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Current Gastroenterology Reports

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https://www.readbyqxmd.com/read/27787787/malnutrition-and-nutritional-support-in-alcoholic-liver-disease-a-review
#1
REVIEW
Andrew Chao, Dan Waitzberg, Rosangela Passos de Jesus, Allain A Bueno, Victor Kha, Karen Allen, Matthew Kappus, Valentina Medici
Malnutrition is associated with alcoholic liver disease (ALD) and related complications such as hepatic encephalopathy and increased rate of infections. Avoidance of prolonged fasting and overly restrictive diets is important to avoid poor nutrition. Adequate intake of calories, protein, and micronutrients via frequent small meals and evening supplements and/or enteral and parenteral nutrition when indicated has been associated with reduced mortality and morbidity in patients with ALD. Modification of protein/fat sources and composition in addition to probiotic supplementation are promising interventions for decreased progression of ALD and its complications...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27778304/understanding-the-mechanical-forces-of-self-expandable-metal-stents-in-the-biliary-ducts
#2
Hiroyuki Isayama, Yousuke Nakai, Tsuyoshi Hamada, Saburo Matsubara, Hirofumi Kogure, Kazuhiko Koike
Self-expandable metallic stent (SEMS) was an effective biliary endoprosthesis. Mechanical properties of SEMS, radial and axial force (RF, AF), may play important roles in the bile duct after placement. RF was well known dilation force and influenced on the occurrence of migration. AF, newly proposed by this author, was defined as the recovery force when the SEMS vended. AF was related with the cause of bile duct kinking, pancreatitis, and cholecystitis due to the compression of the bile duct, orifice of the cystic duct, and pancreatic orifice...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27747460/non-celiac-gluten-sensitivity
#3
Maria Teresa Bardella, Luca Elli, Francesca Ferretti
PURPOSE OF REVIEW: A new syndrome responding to gluten-free diet and defined non-celiac gluten sensitivity entered the spectrum of gluten-related disorders, together with celiac disease and wheat allergy. However, its definition, prevalence, diagnosis, pathogenesis, treatment, and follow up are still controversial. The purpose of the review is to summarize the evidence and problems emerging from the current literature. RECENT FINDINGS: Direct implication of gluten in the onset of symptoms is often unproved as a low fermentable oligo-, di- and mono-saccharides and polyols diet or other components of cereals as wheat amylase trypsin inhibitor could be similarly involved...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27747459/complementary-therapies-in-inflammatory-bowel-diseases
#4
Henit Yanai, Nir Salomon, Adi Lahat
Inflammatory bowel diseases (IBDs) often take a chronic debilitating course. Given the chronicity of IBD, the limitations of the available medications, their potential side effects, and the impact of the disease on patients' quality of life, it is not surprising IBD patients are ranked among the highest users of complementary and alternative medicine (CAM). Since CAM has become very popular in real-life practice of Western Communities, caregivers must gain more knowledge about these therapies, their mechanism of action, benefits, and risks...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27747458/acute-on-chronic-liver-failure
#5
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27738966/chicago-classification-of-esophageal-motility-disorders-applications-and-limits-in-adults-and-pediatric-patients-with-esophageal-symptoms
#6
Kornilia Nikaki, Joanne Li Shen Ooi, Daniel Sifrim
The Chicago classification (CC) is most valued for its systematic approach to esophageal disorders and great impact in unifying practice for esophageal manometric studies. In view of the ever-growing wealth of knowledge and experience gained by the expanding use of high-resolution manometry (HRM) in various clinical scenarios, the CC is regularly updated. Its clinical impact and ability to predict clinical outcome, both in adults and pediatrics, will be further promoted by recognizing its current limitations, incorporating new metrics in its diagnostic algorithms and adjusting the HRM protocols based on the clinical question posed...
November 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27738965/how-to-optimally-apply-impedance-in-the-evaluation-of-esophageal-dysmotility
#7
Amit Patel, C Prakash Gyawali
The utilization of impedance technology has enhanced our understanding and assessment of esophageal dysmotility. Esophageal high-resolution manometry (HRM) catheters incorporated with multiple impedance electrodes help assess esophageal bolus transit, and the combination is termed high-resolution impedance manometry (HRIM). Novel metrics have been developed with HRIM-including esophageal impedance integral ratio, bolus flow time, nadir impedance pressure, and impedance bolus height-that augments the assessment of esophageal bolus transit...
