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Current Treatment Options in Gastroenterology

Jennifer Coukos, Francis A Farraye
PURPOSE OF REVIEW: Patients with inflammatory bowel disease (IBD) are at increased risk of infectious diseases independent of their immunosuppression status, and yet, studies suggest that this population is not receiving standard vaccinations at the same rate as the general population. This review seeks to understand why IBD patients may not be receiving recommended immunizations and to provide guidelines on vaccinating this vulnerable population. RECENT FINDINGS: Inactive vaccines are recommended for patients with IBD regardless of immunosuppression status due to the increased risk for many vaccine-preventable illnesses...
October 6, 2018: Current Treatment Options in Gastroenterology
Ashley Thomas, Bruno de Souza Ribeiro, Miguel Malespin, Silvio W de Melo
PURPOSE OF REVIEW: Gastroparesis (GP) is a disorder of gastrointestinal motility which leads to delayed gastric emptying in the absence of mechanical obstruction. Treatment is limited as many patients are refractory to dietary modification and the use prokinetic medications carry significant adverse risks. These limitations necessitate more research into experimental therapies. The purpose of this article is to summarize the known information and guidelines on the diagnosis and management of GP and to review the latest literature on experimental treatments...
September 26, 2018: Current Treatment Options in Gastroenterology
Ji Young Bang, Michael J Bourke
INTRODUCTION: Colonic laterally spreading lesions (LSL) are increasingly managed using endoscopic methods that comprise two main techniques: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). PURPOSE OF REVIEW: In this review, we aimed to review the most recent literature on selection of the best endoscopic technique in the management of colonic LSL. RECENT FINDINGS: EMR and ESD are complimentary techniques in the management of patients with colonic LSL...
September 21, 2018: Current Treatment Options in Gastroenterology
Soumya Jagannath, Pramod Kumar Garg
PURPOSE OF REVIEW: There have been significant developments in the diagnosis, clinical approach, and management of patients with recurrent acute pancreatitis (RAP) in the last decade. This review systematically summarizes our current understanding of RAP. NEW FINDINGS: Gallstones and alcohol are common causes of RAP. Non-alcohol non-biliary RAP (nAnB RAP) is a difficult group of patients after excluding these two causes because extensive workup is required to elucidate the etiology...
September 19, 2018: Current Treatment Options in Gastroenterology
Livio Cipolletta, Fabio Cipolletta, Antonino Granata, Dario Ligresti, Luca Barresi, Ilaria Tarantino, Mario Traina
OPINION STATEMENT: PURPOSE OF REVIEW: Upper non-variceal gastrointestinal bleeding (UNVGIB) remains an important clinical challenge for endoscopists, requiring skill and expertise for correct management. In this paper, we suggest the best strategy for an effective treatment of this complex category of patients. RECENT FINDINGS: Early endoscopic examination, the increasingly widespread use of endoscopic hemostasis methods, and the most powerful antisecretory agents that induce clot stabilization have radically modified the clinical scenario for treating this pathology...
September 18, 2018: Current Treatment Options in Gastroenterology
Ayush Sharma, Suresh T Chari
PURPOSE OF REVIEW: The relationship between pancreatic ductal adenocarcinoma (PDAC) and diabetes mellitus (DM) is complex. We reviewed the recent medical literature regarding the effect of anti-diabetic medication on PDAC risk and survival, risk of PDAC in DM, and role of DM in early detection of PDAC. RECENT FINDINGS: Studies report that while some anti-diabetic medications (e.g., metformin) may decrease the risk of PDAC, others (insulin, sulfonylureas and incretin-based therapies) may increase the risk...
September 13, 2018: Current Treatment Options in Gastroenterology
Jonathan M Wyse, Anand V Sahai
OPINION STATEMENT: PURPOSE OF REVIEW: Unrelenting pain from chronic pancreatitis (CP) and pancreatic cancer (PC) remain clinical challenges for the physician and a significant cause of decreased quality of life for the patient. Endoscopic ultrasound (EUS)-guided therapy for each condition is distinct and builds on the endosonographer's straightforward access to the celiac axis. RECENT FINDINGS: Over the past 20 years, generally small studies of modest methodology have surfaced for both EUS-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN)...
September 12, 2018: Current Treatment Options in Gastroenterology
Ferga C Gleeson, Michael J Levy
PURPOSE OF REVIEW: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-associated mortality with continued poor outcome and a short-lived treatment response to conventional therapy. However, with the rapidly evolving field of precision oncology, new and novel genomic information is emerging, identifying tumor subtypes by revealing somatic and germline mutations. RECENT FINDINGS: There is growing interest in determining the tumor BRCA status to guide potential PARP inhibitor targeted therapy and for evaluating tumor microsatellite instability status for immune checkpoint inhibitor therapy which has been reported in up to 3% of PDAC patients...
September 3, 2018: Current Treatment Options in Gastroenterology
Ijm Levink, M J Bruno, D L Cahen
PURPOSE OF REVIEW: Management of intraductal papillary mucinous neoplasm (IPMN) is currently based on consensus, in the absence of evidence-based guidelines. In recent years, several consensus guidelines have been published, with distinct management strategies. In this review, we will discuss these discrepancies, in order to guide treating physicians in clinical management. RECENT FINDINGS: The detection rate of pancreatic cysts has increased substantially with the expanded use of high-quality imaging techniques to up to 45%...
