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Topic Review
Risk Factors for NAFLD-Related Hepatocellular Carcinoma
Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of the adult population in many developed and developing countries. This spectrum of liver disease ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. The incidence of NASH is projected to increase by up to 56% in the future. There is growing epidemiological evidence that NAFLD has become the fastest-growing cause of hepatocellular carcinoma (HCC) in industrialized countries. The annual incidence of HCC varies between patients with NASH cirrhosis and patients with noncirrhotic NAFLD.
  • 183
  • 23 Nov 2023
Topic Review
Circulating Adaptive Immune Cells in End-Stage Liver Disease
End-stage liver disease (ESLD) from acute liver failure to compensated advanced chronic liver disease and decompensated cirrhosis at different stages (chronic decompensation, acute decompensation with or without acute-on-chronic liver failure) has high disease severity and poor patient outcome. Infection is a common complication in patients with ESLD and it is associated with a high mortality rate. Multiple mechanisms are involved in this marked susceptibility to infections, noticeably the inadequate immune response known as immune paresis, as part of cirrhosis-associated immune dysfunction (CAID). Specifically in the adaptive immune arm, lymphocyte impairments—including inadequate activation, reduced ability to secrete effector molecules and enhanced immune suppressive phenotypes—result in compromised systemic immune responses and increased risk of infections. 
  • 181
  • 08 Aug 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. 
  • 181
  • 06 Nov 2023
Topic Review
Precision Medicine in Inflammatory Bowel Disease
Ulcerative colitis and Crohn’s disease are traditionally defined as the two main subtypes of inflammatory bowel disease. However, a more recent view considers inflammatory bowel diseases (IBDs) as a spectrum of heterogeneous phenotypes with consistent differences in clinical presentation and behaviors, likely explained by differences in underlying pathogenetic mechanisms. The etiology is still elusive, and the suggested pathogenesis is a complex interplay among genetic predisposition and abnormal immune response at the mucosal intestinal level, activated by only partially identified environmental triggers leading to altered intestinal permeability and impaired handling of gut microbiota. The undeniable continuous progress of medical therapy with more frequent shifts from traditional to more advanced modalities also underlines the actual unmet needs. 
  • 180
  • 27 Oct 2023
Topic Review
Risk Stratification in Primary Biliary Cholangitis
Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease with a heterogeneous presentation, symptomatology, disease progression, and response to therapy. The risk stratification assessment, aimed at identifying patients with a higher risk of disease progression, encompasses an in-depth analysis of demographic data, clinical and laboratory findings, antibody profiles, and the evaluation of liver fibrosis using both invasive and noninvasive techniques. Treatment response scores after one year of therapy remain to date a major factor influencing the prognosis of PBC patients. While the initial therapeutic approach with ursodeoxycholic acid (UDCA) is universally applied, new second-line treatment options have recently emerged, with many others under investigation. Consequently, the prevailing one-size-fits-all approach is poised to be supplanted by tailored strategies, ensuring high-risk patients receive the most appropriate treatment regimen from diagnosis.
  • 178
  • 15 Sep 2023
Topic Review
Microwave Ablation Techniques for Pancreatic Lesions
Thermal ablation is increasingly being utilized for the management of solid parenchymal tumors, such as hepatocellular cancer, renal tumors, thyroid nodules, and pulmonary tumors. However, its application in the management of pancreas lesions was delayed due to fears of causing iatrogenic thermal injury to the surrounding organs. The initial success of radiofrequency ablation (RFA) in inoperable pancreatic cancers led to its application in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms (PCLs).
  • 173
  • 15 Nov 2023
Topic Review
Hepatocellular Carcinoma in Non-Fibrotic Liver
Hepatocellular carcinoma (HCC) in a non-fibrotic liver (F0) is considered to be rare, and there is a marked paucity of studies in the literature on this HCC type. A review of the literature shows some important clinical and tumor characteristics: (a) it occurs mainly in young female and elder male patients; (b) clinically, under normal hepatic function, alpha-fetoprotein level is often normal, and there are no risk factors; (c) associated with metabolic disease; (d) macroscopically, single large lesions are noted; and (e) microscopically, the lesions are well-differentiated and encapsulated. Radiological imaging results are straightforward, showing arterial hyperenhancement and later wash-out. The combined use of B-mode and contrast-enhanced (CE) ultrasound (US) is the most reliable and cost-effective diagnostic method. Few peri-and post-operative complications are noted and 5-year survival is not inferior to patients with HCC on fibrosis liver despite the lesion’s large size. Most clinicians believe that HCC is unlikely to occur if patients have no symptoms and normal hepatic function.
  • 172
  • 15 Nov 2023
Topic Review
The Quality of Upper Gastrointestinal Endoscopy
Upper gastrointestinal endoscopy, or EGD, is essential for diagnosing and managing ailments of the upper gastrointestinal tract. The quality of EGD is crucial and carries significant consequences for patient outcomes, the employment of healthcare resources, and the future course of gastroenterology as a medical specialty.
  • 170
  • 28 Dec 2023
Topic Review
Viral Liver Disease and Intestinal Gut–Liver Axis
The intestinal microbiota is closely related to liver diseases via the intestinal barrier and bile secretion to the gut. Impairment of the barrier can translocate microbes or their components to the liver where they can contribute to liver damage and fibrosis.
  • 169
  • 26 Jan 2024
Topic Review
Gene Variants in Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) describes a steatotic (or fatty) liver occurring as a consequence of a combination of metabolic, environmental, and genetic factors, in the absence of significant alcohol consumption and other liver diseases. Many liver disease-related gene variants have been identified from large-scale genome-wide association studies (GWAS).
  • 164
  • 26 Oct 2023
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