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Current Treatment Options in Gastroenterology

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https://www.readbyqxmd.com/read/28540489/endoscopy-in-patients-on-antiplatelet-agents-and-anticoagulants
#1
REVIEW
Andrew M Veitch
Management of patients on anticoagulant or antiplatelet therapy undergoing endoscopy presents a balance of risks between haemorrhage due to the procedure, and thrombosis due to discontinuation of antithrombotic therapy. Haemorrhage is usually controllable endoscopically, but thrombosis could, on occasion, result in myocardial infarction or stroke, with permanent disability or death. For elective procedures, there is adequate time to plan best management of antithrombotic therapy. International guidelines have been published, but recommendations are based on limited evidence and consultation with appropriate medical specialists, and the patient is important...
May 25, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28508384/endoscopic-management-of-benign-esophageal-ruptures-and-leaks
#2
REVIEW
Milena Di Leo, Roberta Maselli, Elisa Chiara Ferrara, Laura Poliani, Sameer Al Awadhi, Alessandro Repici
Esophageal leaks (EL) and ruptures (ER) are rare conditions associated with a high risk of mortality and morbidity. Historically, EL and ER have been surgically treated, but current treatment options also include conservative management and endoscopy. Over the last decades, interventional endoscopy has evolved as an effective and less invasive alternative to primary surgery in these cases. A variety of techniques are currently available to re-establish the continuity of the digestive tract, prevent or treat infection related to the leak/rupture, prevent further contamination, drain potential collections, and provide nutritional support...
May 15, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28439747/management-of-cirrhotic-patients-after-successful-hcv-eradication
#3
REVIEW
Ryan M Kwok, Tram T Tran
Chronic hepatitis C (HCV) is a hepatotropic virus which, when untreated, can lead to progressive inflammation and fibrosis resulting in cirrhosis, hepatocellular carcinoma (HCC), and decompensations related to end-stage liver disease. The relatively recent introduction of all oral, interferon-free, direct-acting antiviral medications against HCV has transformed the management of these patients. Previous treatment regimens were prolonged, poorly tolerated, and frequently did not result in cure. Current therapies achieve sustained viral response (SVR) in the vast majority of patients including those with decompensated liver disease; a previously challenging population to treat...
April 24, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28432575/liver-transplantation-the-role-of-metabolic-syndrome
#4
REVIEW
Brian C Davis, M Shadab Siddiqui
The long-term survival in liver transplant recipients (LTRs) is currently at an historical high level stemming from improvement in perioperative care, infection control, and immunosuppression medications. However, compared to the general population, LTRs have decreased survival. Metabolic diseases like hypertension, dyslipidemia, type 2 diabetes, and obesity are key determinants of long-term mortality in LTRs. The incidence and prevalence of these metabolic comorbidities is considerably higher in LTRs and likely results from a combination of factors including exposure to chronic immunosuppression, weight gain, and recurrence of chronic liver disease after liver transplantation (LT)...
April 21, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28425018/hepatocellular-carcinoma-and-liver-transplantation-changing-patterns-and-practices
#5
REVIEW
Nicole E Rich, Neehar D Parikh, Amit G Singal
Benefits of liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) are well established. However, there is debate regarding optimal and equitable selection of patients best served by LT, particularly in the face of limited organ availability. Herein, we discuss topics regarding LT selection criteria for patients with HCC. Recent change in UNOS policy currently mandates a 6-month observation period prior to priority listing and institutes a cap of 34 MELD exception points for patients with HCC...
April 19, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28421454/quality-indicators-in-endoscopic-ablation-for-barrett-s-esophagus
#6
REVIEW
Samuel Han, Sachin Wani
Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC); a cancer that is associated with a poor 5-year survival rate. Several strategies have been explored in the context of reducing the burden of EAC. Endoscopic eradication therapy (EET) is considered the standard of care for the management of patients with BE with dysplasia and early neoplasia; a practice that has been endorsed by all gastroenterology societal guidelines. The effectiveness of EET has been demonstrated in multiple studies and contemporary management includes a combination of endoscopic mucosal resection (EMR) of all visible lesions followed by eradication of the remaining BE using ablative techniques of which radiofrequency ablation (RFA) has the best evidence supporting effectiveness and safety...
April 18, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28447197/role-of-zinc-in-the-development-progression-of-alcoholic-liver-disease
#7
REVIEW
Craig McClain, Vatsalya Vatsalya, Matthew Cave
Many variables, aside from the amount and duration of alcohol consumption, play a role in the development and progression of alcoholic liver disease (ALD). One critical factor that can be modified is diet/nutrition. We have made major recent advances in our understanding of the interactions of nutrition and ALD. In this article, we review advances made in zinc metabolism/therapy for ALD. There is major zinc dyshomeostasis with ALD which is mediated, in part, by poor intake and absorption, increased excretion, and altered zinc transporters, especially ZIP14...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28265971/application-of-the-functional-lumen-imaging-probe-to-esophageal-disorders
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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