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Current Treatment Options in Gastroenterology

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https://www.readbyqxmd.com/read/27807793/opioids-and-gi-motility-friend-or-foe
#1
REVIEW
Allen A Lee, William L Hasler
The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS)...
November 2, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27757817/novel-treatments-for-cyclic-vomiting-syndrome-beyond-ondansetron-and-amitriptyline
#2
Sanjay Bhandari, Thangam Venkatesan
Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder that is characterized by episodic nausea and vomiting. Initially thought to only affect children, CVS in adults was often misdiagnosed with significant delays in therapy. Over the last decade, there has been a considerable increase in recognition of CVS in adults but there continues to be a lack of knowledge about management of this disorder. This paper seeks to provide best practices in the treatment of CVS and also highlight some novel therapies that have the potential in better treating this disorder in the future...
October 18, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27734216/central-aspects-of-nausea-and-vomiting-in-gi-disorders
#3
Prashant Singh, Braden Kuo
Nausea and vomiting result from continuous interactions among gastrointestinal, central nervous system, and autonomic nervous system. Despite being closely associated, central pathways of nausea and vomiting appear to be at least partly different and nausea is no longer considered only a penultimate step of vomiting. Although our understanding of central pathways of nausea has improved over the last one decade, it is still very basic. Afferent pathways from gastrointestinal tract via vagus, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius which, in turn, relays the signal to central pattern generator initiating multiple downstream pathways...
October 12, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27726068/newest-drugs-for-chronic-unexplained-nausea-and-vomiting
#4
William L Hasler
Chronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g., gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates...
October 10, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27709332/interactions-between-inflammatory-bowel-disease-drugs-and-chemotherapy
#5
Galen Leung, Marianna Papademetriou, Shannon Chang, Francis Arena, Seymour Katz
As new and effective novel therapies in inflammatory bowel disease (IBD) become available, patients are living longer with advancing age and are at increased risk for malignancy. The management of IBD and malignancy involves multiple combinations of chemotherapy agents and IBD drugs, with the potential for interactions between these therapies. Interactions may either potentiate the effectiveness of drug class or exacerbate their common side effects. In this review article, we present a guide on studied interactions between IBD therapies and chemotherapy agents, specifically those of colorectal cancer, breast cancer, non-Hodgkin's lymphoma, and melanoma...
October 5, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27699625/cannabinoids-and-gi-disorders-endogenous-and-exogenous
#6
Zachary Wilmer Reichenbach, Ron Schey
Despite the political and social controversy affiliated with it, the medical community must come to the realization that cannabinoids exist as a ubiquitous signaling system in many organ systems. Our understanding of cannabinoids and how they relate not only to homeostasis but also in disease states must be furthered through research, both clinically and in the laboratory. The identification of the cannabinoid receptors in the early 1990s have provided us with the perfect target of translational research. Already, much has been done with cannabinoids and the nervous system...
October 3, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27687234/finding-the-right-treatment-for-achalasia-treatment-risks-efficacy-complications
#7
An Moonen, Guy Boeckxstaens
Achalasia is a primary esophageal motor disorder of the esophagus that is characterized by the absence of esophageal peristalsis and a failure of the lower esophageal sphincter (LES) to relax upon swallowing. The defective relaxation leads to symptoms of dysphagia for solids and liquids, regurgitation, aspiration, chest pain, and weight loss. Achalasia is believed to result from a selective loss of enteric inhibitory neurons, most likely due to an autoimmune phenomenon in genetic susceptible individuals. As there is no curative treatment for achalasia, treatment is confined to disruption of the LES to improve bolus passage...
September 29, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27682148/gastrointestinal-transit-assessment-role-of-scintigraphy-where-are-we-now-where-are-we-going
#8
Harvey A Ziessman
The diagnostic imaging evaluation of patients with suspected esophagogastrointestinal transit disorders is changing. Anatomical methods, e.g., barium studies, endoscopy, manometry, radiopaque markers, have long been the techniques available and used for diagnosis. The one exception has been gastric emptying, where radionuclide scintigraphy has been the standard for decades. Esophageal transit scintigraphy is an old and reliable methodology but probably underutilized. The diagnostic use of small and large intestinal transit scintigraphy is increasing, in part, because of the limitations of the other methods but, most importantly, because it is truly physiologic, i...
