Frontiers in Gastroenterology is delighted to present the ‘Reviews in’ article collection. 'Reviews in Frontiers in Gastroenterology' will publish high-quality scholarly review papers on key topics in gastroenterology. It aims to highlight recent advances in the field, whilst emphasizing important directions and new possibilities for future inquiries. We anticipate the research presented will promote discussion in the community that will translate to best practice applications in clinical, public health and policy settings. The 'Reviews in Frontiers in Gastroenterology' collection welcomes full-length, mini or systematic review papers. New articles will be added to this collection as they are published.

Golestan University of Medical Sciences

Center for Discovery and Innovation, Hackensack Meridian Health

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Therapy in Gastroenterology

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Reviews in Frontiers in Gastroenterology 2024

Cirrhotic ascites refers to the accumulation of fluid in the peritoneal cavity due to severe liver disease and impaired liver function, which leads to poor blood circulation in the body, increased pressure in the hepatic sinus wall, and the exudation of fluid from the plasma into the peritoneal cavity. Cirrhotic ascites is a common complication of cirrhosis and poses a threat to the health and lives of modern people, causing a heavy social burden worldwide. So far, there are no effective treatment methods available to improve the quality and quantity of life for patients and their partners; existing drugs can only alleviate the symptoms of cirrhotic ascites and slow down its progression. This article aims to carefully examine the pathogenesis of cirrhotic ascites by exploring various contributing factors such as portal hypertension, renal dysfunction, inflammation, growth factors, oxidative stress, immunocytes, and gut microbiota. The purpose is to gain better insights and deeper understanding of the mechanisms involved in this condition.

Cirrhotic ascites refers to the accumulation of fluid in the peritoneal cavity due to severe liver disease and impaired liver function, which leads to poor blood circulation in the body, increased pressure in the hepatic sinus wall, and the exudation of fluid from the plasma into the peritoneal cavity. Cirrhotic ascites is a common complication of cirrhosis and poses a threat to the health and lives of modern people, causing a heavy social burden worldwide. So far, there are no effective treatment methods available to improve the quality and quantity of life for patients and their partners; existing drugs can only alleviate the symptoms of cirrhotic ascites and slow down its progression. This article aims to carefully examine the pathogenesis of cirrhotic ascites by exploring various contributing factors such as portal hypertension, renal dysfunction, inflammation, growth factors, oxidative stress, immunocytes, and gut microbiota. The purpose is to gain better insights and deeper understanding of the mechanisms involved in this condition.

Recent insights into contributing factors in the pathogenesis of cirrhotic ascites

Climate change and liver disease: a mini review

Background and aimsChronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are leading causes of liver-related morbidity and mortality. The interaction between these two disease processes is poorly defined and the impact of NAFLD on HBV-related cirrhosis and HCC remains unclear. The aim of this study was to evaluate the impact of NAFLD on response to antiviral CHB therapy to inform the debate on changing CHB treatment thresholds for these comorbid patients.</sec>MethodsStudies with a minimum of 50 adult CHB patients on nucleoside analogue therapy with or without concurrent NAFLD were identified from PubMed/Medline and EMBASE to February 21, 2023. Data extraction from each study included HBeAg and treatment status, diagnostic method of NAFLD, frequency of monitoring intervals, patient age, gender, grade of hepatic steatosis, BMI and metabolic comorbidities. The outcomes of interest, complete virological response (CVR), biochemical response (BR) and HBeAg loss/seroconversion, were recorded at each available monitoring interval. Comparing CHB-NAFLD and CHB-only groups, pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using random- or fixed-effects models depending on heterogeneity.</sec>ResultsFrom a search of 470 citations, we identified 32 potentially relevant papers. Overall, 11 studies, comprising 2580 unique patients, met the inclusion criteria of the meta-analysis. CHB-NAFLD patients exhibited significantly lower rates of CVR compared to CHB-only patients. This was demonstrated by an OR of 0.59 (0.38-0.93, p=0.001, I2 = 72%) at 12 months, which tapered off to an OR of 0.67 (0.48-0.95, p=0.02) at 60 months. CHB-NAFLD patients also exhibited significantly lower rates of BR compared to CHB-only patients, as demonstrated by ORs of 0.39 (0.24-0.62, p<0.0001, I2 = 53%) at 12 months and 0.33 (0.17-0.63, p=0.0008) at 24 months.</sec>ConclusionPatients with concurrent CHB and NAFLD experience delayed CVR to antiviral therapy and more persistent biochemical abnormalities in comparison to patients with CHB only. This supports the argument for earlier antiviral therapy in order to avert CHB complications in these multi-morbid patients, as the global disease burden of NAFLD continues to increase.</sec>