September 2018: Current Treatment Options in Gastroenterology
Lotte Boxhoorn, Paul Fockens, Marc G Besselink, Marco J Bruno, Jeanin E van Hooft, Robert C Verdonk, Rogier P Voermans
PURPOSE OF REVIEW: Endoscopic management of infected necrotizing pancreatitis has evolved rapidly over the past years and there have been interesting innovations in this field. This review provides an update on the most recently published literature regarding endoscopic management of infected necrotizing pancreatitis. RECENT FINDINGS: A recent randomized trial demonstrated no difference in mortality and major morbidity between endoscopic and surgical step-up treatment of infected necrotizing pancreatitis...
September 2018: Current Treatment Options in Gastroenterology
Chris E Forsmark
PURPOSE OF REVIEW: Recent studies have documented that many patients with pancreatic exocrine insufficiency (EPI) are not identified and are not treated with appropriate dosages of pancreatic enzyme replacement therapy. This review will summarize the approach to diagnosis, treatment, and monitoring for treatment effect and complications in patients with exocrine insufficiency. RECENT FINDINGS: While chronic pancreatitis is the most commonly identified cause of EPI, pancreatic cancer and pancreatic surgery are increasingly important...
September 2018: Current Treatment Options in Gastroenterology
Keith Siau, Neil D Hawkes, Paul Dunckley
PURPOSE OF THE REVIEW: Progress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency acquisition in novice endoscopy trainees. RECENT FINDINGS: Increasing data on the learning curves for different endoscopic procedures has highlighted variations in performance amongst trainees...
September 2018: Current Treatment Options in Gastroenterology
Anita Afzali, Seymour Katz
PURPOSE OF REVIEW: Early- and late-onset of inflammatory bowel disease (IBD) may perhaps be etiologically distinct and potentially attributed to genetics, environmental or microbial factors. We review disease factors and clinical characteristics, as well as unique management and treatment strategies to consider when caring for the "baby" or "baby boomer" with IBD. RECENT FINDINGS: Around 25% of cases of initial diagnosis of IBD is made before the age of 18 years old, and another 15-20% made after the age of 60...
July 13, 2018: Current Treatment Options in Gastroenterology
James Q Zhou, Sean Michael Duenas, Tarik Kirat, Feza Remzi, Shannon Chang
PURPOSE OF REVIEW: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients undergoing colectomy to maintain intestinal continuity. Earlier studies have suggested that outcomes are worse in elderly patients who underwent IPAA. However, more recent reports have shown that IPAA outcomes in the elderly are comparable to younger patients. We review the recent medical literature regarding outcomes and treatments for common complications in elderly IPAA patients...
July 12, 2018: Current Treatment Options in Gastroenterology
Silvia Nardelli, Lorenzo Ridola, Stefania Gioia, Oliviero Riggio
PURPOSE OF REVIEW: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment...
June 2018: Current Treatment Options in Gastroenterology
Jody C Olson
PURPOSE OF REVIEW: Cirrhosis is a major worldwide health problem which results in a high level of morbidity and mortality. Patients with cirrhosis who require intensive care support have high mortality rates of near 50%. The goal of this review is to address the management of common complications of cirrhosis in the ICU. RECENT FINDINGS: Recent epidemiological studies have shown an increase in hospitalizations due to advanced liver disease with an associated increase in intensive care utilization...
June 2018: Current Treatment Options in Gastroenterology
Beverley Kok, Puneeta Tandon
PURPOSE OF REVIEW: This review gives an overview of the evolving concept of physical frailty in patients with cirrhosis. As well as summarizing the available metrics that have been used to diagnose it, this review also examines the major recent trials that have investigated frailty in patients with cirrhosis. The complex relationship between sarcopenia and frailty is explored, and strategies to optimize frailty, such as including pharmacological and non-pharmacological therapies, are discussed...
June 2018: Current Treatment Options in Gastroenterology
Carlos Moctezuma-Velázquez, Juan G Abraldes, Aldo J Montano-Loza
PURPOSE OF REVIEW: Statins are drugs developed to treat hypercholesterolemia. Its use in patients with liver disease has been limited because one of its potential and most feared side effects is hepatotoxicity. However, there is robust evidence that supports the safety of statins in this population in the absence of severe liver dysfunction. In this review, we will summarize the efficacy and safety of statins in cirrhosis. RECENT FINDINGS: Statins are effective in the treatment of dyslipidemia in patients with liver disease, because of their pleiotropic properties...
June 2018: Current Treatment Options in Gastroenterology
Venkata Rajesh Konjeti, Binu V John
PURPOSE OF REVIEW: The approval of direct-acting antiviral (DAA) therapy has revolutionized hepatitis C virus (HCV) treatment. However, the publication of a study from Barcelona in 2016 raised concern for an increased risk of recurrence of hepatocellular carcinoma (HCC) after potentially curative therapy in patients receiving DAAs. This article reviews the current literature on the interaction between HCC and hepatitis C eradication with DAAs. RECENT FINDINGS: Following publication of the initial observation in 2016, a number of studies have looked at the impact of active HCC on the success of antiviral therapy, as well as that of treatment with DAAs on both the occurrence and recurrence of HCC...
June 2018: Current Treatment Options in Gastroenterology
Bram D Vermeulen, Peter D Siersema
OPINION STATEMENT: PURPOSE OF REVIEW: Esophageal stents are used in clinical practice for endoscopic treatment of a wide variety of esophageal diseases and conditions. This review provides key principles and a literature update on the utility and limitations of esophageal stenting in clinical practice. RECENT FINDINGS: Indications for esophageal stenting can be subdivided into two groups. The first group consists of patients with malignant or benign dysphagia, in which an esophageal stent restores luminal patency...
June 2018: Current Treatment Options in Gastroenterology
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