Expert Review of Gastroenterology & Hepatology

INTRODUCTION: Duodenal biopsy is the gold standard in the diagnosis of celiac disease, with increasing utilization of serology. A gluten challenge may be required, for example, when dietary gluten reduction precedes appropriate diagnostic evaluations. Evidence on the best challenge protocol is currently sparse. Pharmaceutical trials in recent years may have provided new insights into the challenge and advanced the development of novel sensitive histological and immunological methods. AREAS COVERED: This review outlines the current perspectives on the use of gluten challenge in the diagnosis of celiac disease and explores future directions in this area...

INTRODUCTION: Most patients with pancreatic cancer present with advanced stage, incurable disease. However, patients with high-grade precancerous lesions and many patients with low-stage disease can be cured with surgery, suggesting that early detection has the potential to improve survival. While serum CA19.9 has been a long-standing biomarker used for pancreatic cancer disease monitoring, its low sensitivity and poor specificity have driven investigators to hunt for better diagnostic markers...

INTRODUCTION: Portal hypertension exacerbates the disease course of cirrhosis and is responsible for major complications, including bleeding from oesophageal varices, ascites, and encephalopathy. More than forty years ago Lebrec and colleagues introduced beta-blockers to prevent esophageal bleeding. However, evidence now suggests that beta-blockers may cause adverse reactions in patients with advanced cirrhosis. AREAS COVERED: This review addresses current evidence for the pathophysiology of portal hypertension, focusing on the pharmacological effects of treatment with beta-blockers, indications for preventing variceal bleeding, their effects on decompensated cirrhosis, and the risk of treating patients suffering from decompensated ascites and renal dysfunction with beta-blockers...

INTRODUCTION: Transarterial radioembolization (TARE) with yttrium-90 (90 Y)-labeled microspheres and immune check-point inhibitors (ICIs) have been successfully applied for the management of advanced hepatocellular carcinoma (HCC) and hepatic metastases. The potential synergism of 90 Y-microspheres and ICIs in integrated therapeutic regimens represents a topic of great interest. AREAS COVERED: The main characteristics of resin and glass 90 Y-microspheres are covered, as well as the basic principles of TARE...

INTRODUCTION: With the global increase in life expectancy, there is an increase in gastrointestinal presentations in the elderly. Small bowel bleeding (SBB) is a cause of significant morbidity in the elderly requiring multiple hospital visits, investigations, and potentially expensive therapy. AREAS COVERED: In this review, we will outline the different modalities which are used for the diagnosis and management of SBB. We will also discuss the common causes of SBB in the elderly...

INTRODUCTION: Crohn's disease (CD) is a complex disease, and assessing activity is challenging due to pathobiologic process e.g. ECM remodeling, mucosal damage, and intestinal fibrosis, which greatly limits current disease activity assessments through e.g. endoscopy and imaging techniques. AREAS COVERED: The review highlights the importance of novel biomarkers reflecting ECM remodeling and immune cell activity that accurately reflect CD activity and progression...

OBJECTIVES: To describe gastrointestinal-related side-effects reported following One Anastomosis Gastric Bypass (OAGB). METHODS: A multicenter study among OAGB patients across Israel (n=277) and Portugal (n=111) who were recruited to the study based on time elapsed since surgery was performed. An online survey with information on demographics, anthropometrics, medical conditions, and gastrointestinal outcomes was administered in both countries simultaneously. RESULTS: Respondents from Israel (pre-surgery age of 41...

INTRODUCTION: Screening-related colonoscopy is a vital component of screening initiatives to both diagnose and prevent colorectal cancer (CRC), with prevention being reliant upon early and accurate detection of pre-malignant lesions. Several strategies, techniques, and interventions exist to optimize endoscopists' adenoma detection rates (ADR). AREAS COVERED: This narrative review provides an overview of the importance of ADR and other colonoscopy quality indicators...

BACKGROUND: Tenofovir (TDF) and entecavir (ETV) are first-line treatments for patients with chronic hepatitis B virus (HBV) infection. However, the effect of TDF versus ETV on the prognosis of HBV-related hepatocellular carcinoma (HCC) has not been fully clarified yet. RESEARCH DESIGN AND METHODS: PubMed, Embase and Web of science were searched up to March, 2021. Meta-analyses were performed for overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS) to assess the effect of TDF versus ETV on the prognosis of HBV-related HCC...

INTRODUCTION: The novel coronavirus disease 2019 has thrown light on various heterogeneous afflictions of newly emerging viruses on the human body. Early reports demonstrated direct effect of novel coronavirus on the liver, but subsequently, this did not stand up to validation. The SARS-CoV-2 virus affects the liver differentially; in healthy compared to those with preexisting liver disease. AREAS COVERED: This exhaustive paper reviews the current, literature on mechanisms by which COVID-19 affects the healthy liver and those with preexisting liver disease such as alcohol-related and nonalcoholic fatty liver, autoimmune liver disease, chronic liver disease and cirrhosis, hepatocellular carcinoma, viral hepatitis, and liver transplant recipients, with special mention on drug-and herb-induced liver injury with COVID-19 therapies...