September 28, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27722801/chronic-unexplained-nausea-and-vomiting-or-gastric-neuromuscular-dysfunction-gnd-an-update-on-nomenclature-pathophysiology-and-treatment-and-relationship-to-gastroparesis
#9
REVIEW
Kimberly N Harer, Pankaj J Pasricha
Chronic unexplained nausea and vomiting is a debilitating condition that dramatically decreases patient quality of life and creates diagnostic and treatment challenges for healthcare providers. Additionally, the significant overlap in symptoms between disorders such as chronic unexplained nausea and vomiting, gastroparesis, and functional dyspepsia has resulted in a blurring of diagnostic lines and added confusion to the therapeutic approach. The identified overlap in clinical symptoms also suggests a common underlying pathophysiological mechanism may drive these conditions, indicating they could possibly be part of a spectrum of gastric neuromuscular disorders instead of discrete processes...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27709331/how-to-diagnose-and-treat-functional-chest-pain
#10
REVIEW
Jose M Remes-Troche
Chest pain that is not explained by reflux disease or cardiac, musculoskeletal, mucosal, or motor esophageal abnormalities is classified as functional chest pain (FCP). Although several mechanisms are involved, esophageal hypersensitivity plays a major role and it could be considered a biomarker for FCP. Psychologic comorbidity such as anxiety, neuroticism, depression, and somatization is common. When the diagnosis of FCP is suspected, patients should undergo evaluation with esophageal motility testing, endoscopy, 24-h esophageal pH monitoring, and in some cases, sensory tests...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27696279/diet-and-complementary-medicine-for-chronic-unexplained-nausea-and-vomiting-and-gastroparesis
#11
REVIEW
Ekta Gupta, Linda A Lee
Chronic nausea and vomiting, whether or not associated with gastroparesis, are among the most difficult symptoms to manage. Patients typically undergo extensive evaluation and empiric treatment often with suboptimal results. Conventional therapies may not produce adequate symptom relief or may cause unacceptable side effects. Thus, it is not surprising that patients report a negative impact on well-being, since the intermittent or constant occurrence of these symptoms are a source of anxiety as they impact social interactions and ability to work...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27678506/gastric-electrical-stimulation-for-gastroparesis-and-chronic-unexplained-nausea-and-vomiting
#12
REVIEW
John M Wo, Thomas V Nowak, Shamaila Waseem, Matthew P Ward
Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27423892/managing-esophageal-dysphagia-in-the-elderly
#13
REVIEW
Felice Schnoll-Sussman, Philip O Katz
Esophageal dysphagia in the elderly is a common clinical problem. Achalasia is a disease in which there is loss of ganglion in the myenteric plexus of the lower esophageal sphincter resulting in incomplete relaxation of that muscle causing a functional obstruction to outflow. Treatment is aimed at reducing sphincter pressure allowing for gravity and the oral portion of the swallow to propel the bolus through the esophagus. Pneumatic dilatation, Heller myotomy (laparoscopic), and the newest procedure peroral endoscopic esophageal myotomy (POEM) are all reasonable options for effective treatment even in the elderly...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27392638/management-of-disconnected-pancreatic-duct-syndrome
#14
REVIEW
Michael Larsen, Richard A Kozarek
A disconnected pancreatic duct most commonly follows an episode of severe pancreatitis and walled-off necrosis (WON). When the latter is drained percutaneously, a pancreatic fistula connected to an upstream and disconnected duct is commonly seen. Transgastric drainage of WON with or without concomitant percutaneous drainage (dual drainage) will allow placement of two pigtail stents to drain the upstream duct and ultimately allows removal of percutaneous tubes and avoids the need for distal pancreatectomy. These stents should be left in place indefinitely...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27387455/management-of-inflammatory-bowel-disease-in-the-elderly
#15
REVIEW
Elizabeth S John, Kristina Katz, Mark Saxena, Sita Chokhavatia, Seymour Katz
