Can digital therapeutics such as apps help in the management of patients with disorders of gut-brain interaction? This question is explored in the Advances in IBS column in this month’s issue of Gastroenterology & Hepatology. Dr Kyle Staller discusses whether brain-gut behavioral therapies can be delivered effectively by digital therapeutics and examines the evidence supporting the use of these tools. He also reviews different behavioral health digital therapeutics in development and offers an example of an app that delivers gut-directed hypnotherapy, which he recommends for patients with irritable bowel syndrome. Other topics of discussion include considerations to take into account before recommending digital therapeutics for disorders of gut-brain interaction, the limitations of these tools, and how their use can serve gastroenterologists and gastrointestinal psychologists.
One of our feature articles this month provides historical context for the current pharmacologic landscape in eosinophilic esophagitis (EoE). Dr Susie Min and Dr Joy W. Chang outline the evolution of drug treatment across 3 decades in this disease setting. The authors review the changing role of proton pump inhibitors, the use of swallowed topical corticosteroids, the recent approvals of dupilumab and budesonide oral suspension by the US Food and Drug Administration, as well as other pharmacologic therapies under study. Additionally, the authors provide their perspective on how future development may improve our understanding and treatment of EoE.
Our other feature article highlights recent and emerging therapies for patients with hepatocellular carcinoma (HCC). Dr Sanjana Rao, Dr Sean-Patrick Prince, Dr Sirisha Gaddipati, Dr Lynn Feun, Dr Nkiruka Ezenwajiaku, Dr Paul Martin, and Dr Patricia D. Jones discuss treatments for very early– and early-stage HCC and locoregional treatments for intermediate-stage HCC. The authors then focus on systemic therapies for intermediate- and advanced-stage HCC, including recent data on targeted therapies, immunotherapies, and combination immune checkpoint inhibitors. Additionally, the authors discuss emerging monotherapies and combination therapies in various stages of development, novel targets and treatment strategies, treatment following liver transplant, and future directions in HCC management.
Our HCC coverage continues with a column focusing on recent guidelines from the Asian Pacific Association for the Study of the Liver on systemic therapy. In our HCC in Focus column, Professor George Lau discusses why the guidelines were released and how they were developed. He also discusses recommendations for first- and second-line systemic HCC therapy, management of immune-related adverse events, and the use of systemic therapy with ablation or transarterial chemoembolization as well as before and after liver transplant.
In other liver-related coverage this month, our Advances in Hepatology column focuses on cholestatic pruritus. Dr Kimberly Brown discusses the importance and pathophysiology of this condition and how it can be best assessed. Other topics of discussion include traditional treatment options, novel therapeutic agents, therapies in development using different targets, and the remaining research needs in this area.
Cell therapies are explored in this month’s Advances in IBD column. Dr Louis J. Cohen discusses why there has been interest in using this therapeutic approach in inflammatory bowel disease, which types of cells have been studied, the dosing and administration of cell therapies, whether there are safety concerns, and the potential for long-term remission.
Finally, our Advances in Endoscopy column features an interview with Dr Joo Ha Hwang on the use of endoscopy for the detection of intestinal metaplasia and gastric cancer in the United States. His discussion includes the risk of gastric cancer worldwide and in the United States, whether endoscopic screening is indicated for gastric cancer in this country, features of high-quality endoscopic screening examinations, and the role of endoscopy in the management of early gastric cancer.
May this issue provide you with helpful information that you can put to good use in your clinical practice.
Sincerely,
Gary R. Lichtenstein, MD, AGAF, FACP, FACG