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Current Opinion in Gastroenterology

Anthony N Kalloo
No abstract text is available yet for this article.
July 3, 2018: Current Opinion in Gastroenterology
Timothy B Gardner
No abstract text is available yet for this article.
July 3, 2018: Current Opinion in Gastroenterology
Ajay Singhvi, Dhiraj Yadav
PURPOSE OF REVIEW: Alcohol and smoking play an important role in pancreatitis. The present review will address the myths and evidences about alcohol and smoking with pancreatitis to help improve the approach of healthcare professionals when managing of these patients. RECENT FINDINGS: There is a growing recognition that chronic pancreatitis is a multifactorial disease. Eliciting an accurate history of alcohol consumption and smoking from patients, and if necessary, family members, can help determine their contribution to the patient's disease...
June 29, 2018: Current Opinion in Gastroenterology
Theodore W James, Seth D Crockett
PURPOSE OF REVIEW: Acute pancreatitis is a common condition that affects patients with varying degrees of severity and may lead to significant morbidity and mortality. The present article will review the current paradigm in acute pancreatitis management within the first 72 h of diagnosis. RECENT FINDINGS: Patients presenting with acute pancreatitis should be evaluated clinically for signs and symptoms of organ failure in order to appropriately triage. Initial management should focus on fluid resuscitation, with some data to support Ringer's lactate over physiological saline...
June 27, 2018: Current Opinion in Gastroenterology
Jong Jin Hyun, Richard A Kozarek
PURPOSE OF REVIEW: To review important manuscripts published over the previous 2 years relative to sphincter of Oddi dysfunction (SOD). RECENT FINDINGS: The long-term outcomes of the Evaluating Predictors and Interventions of SOD (EPISOD) trial further substantiated results from the initial EPISOD study, reinforcing that neither endoscopic retrograde cholangiopancreatography-manometry nor endoscopic sphincterotomy are appropriate for SOD type III. Pain management in the latter patients has reverted to neuromodulating agents, and recent studies have suggested a role for duloxetine and potentially acupuncture...
June 16, 2018: Current Opinion in Gastroenterology
Jon M Harrison, Carlos Fernandez-Del Castillo
PURPOSE OF REVIEW: With recent advances in radiographic testing, there have been increases in the incidental identification of pancreatic cysts. Determining management, specifically, which cysts can be watched versus intervened upon has significant impact on at the patient-physician level as well as globally on resource allocation and healthcare expenditures. This review focuses on the three main guidelines (Fukuoka guidelines, European consensus, and American Gastroenterological Association recommendations) for management of pancreatic cystic disease after incidental identification...
June 13, 2018: Current Opinion in Gastroenterology
Christopher J DiMaio
PURPOSE OF REVIEW: Acute pancreatitis can result in a number of localized complications such as pancreatic pseudocysts, walled-off pancreatic necrosis (WON), and disconnected pancreatic duct syndrome (DPDS). The management of these conditions has evolved over the past three decades such that minimally invasive endoscopic drainage and debridement methods are now the favored, first-line approach. This article will review the latest developments and controversies regarding the endoscopic management of these conditions...
June 12, 2018: Current Opinion in Gastroenterology
Jolien Derdeyn, Wim Laleman
PURPOSE OF REVIEW: Every year more than one million people worldwide undergo an endoscopic retrograde cholangiopancreatography (ERCP) for disorders of the bile duct system. This review aims to discuss recent clinical data with regard to single-operator peroral cholangioscopy (POC). RECENT FINDINGS: Innovations and technical optimizations of POC devices have extended diagnostic and therapeutic options for patients with complex biliary disease. Most of the currently available clinically relevant data are obtained with the single-operator peroral cholangioscopy (SOC)-system SpyGlass, which in a period of a decade has evolved further to a digital platform with increasing applicability, usefulness and cost-effectiveness...
June 12, 2018: Current Opinion in Gastroenterology
Frank U Weiss, Mariya E Skube, Markus M Lerch
PURPOSE OF REVIEW: Genetic mutations in genes within and outside of the trypsin-dependent pathologic pathway have been found to be associated with chronic pancreatitis. This review highlights recent developments. RECENT FINDINGS: CTRB1-CTRB2 has been identified as a new risk locus for chronic pancreatitis and the disease mechanism may involve trypsin degradation. Misfolding mutations in PRSS1, CPA1, and CEL, as well as environmental stress factors like tobacco and alcohol can trigger endoplasmic reticulum stress (ER-Stress)...
June 8, 2018: Current Opinion in Gastroenterology
Mariya E Skube, Greg J Beilman
PURPOSE OF REVIEW: Patients suffering from chronic pancreatitis often require surgical intervention to treat their disease. This review discusses surgical options as well as reviews current trends and research in the operative management of chronic pancreatitis. RECENT FINDINGS: Relevant current topics in the field include the appropriate timing of surgery as well as the relative benefits of various procedures, particularly duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy...
June 8, 2018: Current Opinion in Gastroenterology
Nicolò de Pretis, Giulia De Marchi, Luca Frulloni
PURPOSE OF REVIEW: Clinical management of autoimmune pancreatitis changed over the last years. The lack of high-quality studies, probably due to the relative rarity of the disease, has not fully clarified many diagnostic and therapeutic aspects. Aim of this review is to overview the literature from a clinical point of view, focusing on diagnostic and therapeutic approach to this complicated disease. RECENT FINDINGS: They have been focused mainly on the risk of misdiagnosing a cancer...
