The global burden of colorectal cancer (CRC) is a pressing concern, with a substantial impact on public health. Despite advancements in understanding the molecular mechanisms of CRC development, challenges remain in translating this knowledge into effective clinical interventions. Key genetic mutations, notably in the adenomatous polyposis coli (APC) and Kirsten rat sarcoma virus (KRAS) genes, are central to CRC initiation and progression. Current CRC treatments include surgery and chemotherapy, often combined with targeted agents. However, resistance and heterogeneity within CRC patients limit the effectiveness of these therapies. Promisingly, research has focused on targeting APC and KRAS mutations for therapy. Small molecules inhibiting the Wnt pathway and antibodies targeting specific components are under investigation. Targeting KRAS itself is challenging due to its conserved structure, but disrupting its membrane interactions and subcellular localization are potential therapeutic strategies. To address the limitations of single-drug therapy, combination approaches are gaining traction. Combination therapy not only minimizes off-target effects but also tackles drug resistance and diverse genetic alterations within tumors. The intricate interplay of mutations and pathways in CRC necessitates multifaceted therapeutic strategies. Although progress has been made in understanding CRC genetics and developing targeted therapies, there is still work to be done to translate these insights into effective clinical treatments for CRC patients. This review provides crucial information for novel combination treatments for CRC.

Obesity is a global health burden and is closely associated with severe chronic co-morbidities, which remain the leading causes of death. Significant progress has been made in the treatment of hypertension, diabetes, and hyperlipidemia over the last half-century. However, advancements in the management of obesity have been slow, with some medications exhibiting inadequate efficacy and dangerous side effects. Improved understanding of the gut-brain axis has inspired the pursuit of novel medications aiming to provide sustainable and safe weight loss. Current evidence-based practices for obesity management involve multi-modal approaches, including lifestyle modification, mechanical gastric restriction, modulation in the secretion of multiple gut hormones, alteration in the composition and secretion of bile acids, and alterations of the gut microbiome. Each physician is responsible for recognizing obesity as a disease and assisting patients in appropriate management based on strong evidence and a good safety profile, aligned with the patient’s goals. Through this review, we aim to inform the readers of recent approaches for managing obesity and comparing their beneficial effects and efficacy on obesity and its long-term co-morbidities.

Clinical unmet need in managing nonalcoholic fatty liver disease (NAFLD), a common liver disorder affecting 25–30% of American adults is to develop noninvasive and robust biomarkers.

We re-measured liver AC by placing a region of interest (ROI, 3 cm tall and 3 cm wide) at 4.5 cm, 6 cm, and 7.5 cm from the skin and a large ROI (6.0 cm tall and 7.3 cm wide) on pre-recorded ATI images from 117 participants screened for NAFLD. The difference in AC value at variable ROI depths was tested using one-way ANOVA (analysis of variance). Diagnostic performances of AC at variable depths in determining hepatic steatosis were examined by area under receiver operating characteristic curve (AUC) using MRI-proton density fat fraction (MRI-PDFF) as reference and were compared using paired-sample Z-test.

Based on MRI-PDFF, 117 livers were divided to 27 normal livers (MRI-PDFF < 5%) or 90 steatotic livers (MRI-PDFF ≥ 5%). Differences in AUC and AC value at variable depths and size were statistically significant (p < 0.01). The best performance for determining hepatic steatosis was the AC measured at 6 cm from the skin (AUC = 0.92). Sources of errors in performing ATI included reverberation, blank color region, and acoustic shadowing within the measurement ROI.

ROI depth significantly influences liver AC estimation. The best ROI depth to measure liver AC in patients with BMI ≥ 30 may be at a depth of 6 cm from the skin. Technical considerations should be taken in performing liver ATI.

The gastrointestinal microbiome remains an explosively increasing topic of study, assessing the potentially pivotal roles of the microbiome in maintaining health or causality in disease pathogenesis. Gastroesophageal reflux disease (GERD) has long been understood to be a result of direct acidic injury. However, emerging evidence suggests that GERD could also be caused by alterations in the esophageal microbiome, causing an induction of a submucosal inflammatory cytokine cascade, that has a retrograde effect on the luminal mucosa. This concept of a microbial shift/dysbiosis in the causality of GERD is clearly a paradigm shift and has led to possible treatment strategies beyond the traditional approach of acid-suppressive therapies. This review focuses on the current evidence surrounding GERD and the rationale for possible esophageal microbiome-directed treatment strategies.

Over the past decade, the approach to gastrointestinal (GI) neuroendocrine tumors (NETs) has increasingly included endoscopic resection (ER) techniques. Underwater endoscopic mucosal resection (UEMR) has been introduced as a potential alternative to conventional mucosectomy. The objective of this systematic review is to investigate the feasibility and outcomes of UEMR in the treatment of GI NETs and to provide a reference for clinical management options.

A systematic search of PubMed, Cochrane Library, and EMBASE was performed to identify guidelines and primary literature published up to 8 August 2023.

Our review did not find any UEMR results for esophageal NETs. For gastric NETs, there is only one case series pilot study with two patients with G1 tumors, that were completely resected without complications. For duodenal NETs eligible for ER, a total of 11 cases are reported, with success in all procedures. For ileum NETs, there is only one report, for an outlier case. Finally, UEMR is best indicated for rectal tumors, where it is an alternative to endoscopic mucosal resection or endoscopic submucosal dissection techniques, as shown in four comparative studies.

UEMR is presented as a good option for selected cases, as it has notable advantages in that it can achieve a complete histological resection at a lower cost, with a short procedure time, and does not require advanced endoscopic skills to ensure good results.

The gut microbiome has been well-established in its role of regulating the onset of many gastrointestinal disorders. Recent evidence has shown a bidirectional relationship between the intestinal microbiota and the liver. The gut microbiome may affect liver disease progression through its bacterial composition, the metabolism of bile acids, and the translocation of bacterial products. Modulation of dysbiosis may be considered as a potential therapeutic target for liver disease regardless of the underlying cause. Continuing to identify parts of the gut-liver axis that are disordered in different etiologies of liver disease may offer insight into potential interventions to restore homeostasis. Thus, this review will focus on exploring some of the major gut microbiome targeted therapies for liver disease, including probiotics, prebiotics, and fecal microbiota transplantation.