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Current Treatment Options in Gastroenterology

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https://www.readbyqxmd.com/read/28265971/application-of-the-functional-lumen-imaging-probe-to-esophageal-disorders
#1
REVIEW
Dustin A Carlson, Ikuo Hirano
The functional luminal imaging probe (FLIP) provides a novel method to evaluate esophageal physiology and function in both health and disease. FLIP enables assessment of a previously underexplored component of esophageal function, distensibility, by utilizing high-resolution impedance planimetry to evaluate the relationship of the esophageal luminal geometry with pressure during controlled volumetric distension. Recent studies have described the potential utility of FLIP to evaluate the severity and effectiveness of therapy for esophageal diseases including achalasia, gastroesophageal reflux disease, and eosinophilic esophagitis...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28205108/water-assisted-colonoscopy
#2
REVIEW
Sergio Cadoni, Felix W Leung
The current review will attempt to describe the important lessons learned from published randomized controlled trials (RCT) comparing water immersion (WI) or water exchange (WE) techniques with gas insufflation colonoscopy. Air insufflation (AI) to distend the colon to permit visualization and passage through the lumen was developed for diagnostic colonoscopy. When screening colonoscopy was adopted, the same AI method was used. Interval cancers, diagnosed within 3 to 5 years after an index screening colonoscopy, appeared to be linked to low adenoma detection rate (ADR)...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28181180/managing-ibd-therapies-in-pregnancy
#3
REVIEW
Jill K J Gaidos, Sunanda V Kane
Inflammatory bowel disease is frequently diagnosed before or during key childbearing years. One of the most important factors for a healthy pregnancy is having quiescent disease prior to conception and maintaining disease remission for the duration of the pregnancy. In order to achieve that, most women will need to continue their inflammatory bowel disease (IBD) treatment during pregnancy. One of the main concerns these women have is whether these medications will have adverse effects on their growing fetus...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28164249/extrapolation-and-interchangeability-of-infliximab-and-adalimumab-in-inflammatory-bowel-disease
#4
REVIEW
Shannon Chang, Stephen Hanauer
Infliximab and adalimumab biosimilars have been approved by the FDA and European Medicines Agency and have already been introduced to the international market. Availability into the US market is imminent. Biosimilars are highly similar to the reference biologic product but should not be referred to as, nor equated with, generic medications as no two biosimilars can ever be identical. Regulatory pathways for biosimilar approval consider the totality of evidence for biosimilar approvals, but the preponderance of development relies on analytic and functional testing and allows extrapolation between indications to reduce the financial burden of completing comparative clinical trials for each indication...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28161819/optimizing-resection-of-large-colorectal-polyps
#5
REVIEW
Steven J Heitman, David J Tate, Michael J Bourke
Polypectomy reduces the incidence and mortality of colorectal cancer (CRC). The widespread adoption of CRC screening, more rigorous colonoscopy techniques, and advancements in endoscopic imaging have led to a greater awareness of complex polyps. Whereas surgery was once considered necessary for many large sessile or laterally spreading lesions (LSLs) in the colorectum, the majority can now be removed endoscopically. Endoscopic mucosal resection (EMR) is an established technique for treatment of colorectal LSLs...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28161818/treat-to-target-in-inflammatory-bowel-disease-an-updated-review-of-literature
#6
REVIEW
Umar Darr, Nabeel Khan
Therapeutic management of patients with inflammatory bowel diseases (IBDs) has, for years, been tailored towards monitoring patient clinical presentation as a way to gauge therapeutic management. With the advent of newer biological agents, treatment and management have begun to focus on more objective rather than subjective parameters. These objective parameters include endoscopic targets and focus on the impact of mucosal healing, radiologic and histologic targets, patient reported outcomes, and use of non-invasive biomarkers...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28160250/thiopurines-and-methotrexate-use-in-ibd-patients-in-a-biologic-era
#7
REVIEW
Gerassimos J Mantzaris
Although we have been living in the era of biologic therapy for several decades, the use of immunomodulators (primarily thiopurines [azathioprine and mercaptopurine] and less so methotrexate) still remains an important component of the inflammatory bowel disease (IBD) pharmaceutical arsenal. Thiopurines as monotherapy exert corticosteroid-sparing effects and can maintain long-term remission in a considerable proportion of patients who have frequent relapses and are or have become mesalazine and/or corticosteroid intolerant or refractory...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28138859/utility-of-biomarkers-in-the-management-of-inflammatory-bowel-disease
#8
REVIEW
Gursimran Kochhar, Bret Lashner
Inflammatory bowel disease (IBD) is comprised of complex clinical and pathological conditions. It runs a chronic course, and proper management requires constant monitoring of disease activity. Recent evidence suggests that subjective patient scores have a poor correlation with disease activity. Endoscopy remains the gold standard for diagnosing and monitoring disease activity. As healthcare is moving towards less costly and less invasive treatments, the need for biomarkers in the management of IBD is evident...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28138858/strategies-to-increase-adenoma-detection-rates
#9
REVIEW
Eelco C Brand, Michael B Wallace
The adenoma detection rate (ADR), i.e., the proportion of average risk patients with at least one adenoma detected during screening colonoscopy, is inversely associated with the development of interval colorectal cancer. Increasing the ADR is therefore an important proxy for increase in quality and efficacy of (screening) colonoscopy. Several potentially modifiable factors, such as, procedural and technological factors, and quality improvement programs, and their effect on the ADR will be reviewed. Procedural factors, such as, bowel preparation, withdrawal time, and position changes of the patient are associated with the ADR...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28130652/clinical-implications-of-emerging-data-on-the-safety-of-proton-pump-inhibitors