A substantial and growing proportion of patients with inflammatory bowel disease (IBD) are elderly, and these patients require tailored treatment strategies. However, significant challenges exist in the management of this population due to the paucity of data. Establishing the initial diagnosis and assessing the etiology of future symptoms and flares can be challenging as several other prevalent diseases can masquerade as IBD, such as ischemic colitis, diverticular disease, and infectious colitis. Important pharmacologic considerations include reduced glomerular filtration rate and drug-drug interactions in the elderly...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27371265/role-of-ercp-in-patients-with-idiopathic-recurrent-acute-pancreatitis
#16
REVIEW
Piyush Somani Md, Udayakumar Navaneethan Md
Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. RAP is differentiated from chronic pancreatitis based on the presence of a normal morphological appearance of the pancreas between episodes. RAP can be due to a variety of etiologies including common bile duct stones or sludge, sphincter of Oddi dysfunction (SOD), pancreas divisum (PD), anomalous pancreaticobiliary junction, genetic mutations, and alcohol related. In approximately 30 % of patients, the etiology of RAP is unclear and the term "idiopathic" is used...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27363979/endoscopy-in-the-elderly-a-cautionary-approach-when-to-stop
#17
REVIEW
Rita Abdelmessih, Christopher D Packey, Garrett Lawlor
Performing endoscopic procedures in the elderly carries known enhanced risk compared to the general population. Weighing the benefits against the risks is easy when a patient is in immediate danger, but a gray area arises in screening protocols in an elderly patient of average risk. In this review, we compare national and international guidelines in average risk screening procedures (colonoscopic colorectal screening, Barrett's surveillance) to find consensus for screening practice in the elderly. With minor differences between societal guidelines, it is widely agreed that 75 years is the appropriate age to begin to weigh risks and benefits according to a patient's state of health and comorbidities...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27363978/interventional-pain-management-approaches-for-control-of-chronic-pancreatic-pain
#18
REVIEW
Leonardo Kapural, Suneil Jolly
Treatment of persistent pain from chronic pancreatitis historically was difficult to treat. For years, focus was on opioid and other analgesics and psychological treatments. Recent studies provided evidence for decrease in analgesic intake and pain scores after properly conducted sympathetic blocks (celiac, splanchnic nerve blocks). These therapies should be considered as parts of a multimodal analgesic strategy. Animal studies suggest that spinal cord stimulation suppresses visceral hyperalgesia. Large case series of spinal cord stimulation demonstrated a significant pain relief in patients with chronic pancreatitis...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27349659/preventing-post-ercp-pancreatitis-update-2016
#19
REVIEW
Martin L Freeman
Post-ERCP remains a major challenge, although significant progress has been made in predicting risk and methods of prevention. Facets of post-ERCP pancreatitis can be divided into the four "P's": they are patient-related factors, procedure-related factors, pancreatic stents, and pharmacoprophylaxis. New information about risk factors includes a description of IPMN as a patient-related risk, with smoking and chronic liver disease as protective factors. Procedure-related factors include one or more deep passages of a guidewire into the pancreatic duct as a salient risk, perhaps outweighing difficult cannulation or contrast injection, but one that can be mitigated by placement of a pancreatic stent...
September 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27059229/poem-and-submucosal-tunneling
#20
REVIEW
Yuki B Werner, Thomas Rösch
Submucosal endoscopy has introduced new and important aspects into gastrointestinal endoscopic therapeutics by opening the way to interventions even outside of the GI tract. At present, innovative techniques for submucosal endoscopy in different esophageal diseases include peroral endoscopic myotomy (POEM) for idiopathic achalasia and related motility disorders, submucosal tunneling endoscopic resection (STER) for submucosal tumors arising from the muscularis propria, and endoscopic submucosal tunneling dissection (ESTD) for superficial esophageal neoplastic lesions...
June 2016: Current Treatment Options in Gastroenterology
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