M and Arrizabalo S
Abdominal pain disorders (APDs), including irritable bowel syndrome (IBS) and functional abdominal pain - not otherwise specified (FAP), are highly prevalent in children and significantly impact quality of life. This review highlights advances addressing the need for standardized, evidence-based management in this population.
Diagnostic and therapeutic strategies for biliary strictures: a comparison of ACG, ESGE, and ASGE guidelines
Gadour E, Crinò SF, Spadaccini M and Facciorusso A
The diagnostic management of biliary strictures remains a complex clinical challenge requiring evidence-based guidance. Multiple societies, including the European Society of Gastrointestinal Endoscopy (ESGE), American College of Gastroenterology (ACG), and American Society for Gastrointestinal Endoscopy (ASGE), have recently published guidelines with both consensus and divergence.
Measuring gut microbiome as a colorectal cancer screening tool: potential and challenges
Severino A, Marchitto SA, Bisegna P, Porcari S, Rondinella D, Schepis T, Barbaro F, Pecere S, Maida M, Spada C, Gasbarrini A, Cammarota G, Facciorusso A and Ianiro G
Colorectal cancer (CRC) represents a global public health challenge, ranking as the third most prevalent cancer globally. Population-based screening programs for average-risk populations have proven effective in reducing incidence and mortality of CRC through early detection of cancer. The fecal immunochemical test (FIT), the standard diagnostic method in many nations, still falls short in diagnostic effectiveness, resulting in undetected adenomas and, more significantly, unnecessary colonoscopies.
A contemporary review of care gaps in hepatocellular carcinoma surveillance
Duong N, Nguyen V and Nguyen M
Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality in patients with cirrhosis and carries a substantial public health burden. Primary liver cancer is the sixth most common cancer worldwide. Despite guideline recommendations for HCC surveillance, pooled surveillance rates are around 18%. Further, racial, ethnic, and socioeconomic disparities exist. Along the HCC care continuum, care gaps exist from access to care, to surveillance, and ultimately in linkage to treatment.
Altered gastrointestinal motility after bariatric surgery: consequences, complications and clinical considerations
Masclee GMC and Masclee AAM
Bariatric surgical interventions such as laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), One-Anastomosis Gastric Bypass (OAGB) and Laparoscopic Adjustable Gastric Banding (LAGB) have proven to be effective in long-term management of obesity. These procedures result in changes in anatomy and in motor and secretory function of the gastrointestinal (GI) tract.
Multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: when, why and how?
Martino A, Di Serafino M, Manguso F, Zito FP, Bennato R, Orsini L, Lisanti F, Di Bello S, Martino R, Guardascione M, Amitrano L, Paternoster G and Lombardi G
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. According to current gastroenterological guidelines, esophagogastroduodenoscopy (EGD) represents the first-line modality for both diagnosis and treatment of NVUGIB. As opposed to lower gastrointestinal bleeding, multidetector-row computed tomography angiography (MDCTA) has a limited and no well-established role in the diagnostic process of NVUGIB. However, gastroenterological guidelines mainly focus on peptic-related NVUGIB only. Moreover, the adoption of MDCTA in NVUGIB has recently been encountered in radiological guidelines for special situations.
Extra-pancreatic malignancies in patients with intraductal papillary mucinous neoplasms
Orzan RI and Khoury T
Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions of pancreatic ductal adenocarcinoma, and clinical markers of increased risk of extra-pancreatic malignancies (EPMs). However, the true burden, organ-specific risks, and optimal screening strategies for EPMs in this population remain unclear.
Current treatment strategy for asymptomatic bile duct stones
Hakuta R, Nakabayashi R, Shimamatsu Y, Otsuka N, Takayama Y, Kikuyama M and Nakai Y
Asymptomatic bile duct stones are increasingly diagnosed by imaging studies. Guidelines recommend endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of bile duct stones, but evidence regarding short- and long-term outcomes of asymptomatic bile duct stones remains inadequate.
Carcinoid syndrome mimicking irritable bowel syndrome: don't fall into the trap
Massironi S, Gallo C, Franchina M, Sbarigia C, Corsetti M and Danese S
Carcinoid syndrome (CS) is a complex condition caused by the systemic release of bioactive substances from neuroendocrine neoplasms (NENs), particularly small bowel tumors (sbNENs). Its symptoms-flushing, abdominal pain, and diarrhea-often resemble irritable bowel syndrome (IBS), resulting in misdiagnosis and delayed therapy.
Non-invasive assessment of liver fibrosis in MASLD: the need of sex-adjusted scores
Novielli F, De Matteis C, Moschetta A and Crudele L
Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum of conditions from simple steatosis to advanced fibrosis that may represent the cradle for hepatocellular carcinoma. Thus, an accurate assessment of fibrosis is critical for patient management. Noninvasive tools, including serum biomarkers and imaging techniques, have emerged as practical alternatives to liver biopsy, which presents limitations for invasiveness, cost, and sampling variability.
How to deal with lower gastrointestinal defects: the role of endoscopy
Matteo MV, Santi G, Bove V, De Siena M, Gualtieri L, Pontecorvi V, Barbaro F, Spada C and Boškoski I
Lower gastrointestinal (GI) defects, including leaks, perforations, and fistulas, pose significant challenges for diagnosis and management. These conditions are associated with high morbidity and mortality rates, necessitating effective treatment strategies to restore GI continuity and improve patient outcomes.
The eternal dichotomy between early biologic therapy and early surgery in Crohn's disease: which should truly take precedence?
Pellegrino R, Gravina AG and Federico A
Clinical management of inflammatory bowel disease from preconception to postpartum
Rabinowitz LG, Gade A, Deyhim T, Saraga A and Feuerstein JD
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, often affects individuals during their peak reproductive years. Female patients with IBD face unique challenges across the reproductive years, from fertility and conception to delivery and lactation. Despite increasing awareness, knowledge gaps remain regarding optimal management during pregnancy and postpartum. This review outlines these challenges and provides a practical, evidence-based approach across reproductive stages.
Impact of GLP-1 receptor agonists on gastrointestinal function and symptoms
Frazier RD and Hasler WL
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are approved for diabetes, obesity, and metabolic liver disease, but are also used off-label for other conditions. Adverse events associated with GLP-1RAs have become evident with their increased use.