Although treatment of Barrett’s esophagus by endoscopic resection or radiofrequency ablation (RFA) is well established, the long-term outcomes of these endoscopic procedures has yet to be fully investigated. A nationwide cohort study in the Netherlands now shows that RFA with or without endoscopic resection is highly effective at treating Barrett’s-related neoplasia, with a very low risk of recurrence. The authors conclude that lenient follow-up intervals may be sufficient, and that the value of random biopsies is questionable for follow-up care (van Munster et al.). Immunotherapy with checkpoint inhibitors is increasingly being used to treat gastrointestinal cancer in addition to other malignancies. These drugs are of particular value for advanced esophageal squamous-cell carcinoma, as they resulted in significantly longer overall survival in a phase 3 study on first-line therapy with nivolumab plus chemotherapy or nivolumab plus ipilimumab versus chemotherapy alone (Doki et al.). However, it has been proposed for many years that the effectiveness of immunotherapy may be dependent on the gut microbiota. A recent study combines a translational animal model with a retrospective analysis of patients with non-small cell lung cancer. The results of this study suggest that infection with Helicobacter pylori may have a very negative impact on the efficacy of immunotherapy with checkpoint inhibitors. Hence, H. pylori serology may represent a future biomarker for personalized treatment decisions (Oster et al.). [...]
On the other hand, the gut microbiota naturally represents a major target for treating intestinal disorders, with several studies reporting the successful application of fecal microbiota transplantation (FMT) to treat ulcerative colitis. However, the use of frozen donor stool requires complex logistics. A pilot study in patients with ulcerative colitis has now demonstrated that FMT using lyophilized/freeze-dried stool can lead to significantly higher rates of corticosteroid-free clinical remission with endoscopic response versus placebo after 8 weeks (Haifer et al.). A different approach was taken for treating Clostridioides difficile infection (CDI): Firmicutes spores administered for only 3 days greatly reduced the risk of recurrence versus placebo (Feuerstadt et al.). The gut microbiota also appears to influence the risk of anti-drug antibody (ADA) formation in patients with inflammatory bowel disease receiving anti-tumor necrosis factor antibody therapy. In an Israeli cohort, prior treatment with cephalosporins or penicillins plus beta-lactamase inhibitors was associated with an elevated risk of developing ADA. Conversely, this risk was reduced following treatment with macrolides or fluoroquinolones (Gorelik et al.). These studies highlight the fact that interactions between the host and the intestinal microbiome can have a wide range of effects on other diseases and their treatment, and hence more research is needed into this phenomenon.
Metabolic syndrome (MetS) represents an important risk factor for cancer. A nationwide cohort study in the Republic of Korea now reports that MetS is also associated with a greater risk of developing pancreatic cancer. However, this risk could be reduced when MetS is successfully treated or reversed (Park et al.).
Non-alcoholic fatty liver disease (NAFLD) is linked to other components of MetS. A recent meta-analysis has shown that NAFLD is also associated with a 1.45-fold greater long-term risk of stage ≥ 3 chronic kidney disease, a risk that was independent of age, sex, obesity, hypertension, diabetes, and other conventional risk factors for chronic kidney disease. Accordingly, kidney function should be monitored in NAFLD patients and nephrological care should be initiated as early as possible when indicated (Mantovani et al.). A new population-based study from the US reports that while pregnancy in women with autoimmune hepatitis (AIH) has a favorable prognosis (no association with increased maternal or perinatal mortality), it is linked to serious complications such as gestational diabetes, hypertensive complications (pre-eclampsia, eclampsia, and HELLP syndrome [hemolysis, elevated liver enzymes, and low platelets]) or preterm birth. These findings emphasize the importance of close interdisciplinary collaboration in the care of pregnant AIH patients (Wang et al.). In a recent meta-analysis, the prevalence of sarcopenia among cirrhosis patients was nearly 40%, with sarcopenia greatly increasing their mortality risk. These findings underscore the importance of adequate nutrition and exercise for individuals with cirrhosis (Tantai et al.).
We hope you find the literature selection in this issue of the Falk Gastro Review Journal inspiring and engaging!
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinic of Freiburg (Germany)