This narrative review aims to describe the current state of real-time AI-assisted detection and characterization of GI neoplasia across upper endoscopy and colonoscopy, with a focus on studies using video-based or live endoscopic settings. Across all GI settings, real-time AI systems have demonstrated high standalone diagnostic accuracy — achieving high sensitivity and specificity depending on the indication and training set. For upper endoscopy, computer-aided detection (CADe) systems allowed to reduce neoplasia missing rates and improved non-expert performance to expert level in early gastric cancer, esophageal squamous cell and Barrett’s esophagus related neoplasms. As for computer-aided diagnosis (CADx) tools, the prediction of invasion depth upon lesion assessment shows promising accuracy, but performance remains modest for all upper GI neoplasias. In randomized trials, CADe colonoscopy has been associated with approximately a 20
This review aims to examine evidence-based nutrition management strategies across the continuum of disease in patients with recurrent acute pancreatitis (RAP), a population characterized by repeated inflammatory episodes, cumulative nutritional decline, and increased risk of progression to chronic pancreatitis (CP). It addresses key questions regarding optimal timing and delivery of nutrition support, as well as the identification and treatment of exocrine pancreatic insufficiency (EPI), gastrointestinal complications, metabolic derangements, and micronutrient deficiencies. Although current evidence demonstrates reduced infectious complications and improved clinical outcomes with early enteral nutrition in AP, important gaps persist regarding nutritional management between recurrent episodes. Across recurrent episodes, cumulative effects of EPI, persistent gastrointestinal symptoms, and metabolic derangements may contribute to progressive malnutrition, sarcopenia, and declining quality of life. Recognition of EPI during and after AP has increased; however, recurring pancreatic injury in RAP places patients at particularly high risk for persistent or progressive exocrine and endocrine dysfunction necessitating ongoing surveillance and optimization of PERT. Repeated inflammatory events may accelerate structural pancreatic damage and progression toward CP, underscoring the need for early identification and treatment of nutritional complications. Overall, nutritional management is a critical, yet underdeveloped component of RAP care. Future research and stronger study designs are necessary to understand how nutritional management of RAP impacts the frequency and severity of recurrent attacks. No potential conflicts of interest relevant to this article were reported.
Esophageal disorders of gut–brain interaction (e-DGBIs), including functional heartburn, reflux hypersensitivity, functional chest pain, globus, and functional dysphagia, are characterized by chronic esophageal symptoms in the absence of structural, inflammatory, or major motor abnormalities. Esophageal hypersensitivity represents the unifying pathophysiologic mechanism across these conditions. This review outlines the current approaches to managing esophageal DGBI, emphasizing both evidence-based treatments and emerging therapeutic options. Emerging therapeutic strategies include novel neuromodulators such as pregabalin and low-dose naltrexone, noninvasive neuromodulation techniques including transcranial magnetic stimulation, and microbiome-targeted interventions. Digital therapeutics and artificial intelligence–supported collaborative care models represent promising approaches to scale evidence-based treatment delivery. Management of e-DGBIs requires a patient-centered approach that prioritizes the therapeutic relationship between the provider and the patient, early introduction of the brain–gut model, and multidisciplinary collaboration. Pharmacologic neuromodulation remains the cornerstone of therapy, with tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin–norepinephrine reuptake inhibitors demonstrating efficacy across the different e-DGBIs. For reflux hypersensitivity, proton pump inhibitors and potassium-competitive acid blockers may reduce symptom-triggering reflux events, while antireflux surgery and endoscopic interventions may benefit carefully selected patients. Brain–gut behavioral therapies, particularly cognitive behavioral therapy and gut-directed hypnotherapy, have shown meaningful improvements in symptom severity and quality of life in patients with functional heartburn, functional chest pain, and globus. Future progress will depend on rigorous randomized controlled trials and translational research to develop personalized treatment algorithms that incorporate genetic, microbial, and neurophysiologic biomarkers.
Structured exercise (SE) and physical therapy (PT) are integral components of disease management. Older adults with inflammatory bowel disease (IBD) represent a growing proportion of patients, and are at disproportionate risk of functional decline due to the combined effects of aging, chronic inflammation, malnutrition, and inactivity. Despite the well-established benefits of SE and PT, most gastroenterologists report feeling inadequately equipped to counsel and refer patients with physical function limitations, and thus these therapies remain underutilized. The purpose of this review is to synthesize the existing evidence and provide practical, actionable guidance for gastroenterologists to incorporate SE and PT into IBD care. Initial studies suggest complementary SE and PT may significantly improve IBD-related musculoskeletal extraintestinal manifestations (EIMs), such as joint pain, fatigue, sarcopenia, frailty, and improve exercise confidence as compared with standard care alone. Additionally, multimodal prehabilitation strategies may significantly reduce severe postoperative complications and shorten hospital stays in older patients undergoing IBD-related surgery. SE and PT are low-cost, low-risk interventions with benefits spanning multiple domains of physical function and morbidity in older adults with IBD. This article highlights pertinent SE and PT literature in the aging IBD population, including underlying pathophysiology, interventions, and scope of practice. Gastroenterologists are provided evidence-based, condition-specific assessments and PT referral pathways that can be implemented in routine practice. Integrating this into the multidisciplinary IBD care team may improve patients’ physical function and quality of life. Older adults with IBD are at disproportionate risk of functional decline due to chronic inflammation, malnutrition, and EIMs, which can accelerate frailty in this population. Structured exercise and physical therapy are low-cost and low-risk interventions that meaningfully improve function, symptoms, and quality of life in older adults with IBD, yet remain underused in routine care. Evidence supports the use of structured exercise and physical therapy across multiple domains including fatigue, arthropathy, pelvic floor dysfunction, bone loss, and perioperative outcomes. Gastroenterologists can implement condition-specific screening to trigger targeted PT referral pathways, particularly for older adults with identified functional deficits or frailty. Intervening before overt frailty or disability across the IBD lifespan may alter trajectory and improve long-term outcomes.
With the rising age of the population worldwide, the burden on healthcare and inpatient medicine will substantially increase. In these patients, gastrointestinal conditions are frequently the reason for their admission or prolonged hospitalization. This review provides a pragmatic approach to the most common gastrointestinal conditions affecting hospitalized older patients including gastrointestinal bleeding, dysphagia, constipation, and diarrhea. Older adult patients can have atypical presentations of gastrointestinal disorders. Recognition of special signs and symptoms is important to prevent morbidity and mortality. Importantly, these patients can be complex. As patients age, they have more co-morbidities and take more medications. The interplay between this and their functional status, quality-of-life, and goals-of-care is of paramount importance. The decision to proceed with medical therapy, endoscopy, or surgery requires a thoughtful risk-benefit assessment. An overarching principle is that the ideal management of these patients requires consideration of the multiple factors prevalent in this population: co-morbidities, polypharmacy, functional status, frailty, and goals-of-care. The older adult population is heterogeneous, and treatment should be tailored based on weighing all these factors.
