The field of endoscopic bariatric and metabolic therapies (EBMTs) is advancing rapidly. This month’s issue of Gastroenterology & Hepatology features an interview in our Advances in Endoscopy column with Dr Shelby A. Sullivan, coauthor of the American Society for Gastrointestinal Endoscopy/European Society of Gastrointestinal Endoscopy guideline on primary EBMTs for adults with obesity. Dr Sullivan highlights the latest developments in the field, including recent changes in reimbursement and insurance coverage of endoscopic sleeve gastroplasty, findings from pivotal studies evaluating devices in the pipeline (such as EndoZip and the Allurion Balloon), and the current role of endoscopic procedures in obesity management. Other topics of discussion include how different EBMTs compare in terms of inducing weight loss, how to manage recurrent weight gain or insufficient weight loss after endoscopic therapy, and how weight loss medications impact endoscopic treatment.
Our feature article this month explores the emerging field of precision medicine in disorders of gut-brain interaction (DGBIs). Dr Brian E. Lacy, Dr Hasan Saleh, and Dr David J. Cangemi explain the goal of precision medicine and how this form of medicine differs from personalized medicine. Additionally, they examine the use of precision medicine in other fields such as oncology and inflammatory bowel disease (IBD), the importance of multiomics for precision medicine in DGBIs, and in which DGBI patients precision medicine would appear to be especially well suited. The authors also discuss how this approach could fit into future clinical practice as well as challenges that remain.
Our Advances in Hepatology column highlights the test-and-treat algorithm using point-of-care testing for hepatitis C virus (HCV) RNA that was recently released by the American Association for the Study of Liver Diseases and Infectious Diseases Society of America. Dr Andrew Aronsohn discusses how and why this algorithm was developed, the effects of point-of-care HCV testing, and the target patients and goals of this streamlined approach, among other topics.
Our Advances in IBD column explores the emerging therapeutic approach of tumor necrosis factor-like ligand 1A (TL1A) inhibition. Along with related issues, Dr Stephan Targan discusses how TL1A compares with tumor necrosis factor, emerging research on the anti-TL1A monoclonal antibodies tulisokibart and afimkibart, the importance of companion diagnostics, and the potential positioning of TL1A inhibition in IBD.
Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is highlighted in our MASH in Focus column. Dr Mazen Noureddin discusses which MASH patients have the greatest risk of progressing to cirrhosis, outcomes of MASH cirrhosis, and noninvasive tests commonly used to assess this condition. Also discussed is research that focuses on different therapeutic approaches in this setting, including resmetirom, efruxifermin, and glucagon-like peptide-1 receptor agonists.
Our Advances in Upper GI Disorders column, authored by Professor Edoardo V. Savarino, examines emerging therapies in the management of eosinophilic esophagitis (EoE). His discussion includes a review of recently approved and emerging swallowed topical corticosteroid preparations, whether bioadhesive agents might be helpful, and which biologics appear most promising for the treatment of EoE.
Finally, Dr Bryan Curtin presents a case of a patient with irritable bowel syndrome with constipation in our Case Study Series section. Additionally, he discusses the objectives of the first patient visit as well as sample questions and answers, key patient factors of individualizing treatment, when and how to conduct a follow-up visit, and long-term strategies for successful outcomes.
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