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Gastroenterology

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By Jeff Bank Internal Medicine R2 at the University of Utah
https://www.readbyqxmd.com/read/28195178/recurrence-of-barrett-s-esophagus-is-rare-following-endoscopic-eradication-therapy-coupled-with-effective-reflux-control
#1
Srinadh Komanduri, Peter J Kahrilas, Kumar Krishnan, Tim McGorisk, Kiran Bidari, David Grande, Laurie Keefer, John Pandolfino
OBJECTIVES: Recent data suggest that effective control of gastroesophageal reflux improves outcomes associated with endoscopic eradication therapy (EET) for Barrett's esophagus (BE). However, the impact of reflux control on preventing recurrent intestinal metaplasia and/or dysplasia is unclear. The aims of the study were: (a) to determine the effectiveness and durability of EET under a structured reflux management protocol and (b) to determine the impact of optimizing anti-reflux therapy on achieving complete eradication of intestinal metaplasia (CE-IM)...
February 14, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28195180/successful-resolution-of-recurrent-clostridium-difficile-infection-using-freeze-dried-encapsulated-fecal-microbiota-pragmatic-cohort-study
#2
Christopher Staley, Matthew J Hamilton, Byron P Vaughn, Carolyn T Graiziger, Krista M Newman, Amanda J Kabage, Michael J Sadowsky, Alexander Khoruts
OBJECTIVES: Fecal microbiota transplantation (FMT) is increasingly being used for treatment of recurrent Clostridium difficile infection (R-CDI) that cannot be cured with antibiotics alone. In addition, FMT is being investigated for a variety of indications where restoration or restructuring of the gut microbial community is hypothesized to be beneficial. We sought to develop a stable, freeze-dried encapsulated preparation of standardized fecal microbiota that can be used for FMT with ease and convenience in clinical practice and research...
February 14, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28130846/aasld-guidelines-for-the-treatment-of-hepatocellular-carcinoma
#3
Julie Heimbach, Laura M Kulik, Richard Finn, Claude B Sirlin, Michael Abecassis, Lewis R Roberts, Andrew Zhu, M Hassan Murad, Jorge Marrero
No abstract text is available yet for this article.
January 28, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28071659/acg-clinical-guideline-treatment-of-helicobacter-pylori-infection
#4
William D Chey, Grigorios I Leontiadis, Colin W Howden, Steven F Moss
Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28094313/comparison-of-symptoms-healthcare-utilization-and-treatment-in-diagnosed-and-undiagnosed-individuals-with-diarrhea-predominant-irritable-bowel-syndrome
#5
Gregory S Sayuk, Ray Wolf, Lin Chang
OBJECTIVES: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by symptoms including abdominal pain and altered bowel function. Up to 75% of individuals with IBS may be undiagnosed. The aim of this study was to characterize symptoms, healthcare utilization, and treatments in populations with both diagnosed and undiagnosed IBS. METHODS: An online survey was conducted to compare gastrointestinal (GI) symptoms, healthcare visits, well-being, symptom management, and treatment satisfaction in individuals with and without medically diagnosed IBS (Rome III criteria)...
January 17, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28088461/changes-in-the-prevalence-of-hepatitis-c-virus-infection-non-alcoholic-steatohepatitis-and-alcoholic-liver-disease-among-patients-with-cirrhosis-or-liver-failure-on-the-waitlist-for-liver-transplantation
#6
David Goldberg, Ivo C Ditah, Kia Saeian, Mona Lalehzari, Andrew Aronsohn, Emmanuel C Gorospe, Michael Charlton
BACKGROUND & AIMS: Concurrent to development of more effective drugs for treatment of hepatitis C virus (HCV), infection, there has been an increase in the incidence of non-alcoholic fatty liver disease (NAFLD). Data indicate that liver transplantation prolongs survival times of patient with acute hepatitis associated with alcoholic liver disease (ALD). We compared data on disease prevalence in the population with data from liver transplantation waitlists to evaluate changes in the burden of liver disease in the United States...
January 11, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28069350/prevalence-risk-factors-and-outcomes-of-irritable-bowel-syndrome-after-infectious-enteritis-a-systematic-review-and-meta-analysis
#7
Fabiane Klem, Akhilesh Wadhwa, Larry Prokop, Wendy Sundt, Gianrico Farrugia, Michael Camilleri, Siddharth Singh, Madhusudan Grover
BACKGROUND & AIMS: Foodborne illness affects 15% of the United States population each year and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis METHODS: We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared to individuals without infectious enteritis) and host- and enteritis-related risk factors...
January 6, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28053053/acute-on-chronic-liver-failure-an-update
#8
REVIEW
Ruben Hernaez, Elsa Solà, Richard Moreau, Pere Ginès
Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver diseases. Up to 40%-50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF...
March 2017: Gut
https://www.readbyqxmd.com/read/28043907/gastrointestinal-safety-of-direct-oral-anticoagulants-a-large-population-based-study
#9
Neena S Abraham, Peter A Noseworthy, Xiaoxi Yao, Lindsey R Sangaralingham, Nilay D Shah
BACKGROUND & AIMS: Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding. METHODS: We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with nonvalve atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015...
December 30, 2016: Gastroenterology
https://www.readbyqxmd.com/read/27942871/evidence-based-clinical-practice-guidelines-for-cholelithiasis-2016
#10
REVIEW
Susumu Tazuma, Michiaki Unno, Yoshinori Igarashi, Kazuo Inui, Kazuhisa Uchiyama, Masahiro Kai, Toshio Tsuyuguchi, Hiroyuki Maguchi, Toshiyuki Mori, Koji Yamaguchi, Shomei Ryozawa, Yuji Nimura, Naotaka Fujita, Keiichi Kubota, Junichi Shoda, Masami Tabata, Tetsuya Mine, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa
Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012...
