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Topic Review
Gut Microbiota and NAFLD Development
NAFLD, the most common liver disorder in the Western world, is characterized by intrahepatic lipid accumulation; is highly prevalent in the aging population; and is closely associated with obesity, insulin resistance, hypertension, and dyslipidemia.
  • 525
  • 23 Sep 2022
Topic Review
Endoscopy on Reducing and Preventing Musculoskeletal Injuries
Gastrointestinal (GI) endoscopy forms an important part of the daily practice of a gastroenterologist. Its use and applicability nowadays shift from diagnostic to therapeutic fields, and it forms a significant part of the workload of the GI practitioner. Ergonomics in GI endoscopy plays an important role in occupational injury prevention. Due to a higher volume of procedures, the problem with musculoskeletal injuries is becoming bigger and everyday more present among fellow gastroenterologists.
  • 524
  • 22 Sep 2023
Topic Review
Mechanistic Insights into Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by eosinophilic infiltration of the esophagus. It arises from a complex interplay of genetic predisposition (susceptibility loci), environmental triggers (allergens and dietary antigens), and a dysregulated immune response, mainly mediated by type 2 T helper cell (Th2)-released cytokines, such as interleukin (IL)-4, IL-5, and IL-13.
  • 523
  • 27 Dec 2023
Topic Review
Esophageal Mucosal Resistance in Reflux Esophagitis
Gastroesophageal reflux disease (GERD) has the highest prevalence among diseases of the digestive system and is characterized by a significant decrease in patients’ quality of life, comparable to arterial hypertension and coronary heart disease. One in every ten cases of reflux esophagitis leads to the formation of Barrett’s esophagus, which is associated with a high risk of esophagus adenocarcinoma. The key factors determining the progression of the disease are the frequency and duration of the reflux of the stomach’s contents. As a result, refluxate, which includes hydrochloric acid, pepsin, and, in the case of concomitant duodeno-gastric reflux, bile acids and lysolecithin, is thrown into the overlying sections of the digestive tract.
  • 520
  • 21 Aug 2023
Topic Review
Appetite Regulation and Bariatric Surgery
Obesity remains a common metabolic disorder and a threat to health as it is associated with numerous complications. Lifestyle modifications and caloric restriction can achieve limited weight loss. Bariatric surgery is an effective way of achieving substantial weight loss as well as glycemic control secondary to weight-related type 2 diabetes mellitus.
  • 519
  • 27 May 2024
Topic Review
Tyrosine Kinase Inhibitors in BCLC-B Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) represents an entity of poor prognosis, especially in cases of delayed diagnosis. Tyrosine kinase inhibitors (TKIs) have multiple anti-tumor effects and are widely used in several types of cancers. They down-regulate different molecular pathways that take part in carcinogenesis. The primary targets are the tyrosine kinase receptors (RTKs), key proteins that regulate cancer growth and metastasis. Specifically, TKIs block the phosphorylation of tyrosine kinases and the subsequent signaling pathways, slowing down cancer growth. Some of the inhibited networks are the rat sarcoma (RAS)/mitogen-activated protein kinases (MAPKs), phosphoinositide 3-kinase (Pi3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR), phospholipase C (PLC)/Ca2+/calmodulin-dependent protein kinase-protein kinase C (CaMK-PKC), Janus kinase (JAK)/signal transducer and activator of transcription protein family (STAT), epidermal growth factor receptor (EGFR), vascular endothelial growth factor receptor (VEGFR), fibroblast growth factor receptor (FGFR), platelet-derived growth factor receptor (PDGFR), hepatocyte growth factor receptor (HGFR, Met), and RAF kinases. Due to their multiple actions, TKIs were the standard treatment of care in advanced HCC over the last 15 years, but after the induction of IO, they now comprise the second-line option.
  • 514
  • 27 Dec 2023
Topic Review
Endoscopic Salvage of Gastrointestinal Anastomosis Leaks
Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. 
  • 512
  • 07 Oct 2023
Topic Review
Pancreatic Neuroendocrine Tumors and Management
The growing importance of advanced endoscopy in the diagnosis and treatment of pancreatic neuroendocrine neoplasms (PanNETs) necessitates a comprehensive understanding of various biochemical markers, genetic testing methods, radiological techniques, and treatment approaches that encompass multiple disciplines within and beyond gastrointestinal oncology.
  • 504
  • 16 Aug 2023
Topic Review
New Scenarios of Systemic Therapy for Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is the fifth neoplasm in the world and the fourth leading cause of death from cancer. Treatment options for early stage HCC include potentially curative techniques such as liver transplantation (LT), liver resection (LR) and radiofrequency ablation (RFA). The advent of immunotherapy in HCC treatment has significantly improved the rate of response to systemic therapy and could offer the rationale for adjuvant and/or neoadjuvant therapeutic schemes also in the management of liver neoplasms. 
