Editorial
Dear colleagues,
One major prerequisite for personalized medicine strategies in gastroenterology is the development and validation of biomarkers for disease prognosis and response to treatment. In the case of Crohn’s disease, the first prospective study (PROFILE) of a promising biomarker for gene expression in cytotoxic T cells in peripheral blood showed that the biomarker has no value in routine clinical practice. Yet, the study was able to impressively prove that, after an initial diagnosis of Crohn’s disease, early combination therapy consisting of infliximab and a thiopurine (top down) is clearly superior to conventional escalation (step up) (Noor et al.). It may, however, be possible to infer indications of responses to treatment using biomarkers from fecal tests. Using the characterization of dysbiosis, stool moisture and calprotectin, it was possible to predict response to treatment with biologics with an accuracy of 73.9% in a prospective cohort of patients with inflammatory bowel disease (Caenepeel et al.). But biomarkers are also urgently needed for early forecasting of the course of acute pancreatitis. Here, too, the gut flora appears to play a role – in a multicenter study, the composition of the oral-intestinal microbiota was thus better able to predict the severity of acute pancreatitis than conventional risk scores. Short-chain fatty acids, in particular, may be relevant for future diagnostic and treatment strategies (Ammer-Herrmenau et al.). [...]
Endoscopic ultrasonography-guided gastroenterostomy (GE) using lumen-apposing metal stents (LAMS) serves as a good alternative to the placement of duodenal stents in the case of malignant gastroparesis. Within the scope of a multicenter randomized study, it was possible to show that GE using LAMS performs significantly better in terms of stent patency, food intake, and the number of subsequent interventions, and should therefore be given preference for use in correspondingly specialized centers (Teoh et al.). The pharmacological treatment options for irritable bowel syndrome (IBS) continue to be limited, and many patients associate the symptoms with “histamine intolerance”. In light of these concerns, it is interesting that, in a randomized study with patients with non-constipated IBS, treatment with the antihistamine ebastine was significantly more effective than placebo (Decraecker et al.).
Climate change and CO2 emissions have a major effect on our day-to-day lives. Against this backdrop, the question arises as to what ecological fingerprint is left behind as a result of work in interventional endoscopy. This question was examined in two papers (Desai et al. and Henniger et al. It comes as no surprise that rational use of equipment and resources as well as packaging waste can lead to a considerably improved environmental balance sheet and should be given greater attention in the future.
In the case of primary biliary cholangitis (PBC), a drop in alkaline phosphatase (ALP) levels to less than 1.5 times the upper limit of normal is usually deemed an adequate response to treatment. However, a current large-scale international cohort study shows that especially patients with advanced fibrosis and/or patients of a relatively young age benefit considerably from complete ALP normalization. Consequently, for these patients, supplementary therapy should be taken into consideration (Corpechot et al.). In the case of autoimmune hepatitis as well, current findings indicate the relevance of a complete response to treatment: data from the retrospective registry of the International Autoimmune Hepatitis Group (IAIHG-RR) shows that a lack of complete biochemical response constitutes a major adverse prognosis factor (Slooter et al.). For the first time, a specific drug has been approved in the United States for non-alcoholic steatohepatitis (NASH) or, according to the new nomenclature, metabolic dysfunction-associated steatohepatitis (MASH). Resmetirom is an oral, liver-directed, thyroid hormone receptor β-selective agonist. In a randomized, controlled phase 3 study, resmetirom was superior to placebo in terms of MASH resolution as well as in terms of improvement of liver fibrosis (Harrison et al.).
We very much hope that this small selection of papers has kindled your interest in reading these and other publications summarized in this issue in greater depth, and wish you enjoyable reading as well as happy and peaceful summer days!
Best wishes
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinic of Freiburg (Germany)
Christoph Neumann-Haefelin
Peter Hasselblatt