Background and aims: Chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are leading causes of liver-related morbidity and mortality. The interaction between these two disease processes is poorly defined and the impact of NAFLD on HBV-related cirrhosis and HCC remains unclear. The aim of this study was to evaluate the impact of NAFLD on response to antiviral CHB therapy to inform the debate on changing CHB treatment thresholds for these comorbid patients.Methods: Studies with a minimum of 50 adult CHB patients on nucleoside analogue therapy with or without concurrent NAFLD were identified from PubMed/Medline and EMBASE to February 21, 2023. Data extraction from each study included HBeAg and treatment status, diagnostic method of NAFLD, frequency of monitoring intervals, patient age, gender, grade of hepatic steatosis, BMI and metabolic comorbidities. The outcomes of interest, complete virological response (CVR), biochemical response (BR) and HBeAg loss/seroconversion, were recorded at each available monitoring interval. Comparing CHB-NAFLD and CHB-only groups, pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using random- or fixed-effects models depending on heterogeneity.Results: From a search of 470 citations, we identified 32 potentially relevant papers. Overall, 11 studies, comprising 2580 unique patients, met the inclusion criteria of the meta-analysis. CHB-NAFLD patients exhibited significantly lower rates of CVR compared to CHB-only patients. This was demonstrated by an OR of 0.59 (0.38-0.93, p=0.001, I2 = 72%) at 12 months, which tapered off to an OR of 0.67 (0.48-0.95, p=0.02) at 60 months. CHB-NAFLD patients also exhibited significantly lower rates of BR compared to CHB-only patients, as demonstrated by ORs of 0.39 (0.24-0.62, p&lt;0.0001, I2 = 53%) at 12 months and 0.33 (0.17-0.63, p=0.0008) at 24 months.Conclusion: Patients with concurrent CHB and NAFLD experience delayed CVR to antiviral therapy and more persistent biochemical abnormalities in comparison to patients with CHB only. This supports the argument for earlier antiviral therapy in order to avert CHB complications in these multi-morbid patients, as the global disease burden of NAFLD continues to increase.

The co-existence of NAFLD and CHB is associated with suboptimal viral and biochemical response to CHB antiviral therapy: a systematic review and meta-analysis

Colon capsule endoscopy (CCE) has been demonstrated to be comparable to traditional colonoscopy and better than CT colonography (CTC) for the detection of colonic pathology. It has been shown to have a high incremental yield after incomplete colonoscopy. It is a safe test with good patient acceptability. Challenges currently include great variability in completion rates and high rates of re-investigation. In this review, we will discuss the evidence to date regarding CCE in symptomatic and surveillance populations, and in those post incomplete colonoscopy. We will discuss current challenges faced by CCE and areas for further research.

Colon capsule endoscopy (CCE) has been demonstrated to be comparable to traditional colonoscopy and better than CT colonography (CTC) for the detection of colonic pathology. It has been shown to have a high incremental yield after incomplete colonoscopy. It is a safe test with good patient acceptability. Challenges currently include great variability in completion rates and high rates of re-investigation. In this review, we will discuss the evidence to date regarding CCE in symptomatic and surveillance populations, and in those post incomplete colonoscopy. We will discuss current challenges faced by CCE and areas for further research.