November 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27726042/eosinophilic-esophagitis-from-an-allergy-perspective-how-to-optimally-pursue-allergy-testing-dietary-modification-in-the-adult-population
#8
Emily C McGowan, Thomas A Platts-Mills
Eosinophilic esophagitis (EoE) is a clinicopathologic condition characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In adults, the three most common treatment options are swallowed steroids, elimination diets, and periodic esophageal dilations. Many different elimination diets have been studied in adults, including elemental diets, allergy testing-directed diets, and empiric elimination diets. This article will review the existing data on these dietary therapies and will propose an approach to dietary management in adult EoE...
November 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27645751/intestinal-transplant-inflammation-the-third-inflammatory-bowel-disease
#9
Alexander Kroemer, Christopher Cosentino, Jason Kaiser, Cal S Matsumoto, Thomas M Fishbein
Intestinal transplantation is the most immunologically complex of all abdominal organ transplants. Understanding the role both humoral and innate and adaptive cellular immunity play in intestinal transplantation is critical to improving outcomes and increasing indications for patients suffering from intestinal failure. Recent findings highlighting the impact of donor-specific antibodies on intestinal allografts, the role of NOD2 as a key regulator of intestinal immunity, the protective effects of innate lymphoid cells, and the role of Th17 in acute cellular rejection are reviewed here...
November 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27641726/erratum-to-sarcopenia-in-patients-with-chronic-liver-disease-can-it-be-altered-by-diet-and-exercise
#10
Matthew R Kappus, Mardeli Saire Mendoza, Douglas Nguyen, Valentina Medici, Stephen A McClave
No abstract text is available yet for this article.
November 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27637649/nutritional-strategies-in-the-management-of-adult-patients-with-inflammatory-bowel-disease-dietary-considerations-from-active-disease-to-disease-remission
#11
REVIEW
Douglas L Nguyen, Berkeley Limketkai, Valentina Medici, Mardeli Saire Mendoza, Lena Palmer, Matthew Bechtold
Inflammatory bowel disease (IBD) is a group of chronic, lifelong, and relapsing illnesses, such as ulcerative colitis and Crohn's disease, which involve the gastrointestinal tract. There is no cure for these diseases, but combined pharmacological and nutritional therapy can induce remission and maintain clinical remission. Malnutrition and nutritional deficiencies among IBD patients result in poor clinical outcomes such as growth failure, reduced response to pharmacotherapy, increased risk for sepsis, and mortality...
October 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27595583/current-practice-of-duodenoscope-reprocessing
#12
REVIEW
Stephen Kim, V Raman Muthusamy
Numerous outbreaks of duodenoscope-associated transmission of multi-drug resistant bacteria have recently been reported. Unlike prior episodes of endoscope-transmitted infections, the latest outbreaks have occurred despite strict adherence to duodenoscope reprocessing guidelines. The current standard for all flexible endoscope reprocessing includes pre-cleaning, leak testing, an additional manual cleaning step, and high-level disinfection. When these steps are strictly followed, the risk of infection transmission during endoscopy is exceedingly rare...
October 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27595155/the-optimal-approach-to-symptomatic-paraesophageal-hernia-repair-important-technical-considerations
#13
REVIEW
Jessica A Zaman, Anne O Lidor
While the asymptomatic paraesophageal hernia (PEH) can be observed safely, surgery is indicated for symptomatic hernias. Laparoscopic repair is associated with decreased morbidity and mortality; however, it is associated with a higher rate of radiologic recurrence when compared with the open approach. Though a majority of patients experience good symptomatic relief from laparoscopic repair, strict adherence to good technique is critical to minimize recurrence. The fundamental steps of laparoscopic PEH repair include adequate mediastinal mobilization of the esophagus, tension-free approximation of the diaphragmatic crura, and gastric fundoplication...
