PURPOSE OF REVIEW:Historically, enteral nutrition has been the preferred therapy due to its physiologic benefits, with parenteral nutrition selected if enteral nutrition was contraindicated or insufficient; however, recent advances in nutrition support have prompted reevaluation of this process. This review summarizes the current evidence regarding enteral nutrition and parenteral nutrition in gastrointestinal oncology, inflammatory bowel disease (IBD), critical care, and gastrointestinal surgery. RECENT FINDINGS:In gastric cancer, parenteral nutrition may improve the nutritional status and clinical outcomes of treatment-related gastrointestinal dysfunction. In IBD, exclusive enteral nutrition may be effective for inducing remission and promoting mucosal healing, whereas parenteral nutrition is preferred in intestinal failure and severe complications. Studies have shown the value of early parenteral nutrition when enteral nutrition is contraindicated or insufficient, specifically for improving nutrient delivery and reducing complications in critically ill and surgical patients. Additional areas of interest include caloric and protein dosing, indirect calorimetry, and the effect of nutrition support on the gut microbiome. SUMMARY:Current evidence supports a patient-centered approach to nutrition support with enteral nutrition remaining as the preference when the gastrointestinal tract can be utilized and parenteral nutrition as an important alternative or adjunct in select populations. Future research should focus on the refinement of supplemental parenteral nutrition practices and the development of evidence-based approaches for specific disease states.
PURPOSE OF REVIEW:Purpose of the review is provision of an up-to-date literature review on the growing importance of endoscopy in neurogastroenterology and its limitations. RECENT FINDINGS:Traditionally, the diagnostic role of endoscopy in neurogastroenterology lies in the initial suspicion of motility disorders and exclusion of important differential diagnoses. Endoscopy may serve also as a carrier for positioning examination devices such as the Bravo reflux-capsule to proof gastroesophageal reflux or the endoluminal functional lumen imaging probe (EndoFLIP). New interesting aspects are the resection-based and biopsy-based extraction of tissue for examination of the enteric nervous system by the full thickness resection device (FTRD) to detect structural gastrointestinal neuromuscular lesion and confocal laser endomicroscopy (CLE) to investigate potential correlations for food intolerance. Effectiveness of endoscopic therapy is dependent on whether the measured circumscribed dysfunction correlates with the symptoms and explains them. This is the case in esophageal achalasia and hypercontractile motility disorders. However, in gastropareses, the significance of endoscopic therapy is limited because of its complex pathophysiology. SUMMARY:There is an emerging role of endoscopy in neurogastroenetrology. However, effectiveness of endoscopic therapy is dependent on careful patient selection and evidence of a circumscribed dysfunction that correlates with the symptoms and explains them.
Purpose of review Eosinophilic esophagitis (EoE) is a chronic, type 2 inflammatory disease with a rapidly rising incidence and is a leading cause of solid-food dysphagia in young adults. While diagnosis has traditionally relied on esophageal eosinophilia, the central role of eosinophils in driving symptoms and disease activity has been increasingly questioned, as several non or low-eosinophilic EoE variants have recently been characterized. This review summarizes the current understanding of these emerging entities and their position within the EoE spectrum. Recent findings Current concepts support EoE as a Th2-mediated, multicellular disorder driven by genetic susceptibility, epithelial barrier dysfunction, and allergen-induced immune responses. Three EoE variants (EoE-like esophagitis, lymphocytic esophagitis, and nonspecific esophagitis) present with EoE-typical symptoms but fall below the diagnostic eosinophil threshold. Molecular and longitudinal data reveal distinct yet overlapping inflammatory signatures and demonstrate dynamic transitions between phenotypes, including progression to classical EoE in a subset of patients. Summary EoE variants demonstrate that clinically meaningful esophageal inflammation and structural remodeling can occur in the absence of significant tissue eosinophilia. Recognition of these entities has direct implications for biopsy strategy, histologic assessment beyond peak eosinophil counts, structured longitudinal monitoring and therapy to prevent fibrostenotic complications.
PURPOSE OF REVIEW:Colorectal polyps can be removed using cold or hot snare techniques, which differ primarily in their use of electrocautery, safety profile, and depth of resection. This review summarizes current evidence comparing cold and hot snare resection and provides a practical framework for technique selection. RECENT FINDINGS:Recent guidelines and randomized trials support cold snare polypectomy (CSP) for polyps 10 mm or less because of its favorable safety profile and low risk of delayed bleeding. For 10-19 mm lesions, technique selection should be guided by histology and morphology, with hot snare polypectomy (HSP) favored for pedunculated, bulky, fibrotic, or high-risk adenomatous lesions and CSP or cold EMR increasingly supported for nondysplastic sessile serrated lesions. For large adenomatous polyps at least 20 mm, in which advanced histology is more common, hot EMR with margin treatment remains standard, where as cold EMR reduces thermal injury at the cost of higher recurrence. SUMMARY:CSP is preferred for most diminutive and small polyps, while larger lesions require individualized selection according to histology, morphology, invasion risk, and the need for durable eradication. The goal is to choose the least injurious technique that still achieves complete and reliable resection. Long-term data are needed to define recurrence and subsequent colorectal cancer risk after different resection strategies.
