This month’s issue of Gastroenterology & Hepatology explores a wide array of current and emerging nonmedical approaches to the treatment of disorders of gut-brain interaction (DGBIs) such as irritable bowel syndrome and functional dyspepsia. In a feature article, Dr Elyse R. Thakur, Ms Kate Scarlata, Dr Brennan Spiegel, and Dr David J. Hass discuss the biopsychosocial framework for DGBIs and how to select potential candidates for integrative and nutrition interventions for DGBIs. The authors discuss recent research on brain-gut behavior therapies, nutrition interventions such as the Mediterranean diet, dietary supplements such as peppermint oil, and pelvic floor physical therapy and biofeedback. Other approaches discussed include meditative movement interventions such as yoga and tai chi, acupuncture, massage therapy, and virtual reality.
Our other feature article focuses on menopause in patients who have inflammatory bowel disease (IBD). Dr Dhruvi Shah, Dr Jana Karam, Ms Angelina Hao, Dr Chrisandra Shufelt, and Dr Jami Kinnucan examine the hormonal and immunologic effects of menopause as well as its impact on the gut microbiome. The authors also highlight important considerations in postmenopausal women with IBD involving skeletal health, cardiovascular and thromboembolic risk, cancer and medication-associated risks, and neuropsychiatric well-being. Additionally, the authors discuss the effects of hormonal therapy on the activity and incidence of IBD and propose a patient-centered management framework for clinicians.
In other IBD coverage, our Advances in IBD column examines the management of IBD in pediatric and adolescent patients with the use of therapies approved for adults. As Dr Michael D. Kappelman notes, there are limited therapeutic options currently approved for pediatric and adolescent patients with IBD. He discusses extrapolation, when adult IBD drugs should be considered in children and adolescents, who should be involved in the decision-making process, the monitoring of children and adolescents using adult drugs, and questions that remain.
Our Advances in Endoscopy column features an interview with Dr Mohammad Bilal on endoscopic submucosal dissection (ESD) innovations. He discusses which recent innovations have had the most impact on ESD performance and compares commercial traction systems with self-made ones. Commercial traction systems for ESD are used to improve visualization of the submucosal layer, enable faster dissection, and reduce complications such as perforation. These systems typically involve specialized devices to create tension, acting as a “second hand” to lift or pull the lesion away from the muscle layer. His discussion also focuses on advances in knives, the integration of digital imaging tools, and the future of ESD.
Our Advances in Upper GI Disorders column investigates the relationship between Helicobacter pylori infection and gastroesophageal reflux disease (GERD). Dr Nimish Vakil discusses which patients with GERD should undergo H pylori testing and whether H pylori infection should always be treated in GERD patients. Additionally, he discusses whether GERD impacts H pylori treatment, if H pylori eradication affects GERD symptoms, and whether there is a relationship between H pylori infection and Barrett esophagus/esophageal adenocarcinoma.
The role of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatocellular carcinoma (HCC) is explored in our HCC in Focus column. Dr Yuko Kono discusses when CEUS is currently being used for HCC diagnosis, its specificity and sensitivity, and its limitations compared with computed tomography and magnetic resonance imaging. Other topics of discussion include the cost and reimbursement of contrast and possible side effects, the examination protocol for using CEUS to diagnose HCC, and adoption of CEUS in the United States.
Finally, our Advances in Hepatology column centers on innovations in the field of liver transplant. Dr Marina Serper discusses the concept of liver organoids, the potential use of gene editing such as CRISPR (clustered regularly interspaced short palindromic repeats), and the status of pig-to-human liver xenotransplant as well as robotic liver transplant. She also discusses emerging applications of artificial intelligence in liver transplant and the challenges of incorporating advances into clinical practice.
May this issue provide you with helpful information that you can put to good use in your clinical practice.
Sincerely,
Gary R. Lichtenstein, MD, FACG, AGAF, FCCF, FACP