October 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27538982/vitamin-d-and-the-pathogenesis-of-inflammatory-bowel-disease
#14
REVIEW
Berkeley N Limketkai, Matthew L Bechtold, Douglas L Nguyen
Vitamin D has traditionally been known for its role in bone metabolism, but emerging evidence has suggested a broader role for vitamin D in immune regulation. Vitamin D deficiency has been associated with the pathogenesis of diverse autoimmune disorders and has similarly been implicated as a contributor to inflammatory bowel disease. In this review, we discuss animal, in vitro, genetic, and epidemiologic studies that have linked vitamin D deficiency with inflammatory bowel disease pathogenesis or severity. Nonetheless, we present the caveat in interpreting these studies in the context of reverse causation: Does vitamin D deficiency lead to gastrointestinal disease, or does gastrointestinal disease (with related changes in dietary choices, intestinal absorption, nutritional status, lifestyle) lead to vitamin D deficiency?...
October 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27461274/next-generation-therapeutics-for-inflammatory-bowel-disease
#15
REVIEW
Parambir S Dulai, William J Sandborn
Tumor necrosis factor (TNF) antagonists are the cornerstone of therapy for moderately to severely active inflammatory bowel disease (IBD). Although our understanding of pharmacokinetics, pharmacodynamics, and treatment optimization for these agents has evolved considerably over the past decade, a substantial majority of individuals fail to respond or lose response to TNF-antagonists over time. A need therefore remains for efficacious treatment options in these patients. Alternative immunological targets have now been identified, and several novel therapeutic agents are in development for IBD...
September 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27448619/approach-to-the-patient-with-mild-crohn-s-disease-a-2016-update
#16
REVIEW
Frank I Scott, Gary R Lichtenstein
Mild Crohn's disease (CD) is classified as those patients who are ambulatory, with <10 % weight loss, are eating and drinking without abdominal mass, tenderness, obstructive symptoms, or fever, and endoscopically they have non-progressive mild findings. Initial evaluation of mild CD should focus on assessment for high-risk features requiring more aggressive therapy. In contrast to moderate-to-severe disease, where therapy is focused on mucosal healing, the management of mild CD is focused on symptom management, while exposing the individual to minimal therapeutic risks...
September 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27448618/progress-in-our-understanding-of-the-gut-microbiome-implications-for-the-clinician
#17
REVIEW
Sara Iqbal, Eamonn M M Quigley
The investigation of the role of the microbial communities of our gastrointestinal tract (microbiota) has accelerated dramatically in recent years thanks to rapid developments in the technologies that allow us to fully enumerate and evaluate the full complement of bacterial species and strains that normally inhabit the gut. Laboratory studies in a range of inventive animal models continue to provide insights into the role of the microbiota in health and to generate plausible hypotheses relating to its potential involvement in the pathogenesis of human disease...
September 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27447791/intestinal-failure-new-definition-and-clinical-implications
#18
REVIEW
Matthew Kappus, Sarah Diamond, Ryan T Hurt, Robert Martindale
Intestinal failure (IF) is a state in which the nutritional demands of the body are not met by the gastrointestinal absorptive surface. It is a long-recognized complication associated with short bowel syndrome, which results in malabsorption after significant resection of the intestine for many reasons or functional dysmotility. Etiologies have included Crohn's disease, vascular complications, and the effects of radiation enteritis, as well as the effects of intestinal obstruction, dysmotility, or congenital defects...
September 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27424219/endoscopic-options-for-gastroesophageal-reflux-where-are-we-now-and-what-does-the-future-hold
#19
REVIEW
George Triadafilopoulos
Early in the twenty-first century, novel endoscopic techniques were introduced for the management of gastroesophageal reflux disease, providing minimally invasive ways to eliminate pharmacologic acid inhibition and avoid the need for anti-reflux surgery. These techniques do not significantly alter the anatomy of the gastroesophageal junction, minimizing short- and long-term adverse effects, such as dysphagia and bloating. After extensive clinical testing, many endoscopic therapies were abandoned due to either lack of durable efficacy or unfavorable safety profile...
September 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27422123/laparoscopic-assisted-percutaneous-endoscopic-gastrostomy
#20
REVIEW
Adarsh M Thaker, Alireza Sedarat
There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible...
September 2016: Current Gastroenterology Reports
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