June 8, 2018: Current Opinion in Gastroenterology
Kendall R McEachron, Melena D Bellin
PURPOSE OF REVIEW: We reviewed the current state of total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis and recurrent acute pancreatitis (RAP). RECENT FINDINGS: An increasing number of centers in the United States and internationally are performing TPIAT. In selected cases, TPIAT may be performed partially or entirely laparoscopically. Islet isolation is usually performed at the same center as the total pancreatectomy surgery, but new data suggest that diabetes outcomes may be nearly as good when a remote center is used for islet isolation...
June 8, 2018: Current Opinion in Gastroenterology
J Enrique Dominguez-Muñoz
PURPOSE OF REVIEW: Pancreatic exocrine insufficiency (PEI), defined as a secretion of pancreatic enzymes and bicarbonate insufficient to maintain a normal digestion, is a frequent but frequently underdiagnosed and undertreated condition. PEI may be secondary to different pancreatic diseases and extrapancreatic conditions. Recent data support the high clinical relevance of PEI and its treatment. RECENT FINDINGS: Together with symptoms of maldigestion, PEI is associated with nutritional deficiencies leading to osteoporosis, low-trauma fractures, sarcopenia and increased mortality...
June 7, 2018: Current Opinion in Gastroenterology
Corey S Miller, Yen-I Chen
PURPOSE OF REVIEW: To provide an overview of the field of pancreatoscopy and to summarize the data informing its clinical utility. RECENT FINDINGS: Regarding the technological advance of pancreatoscopy, recent studies are the first to report the use of digital, single-operator pancreatoscopy (SpyGlass DS; Boston Scientific, Natick, MA). New data on the use of preoperative pancreatoscopy offer promising results for the potential to optimize treatment of intraductal papillary mucinous neoplasms and to differentiate between benign and malignant pancreatic strictures...
May 29, 2018: Current Opinion in Gastroenterology
Mona Haj, Don C Rockey
PURPOSE OF REVIEW: The current review aims to explain the different systems available to clinicians for predicting clinical outcomes in patients with cirrhosis. RECENT FINDINGS: Cirrhosis is the final stage of chronic liver disease and is associated with high morbidity and mortality. The most commonly utilized tools to predict outcomes in patients with cirrhosis include the following: assessing severity of portal hypertension using hepatic venous pressure gradient (HVPG) measurements, using scoring systems such as the Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) scores, and recently, clinical staging systems based on cirrhosis-related clinical complications...
July 2018: Current Opinion in Gastroenterology
Carl Weidinger, Ahmed N Hegazy, Britta Siegmund
PURPOSE OF REVIEW: The occurrence of creeping fat wrapping segments of inflamed gut represents a characteristic yet incompletely understood hallmark of Crohn's disease. Over the last decade, numerous studies have provided a limited understanding of this feature. Still, deciphering the detailed mechanisms and the pathophysiologic relevance of the interplay between creeping fat, barrier function and intestinal inflammation will be the aim of future studies. RECENT FINDINGS: The last 18 months have substantially contributed to this field, starting with an elegant three-dimensional study revealing B cell aggregates around lymphatic vessels embedded in the mesenteric fat, thus bringing back the idea that Crohn's disease might represent a 'lymphatic disease'...
July 2018: Current Opinion in Gastroenterology
Jesus K Yamamoto-Furusho
PURPOSE OF REVIEW: Treatment of inflammatory bowel disease (IBD) patients can vary depending on the degree of response, lack of response or intolerance to conventional or biological agents aimed at blocking various cytokines or integrins. Recent therapies targeting several cytokines were reviewed to evaluate efficacy in IBD patients. RECENT FINDINGS: Ustekinumab is an interleukin inhibitor which blocks the p40 subunit of IL-12 and IL-23 axis and is already approved for the treatment of Crohn's disease patients, specially those who had inadequate response or intolerance to conventional treatment with anti-TNF-α agents...
July 2018: Current Opinion in Gastroenterology
Paul Hobbs, C Prakash Gyawali
PURPOSE OF REVIEW: Ambulatory reflux monitoring is typically performed when esophageal symptoms do not respond to usual antireflux medications, or prior to invasive antireflux therapy. Although pH-based metrics have been the standard in defining esophageal reflux burden, novel impedance parameters have been introduced in recent years that can either be extracted from pH-impedance monitoring or obtained directly from esophageal mucosa. This review evaluates the clinical role of esophageal pH-impedance monitoring in clinical practice in the present day...
July 2018: Current Opinion in Gastroenterology
Alfredo J Lucendo, Javier Molina-Infante
PURPOSE OF REVIEW: For patients with eosinophilic esophagitis (EoE), endoscopic dilation has been used primarily to provide immediate symptomatic relief of dysphagia. This report reviews the current position of esophageal dilation in the therapeutic algorithm for EoE, including effectiveness and safety issues. RECENT FINDINGS: Esophageal strictures in EoE develop as a consequence of long-lasting esophageal eosinophilia, with patient age and diagnostic delay as well established risk factors...
July 2018: Current Opinion in Gastroenterology
Max Schmulson
PURPOSE OF REVIEW: In 2016, the Rome IV process and criteria were published. They provide a system to standardize patient diagnostic requirements for clinical studies and pharmaceutical trials on functional gastrointestinal disorders (FGIDs), which are now called disorders of gut-brain interaction (DGBI). Although the Rome criteria have limitations in clinical practice, an understanding of the criteria can help clinicians to manage symptoms in patients with DGBI, and with organic diseases as well...
July 2018: Current Opinion in Gastroenterology
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