#10
REVIEW
Felice Schnoll-Sussman, Philip O Katz
Proton pump inhibitors (PPI) are among the safest class of drugs used by all care providers, including gastroenterologists. They are the mainstay in treatment of acid-related disease, in particular, gastroesophageal reflux disease. Without them, many patients would experience a major decrement in their quality of life. However, no drug is without side effects or adverse events. In the past decade, numerous reports, principally case control studies and meta-analyses, have raised questions about important adverse events related to the use of PPIs...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28130651/screening-and-surveillance-of-colorectal-cancer-using-ct-colonography
#11
REVIEW
Manoj Kumar, Brooks D Cash
Colorectal cancer (CRC) is a common cancer among throughout the world with the highest rates in developed countries such as the USA. There is ample evidence demonstrating the beneficial effects of colorectal cancer screening and, largely thanks to screening initiatives and insurance coverage, epidemiologic analyses show a steady decline in both CRC incidence and mortality rates over the last several decades. However, screening rates for CRC in the US remain low and approximately 1 in 3 adults between the ages of 50 and 75 years has not undergone any form of CRC screening, highlighting the need for additional accurate, minimally invasive, and acceptable screening options...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28124203/the-role-of-allergy-testing-in-eosinophilic-esophagitis-an-update-of-the-evidence
#12
Hamish Philpott, Francis Thien
Allergy testing has been advocated for patients with eosinophilic esophagitis (EoE) as a means of defining food triggers and directing dietary therapy. Several recent and comprehensive studies have demonstrated the futility of skin prick (SPT), skin patch (APT) and serum food antigen specific IgE (SIgE) estimates in this context. Furthermore, if identification of food triggers is the endpoint (as opposed to the ability of an allergy test-directed diet merely to induce remission), previous positive studies have limitations...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28124202/pyloric-therapies-for-gastroparesis
#13
REVIEW
Nitin K Ahuja, John O Clarke
Gastroparesis is a syndrome that can be difficult to treat effectively and likely represents the common clinical presentation of multiple underlying mechanisms. One of these presumed mechanisms involves pyloric dysfunction, tied perhaps to spasm or fibrosis, manifesting as functional gastric outlet obstruction. Various diagnostic modalities have been used to better characterize this hypothesized abnormality, including most recently antroduodenal manometry and impedance planimetry. A variety of therapeutic interventions specific to the pylorus have also been proposed in the last several years, including intrapyloric injections of botulinum toxin, transpyloric stenting, surgical pyloroplasty, and endoscopic pyloromyotomy...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28120279/update-on-the-use-of-biologic-therapy-in-ulcerative-colitis
#14
REVIEW
Aakash Aggarwal, Timothy Sabol, Haleh Vaziri
Ulcerative colitis (UC) is a major form of inflammatory bowel disease and is characterized by chronic inflammation of the colon and rectum and by alternating periods of flares and remissions. Symptoms may include rectal bleeding, abdominal pain, and diarrhea. The pathogenesis of UC is complex and involves a combination of immune dysregulation, genetics, environmental factors, and microbiota. The goal of medical treatment is to induce and maintain remission. Traditionally, the treatment options for UC included 5-aminosalicylates, corticosteroids, and immunomodulators...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28120278/long-term-management-challenges-in-esophageal-atresia
#15
REVIEW
Abby White, Raphael Bueno
Esophageal atresia is a rare congenital anomaly, but improved surgical and critical care has resulted in survival rates exceeding 90%. Long-term survival is associated with numerous management challenges including chronic motility disorders, dysphagia, strictures, reflux, esophagitis and attendant complications, tracheomalacia and chronic restrictive lung disease, and recurrent pulmonary infections. No guidelines for adolescents and younger or older adults exist for the treatment and monitoring of this specialized patient population...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28116696/endoscopic-management-of-esophageal-perforations-who-when-and-how
#16
REVIEW
Payal Saxena, Mouen A Khashab
Esophageal perforations can be spontaneous or iatrogenic. Although they are a rare occurrence, they are associated with a significant morbidity and mortality. Traditionally, management of esophageal perforation consisted of surgery. However, endoscopic management is now emerging as the primary treatment modality and is less invasive and morbid than surgery. Endoscopic modalities include through-the-scope clips (TTS), over-the-scope clips (OTSC), placement of covered stents, and suturing. Suturing can be used for primary closure of the perforation as well as anchoring of stents to prevent migration...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28116695/update-on-the-management-of-chronic-constipation
#17
REVIEW
Jenna Koliani-Pace, Brian E Lacy
Chronic constipation (CC) is a highly prevalent disorder encountered by health care providers of all specialties. The diagnosis can be confidently made by taking a careful history, evaluating for warning signs and symptoms, performing an examination, including a digital rectal exam, and using the Rome IV criteria. Treatment should begin at the first visit; most patients require few diagnostic tests to make, or confirm, the diagnosis of CC. Assuming that the patient has persistent symptoms of constipation, despite using traditional therapy (fiber, osmotic agents), then patients should be offered one of the newer treatments, rather than repeating prior treatments, which is a common practice...
March 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27757817/novel-treatments-for-cyclic-vomiting-syndrome-beyond-ondansetron-and-amitriptyline
#18
REVIEW
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...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27734216/central-aspects-of-nausea-and-vomiting-in-gi-disorders
#19
REVIEW
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...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27726068/newest-drugs-for-chronic-unexplained-nausea-and-vomiting
#20
REVIEW
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...
December 2016: Current Treatment Options in Gastroenterology
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