INTRODUCTION: Therehas been phenomenal interest concerning gut microbiota dysbiosis includingsmall intestinal bacterial overgrowth (SIBO). However, the diagnostic methodsfor SIBO are still unsatisfactory. AREAS COVERED: Thecurrent review covers the different invasive and non-invasive tests to diagnoseSIBO, their methodology, interpretation, sensitivity, specificity, andlimitations based on the selected articles from literature search using searchterms "small intestinal bacterial overgrowth" AND "digestive diseases" OR"diagnosis" OR "hydrogen breath test" in PubMed in December 2022...

INTRODUCTION: Obesity has been identified by the World Health Organization (WHO) as a significant global medical, social, and public health issue. Surgery is the most important therapeutic option for severe morbid obesity and metabolic diseases linked to obesity. Sleeve gastrectomy-transit bipartition (SG-TB) and the single anastomosis sleeve ileal (SASI) bypass, a more simplified variation of SG-TB, have recently become popular methods for treating these conditions. The clinical investigations of SG-TB and SASI bypass are included in this review...

BACKGROUND: Proton pump inhibitors (PPI) may impact the absorption of vitamin B12. We performed a systematic review to ascertain if PPI use increases risk of vitamin B12 deficiency. METHODS: Electronic databases (PubMed, Embase, Scopus) were searched on first of September 2022. We selected studies that compared the frequency of vitamin B12 deficiency in PPI users and non-users. Pooled Odds Ratio (OR) was calculated for the occurrence of vitamin B12 deficiency in PPI users compared to non-users...

BACKGROUND: Liver transplantation (LT) is the most effective way to save patients with acute-on-chronic liver failure (ACLF). However, the impact of donor diabetes mellitus (DM) on LT outcomes in patients with ACLF has not been fully investigated. RESEARCH DESIGN AND METHODS: We retrospectively analyzed data from the Scientific Registry of Transplant Recipients (SRTR) between Janunary 1st , 2008 to December 31st , 2017 in this study. All the patients were divided into donors with DM and without DM group (DM: 1,394; non-DM: 11,138)...

OBJECTIVES: To analyze prognostic value of total tumor volume (TTV) and tumor burden score (TBS) in surgically treated patients with hepatocellular carcinoma and concurrent fatty liver disease and hepatitis B virus (FLD-HCC). METHODS: FLD-HCC patients who treated with hepatectomy from 2010 to 2018 were analyzed. Prognostic performance of TTV and TBS were determined by ROC analysis. Patients were stratified into low and high tumor burden by optimal cutoff value of 113...

INTRODUCTION: Nucleos(t)ide analogues (NAs) are effective in suppressing the replication of the hepatitis B virus. However, NAs cannot effectively induce hepatitis B surface antigen (HBsAg) seroclearance, which represents the optimal treatment endpoint in chronic hepatitis B (CHB). Hence, most CHB patients are advised for indefinite NA therapy, but recent data has supported the concept of finite NA therapy before HBsAg seroclearance. AREAS COVERED: This article covered the latest evidence on stopping NAs in CHB, with focused analysis on international guidelines...

INTRODUCTION: Ustekinumab is a humanized monoclonal antibody, targeting the p40 subunit common to both human interleukin 12 and 23, approved by the European Medicines Agency and US Food and Drug Administration for the treatment of moderate-to-severe ulcerative colitis. AREAS COVERED: In this review, the results of the phase 3 UNIFI and the real-world studies assessing the efficacy and safety of ustekinumab in moderate-to-severe ulcerative colitis are discussed, as well as limitations of these studies...

BACKGROUND: Contrast-enhanced ultrasound (CEUS) has been proposed for detecting clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH) in patients with chronic liver diseases (CLD). RESEARCH DESIGN & METHODS: Studies were selected that investigated the diagnostic performance of CEUS in patients with CLD up to October 10, 2022. The summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratios, and the summary sensitivities and specificities were used to assess the performance of CEUS for detecting CSPH and SPH...

INTRODUCTION: The aim of this study is to estimate the risk of major adverse cardiovascular events (MACEs) in adult patients with inflammatory bowel disease (IBD) treated with biologic therapies and small molecules. METHODS: Databases were searched up to July 2022 to identify eligible studies that assessed the risk of MACEs in patients (age ≥18 years) with IBD treated with treated with biologic therapies and small molecules. Primary outcome was the rate of MACEs observed in patients receiving biologic or small molecules therapies during induction and maintenance phases of RCTs...

INTRODUCTION: Chronic intestinal pseudo-obstruction (CIPO) is a rare, heterogeneous and severe form of gastrointestinal dysmotility. AREAS COVERED: Pertinent literature on pediatric and adult CIPO management has been assessed via PubMed, Scopus, and EMBASE from inception to June 2022. Prokinetics, aimed at restoring intestinal propulsion (e.g. orthopramides and substituted benzamides, acetyl cholinesterase inhibitors, serotonergic agents and others), have been poorly tested and the available data showed only partial efficacy...