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Current Treatment Options in Gastroenterology

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https://www.readbyqxmd.com/read/28803403/endoscopic-surveillance-in-long-standing-colitis
#1
REVIEW
Brigid S Boland, Amandeep Shergill, Tonya Kaltenbach
There is a relative increase in the risk of colon cancer in patients with inflammatory bowel disease (IBD) affecting the colon, and endoscopic surveillance is advocated to mitigate this risk. The current standard practice is to survey this high-risk patient population using colonoscopy. Chromoendoscopy with targeted biopsies has emerged as the colonoscopy modality recommended by the major societies to optimize dysplasia detection. Studies over the past year support the improved yield from targeted as compared to random biopsies and improved dysplasia detection from chromoendoscopy as compared to white light endoscopy...
August 12, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28801825/intractable-constipation-in-the-elderly
#2
REVIEW
Noemi Baffy, Amy E Foxx-Orenstein, Lucinda A Harris, Susan Sterler
Chronic constipation is a common gastrointestinal disorder disproportionately affecting the elderly. Immobility, polypharmacy, and physiologic changes contribute to its increased prevalence in this population. Unidentified and undertreated constipation leads to a significant negative impact on quality of life and an increase in healthcare spending. Careful physical examination and exploration of the clinical history can unmask primary and secondary forms of constipation, guiding diagnostic and therapeutic considerations...
August 11, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28795293/endoscopic-palliation-of-pancreatic-cancer
#3
REVIEW
Vishal B Gohil, Jason B Klapman
Pancreas cancer is a fourth-leading cause of cancer death in the USA and its incidence is rising as the population is aging. The majority of patients present at an advanced stage due to the silent nature of the disease and treatment have focused more on palliation than curative intent. Gastroenterologists have become integral in the multidisciplinary care of these patients with a focus on providing endoscopic palliation of pancreas cancer. The three most common areas that gastroenterologists palliate endoscopically are biliary obstruction, cancer-related pain, and gastric outlet obstruction...
August 9, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28756531/dysphagia-in-the-elderly
#4
REVIEW
Scott M Smukalla, Irina Dimitrova, Jeremy M Feintuch, Abraham Khan
Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation...
July 29, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28748314/the-present-status-of-fecal-microbiota-transplantation-and-its-value-in-the-elderly
#5
REVIEW
Yao-Wen Cheng, Monika Fischer
OPINION STATEMENT: PURPOSE OF REVIEW: This article will review current literature describing fecal microbiota transplantation (FMT) in the treatment of various diseases, and its potential role in elderly patients (age ≥ 65 years). RECENT FINDINGS: Research on FMT has blossomed in the last decade and its pivotal role in the treatment of recurrent Clostridium difficile infection (CDI) has been recognized by the American College of Gastroenterology in the latest guidelines...
July 26, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28725941/endoscopic-stents-for-the-biliary-tree-and-pancreas
#6
REVIEW
Rajesh Krishnamoorthi, Mahendran Jayaraj, Richard Kozarek
OPINION STATEMENT: PURPOSE OF REVIEW: To review the recently published literature on biliary and pancreatic stents. RECENT FINDINGS: Covered self-expanding metal stents (SEMS) are increasingly being used in the endoscopic management of benign biliary strictures. Given the costs associated with SEMS, plastic stents are still the most commonly used stents. In this setting, SEMS are preferred over plastic stents for palliation of malignant biliary strictures due to superior patency and have a role in preoperative management of malignant biliary strictures...
July 20, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28702775/quality-indicators-in-colonoscopy
#7
REVIEW
Kjetil Garborg, Thomas de Lange, Michael Bretthauer
Colonoscopy is one of the most commonly performed endoscopic procedures. It is the gold standard examination for work-up of colonic symptoms, for follow-up of positive colorectal cancer screening tests and for detection and removal of neoplastic polyps. Colonoscopy is a complex and invasive procedure with a potential not only for colorectal cancer prevention, but also for serious complications. Numerous factors may affect the balance of benefit versus harm of colonoscopy, including the performance of the endoscopist...
July 12, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28540489/endoscopy-in-patients-on-antiplatelet-agents-and-anticoagulants
#8
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...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28508384/endoscopic-management-of-benign-esophageal-ruptures-and-leaks
#9
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...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28447197/role-of-zinc-in-the-development-progression-of-alcoholic-liver-disease
#10
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/28439747/management-of-cirrhotic-patients-after-successful-hcv-eradication
#11
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...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28432575/liver-transplantation-the-role-of-metabolic-syndrome
#12
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)...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28425018/hepatocellular-carcinoma-and-liver-transplantation-changing-patterns-and-practices
#13
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...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28421454/quality-indicators-in-endoscopic-ablation-for-barrett-s-esophagus
#14
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...
June 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28265971/application-of-the-functional-lumen-imaging-probe-to-esophageal-disorders
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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