  • 492
  • 07 Jun 2023
Topic Review
Non-Alcoholic Fatty Liver Disease Patients
Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of disorders ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). Hepatic steatosis may result from the dysfunction of multiple pathways and thus multiple molecular triggers involved in the disease have been described. The development of NASH entails the activation of inflammatory and fibrotic processes. Furthermore, NAFLD is also strongly associated with several extra-hepatic comorbidities, i.e., metabolic syndrome, type 2 diabetes mellitus, obesity, hypertension, cardiovascular disease and chronic kidney disease. Due to the heterogeneity of NAFLD presentations and the multifactorial etiology of the disease, clinical trials for NAFLD treatment are testing a wide range of interventions and drugs, with little success. A review is given to the different phenotypic characteristics of NAFLD patients, whose disease may be triggered by different agents and driven along different pathophysiological pathways. Thus, correct phenotyping of NAFLD patients and personalized treatment is an innovative therapeutic approach that may lead to better therapeutic outcomes.
  • 490
  • 14 Jul 2023
Topic Review
The Role of Cholangioscopy in Biliary Diseases
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). 
  • 489
  • 25 Sep 2023
Topic Review
Inflammatory Bowel Disease and Adverse Pregnancy Outcomes
Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. IBD can affect women of reproductive age aspiring for a safe pregnancy. Effective disease control before conception is vital to improve fertility and ensure a healthy pregnancy, thus reducing potential flare-ups. Continuation of IBD treatments during pregnancy and breastfeeding is generally viewed as safe, emphasizing the importance of thorough disease management for both mother and child.
  • 488
  • 05 Jan 2024
Topic Review
Role of Intestinal Microbiota in Celiac Disease Pathogenesis
The intestinal microbiota contributes to maintaining the integrity of the intestinal barrier, preventing the formation of a “leaky” intestine. On the contrary, a change in the composition of the microbiota can act as a significant link in the pathogenesis of gluten intolerance and exacerbate the course of the disease. The possibility of modulating the composition of the microbiota by prescribing probiotic preparations is being considered. The effectiveness of the use of probiotics containing Lactobacillus and Bifidobacterium bacteria in experimental and clinical studies as a preventive and therapeutic agent has been documented.
  • 487
  • 19 Jan 2024
Topic Review
Endoscopic Ultrasound-Guided Chemoablative Techniques for Pancreatic Cystic Lesions
Pancreatic cystic lesions (PCLs) are known precursors to pancreatic cancer, one of the deadliest types of cancer worldwide. Surgical removal or pancreatectomies remain the central approach to managing precancerous high-risk PCLs. Endoscopic ultrasound (EUS)-guided therapeutic management of PCLs is a novel management strategy for patients with prohibitive surgical risks. Various ablation techniques have been explored utilizing EUS-guided fine needle injection (FNI) of alcohol and chemotherapeutic agents.
  • 484
  • 14 Jul 2023
Topic Review
Artificial Intelligence in Polyp Detection
There has been an exponential rise in the availability of artificial intelligence systems in endoscopy. As a result, maintaining an informed understanding of the utility and efficacy of existing systems has become increasingly complex. 
  • 484
  • 06 Nov 2023
Topic Review
Role of Nutrition in Alcoholic Liver Disease
Alcoholic liver disease (ALD) has different stages as it develops, and the severity of ALD is correlated with malnutrition.
  • 482
  • 25 Apr 2023
Topic Review
Gut–Brain Axis, Microbiota and Probiotics
Irritable bowel syndrome (IBS) is a relatively common digestive disorder. It is estimated that IBS has a prevalence of 10–15% in the general population in industrialized countries and is a factor with a significant impact on both the individual and society in terms of quality of life and health care costs. Depending on symptomatology, comorbidities, quality of life and healthcare needs, IBS can have a mild, moderate, or severe clinical course. Some studies have shown that the severe form occurs in 15–40% of patients with IBS.
  • 468
  • 05 Dec 2023
Topic Review
Pancreatic Walled-off Necrosis Management
Necrotizing pancreatitis is a complex clinical condition burdened with significant morbidity and mortality. In recent years, the huge progress of interventional endoscopic ultrasound (EUS) has allowed a shift in the management of pancreatic necrotic collections from surgical/percutaneous approaches to mini-invasive endoscopic internal drainage and debridement procedures. The development of lumen-apposing metal stents (LAMSs), devices specifically dedicated to transmural EUS interventions, further prompted the diffusion of such techniques.
  • 468
  • 27 Feb 2024
Topic Review
Surveillance and Diagnosis of NAFLD-Related Hepatocellular Carcinoma
With the significant achievements in eradicating the hepatitis C virus by direct-acting antiviral agents and the rising epidemic of obesity, diabetes mellitus, and metabolic syndrome, there is a paradigm shift in the leading cause of liver cirrhosis and cancer to nonalcoholic fatty liver disease (NAFLD). Data highlight the rapidly rising incidence of NAFLD-related hepatocellular carcinoma (HCC) worldwide and expose the unseen part of the iceberg. NAFLD-related HCC has some characteristic features that distinguish it from other etiologies such as HBV and HCV, which makes its diagnosis and management more complicated. 
  • 467
  • 25 Sep 2023
Topic Review
Low-Dose Alcohol Consumption on Chronic Liver Disease
Although alcohol is one of the most important etiologic agents in the development of chronic liver disease worldwide, also recognized as a promoter of carcinogenesis, several studies have shown a beneficial effect of moderate consumption in terms of reduced cardiovascular morbidity and mortality. Whether this benefit is also present in patients with liver disease due to other causes (viral, metabolic, and others) is still debated. Although there is no clear evidence emerging from guidelines and scientific literature, total abstention from drinking is usually prescribed in clinical practice.
  • 466
  • 06 Mar 2024
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