December 10, 2016: Journal of Gastroenterology
https://www.readbyqxmd.com/read/27974040/the-human-intestinal-microbiome-in-health-and-disease
#11
REVIEW
Susan V Lynch, Oluf Pedersen
No abstract text is available yet for this article.
December 15, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27995906/acg-clinical-guideline-evaluation-of-abnormal-liver-chemistries
#12
Paul Y Kwo, Stanley M Cohen, Joseph K Lim
Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepatocellular injury is defined as disproportionate elevation of AST and ALT levels compared with alkaline phosphatase levels. Cholestatic injury is defined as disproportionate elevation of alkaline phosphatase level as compared with AST and ALT levels...
January 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27988382/the-vagus-nerve-in-appetite-regulation-mood-and-intestinal%C3%A2-inflammation
#13
REVIEW
Kirsteen N Browning, Simon Verheijden, Guy E Boeckxstaens
Although the gastrointestinal tract contains intrinsic neural plexuses that allow a significant degree of independent control over gastrointestinal functions, the central nervous system provides extrinsic neural inputs that modulate, regulate, and integrate these functions. In particular, the vagus nerve provides the parasympathetic innervation to the gastrointestinal tract, coordinating the complex interactions between central and peripheral neural control mechanisms. This review discusses the physiological roles of the afferent (sensory) and motor (efferent) vagus in regulation of appetite, mood, and the immune system, as well as the pathophysiological outcomes of vagus nerve dysfunction resulting in obesity, mood disorders, and inflammation...
December 15, 2016: Gastroenterology
https://www.readbyqxmd.com/read/27988383/low-risk-of-high-grade-dysplasia-or-esophageal-adenocarcinoma-among-patients-with-barrett-s-esophagus-less-than-1-cm-irregular-z-line-within-5-years-of-index-endoscopy
#14
Prashanthi N Thota, Prashanth Vennalaganti, Sreekar Vennelaganti, Patrick Young, Srinivas Gaddam, Neil Gupta, David Lieberman, Richard Sampliner, Gary W Falk, Sharad Mathur, Kevin Kennedy, Brooks D Cash, Fouad Moawad, Ajay Bansal, Manon C Spaander, Marco J Bruno, John Vargo, Prateek Sharma
BACKGROUND & AIMS: Many patients with a < 1 cm segment of columnar metaplasia in the distal esophagus, also called an irregular Z line, are encountered. These patients, often referred to as patients with Barrett's esophagus (BE), are enrolled in surveillance programs. However, little is known about their risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We aimed to determine the incidence of HGD and EAC in patients with irregular Z line with intestinal metaplasia...
December 15, 2016: Gastroenterology
https://www.readbyqxmd.com/read/27958288/mucosal-impedance-a-new-way-to-diagnose-reflux-disease-and-how-it-could-change-your-practice
#15
Michael F Vaezi, Yash Choksi
No abstract text is available yet for this article.
January 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27897155/diagnosis-and-management-of-microscopic-colitis
#16
REVIEW
Darrell S Pardi
Microscopic colitis (MC) is a relatively common cause of chronic watery diarrhea, especially in older persons. Associated symptoms, including abdominal pain and arthralgias, are common. The diagnosis is based upon characteristic histological findings in the presence of diarrhea. The two types of MC, collagenous and lymphocytic colitis, share similar clinical features, with the main difference being the presence or absence of a thickened subepithelial collagen band. There are several treatment options for patients with MC, although only budesonide has been well studied in multiple controlled clinical trials...
November 29, 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27729952/cirrhosis-and-autoimmune-liver-disease-current-understanding
#17
REVIEW
Rodrigo Liberal, Charlotte R Grant
Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) constitute the classic autoimmune liver diseases (AILDs). While AIH target the hepatocytes, in PBC and PSC the targets of the autoimmune attack are the biliary epithelial cells. Persistent liver injury, associated with chronic AILD, leads to un-resolving inflammation, cell proliferation and the deposition of extracellular matrix proteins by hepatic stellate cells and portal myofibroblasts. Liver cirrhosis, and the resultant loss of normal liver function, inevitably ensues...
October 8, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27864004/beta-adrenergic-blockade-and-decompensated-cirrhosis
#18
REVIEW
Thomas Reiberger, Mattias Mandorfer
Non-selective betablockers (NSBBs) remain the cornerstone of medical treatment of portal hypertension. The evidence for their efficacy to prevent variceal bleeding is derived from prospective trials, which largely excluded patients with refractory ascites and renal failure. In parallel to the increasing knowledge on portal hypertension-induced changes in systemic hemodynamics, cardiac function, and renal perfusion, emerging studies have raised concerns about harmful effects of NSBBs. Clinicians are facing an ongoing controversy on the use of NSBBs in patients with advanced cirrhosis...
November 15, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27840364/25-years-of-proton-pump-inhibitors-a-comprehensive-review
#19
REVIEW
Daniel S Strand, Daejin Kim, David A Peura
Proton pump inhibitors (PPIs) were clinically introduced more than 25 years ago and have since proven to be invaluable, safe, and effective agents for the management of a variety of acid-related disorders. Although all members in this class act in a similar fashion, inhibiting active parietal cell acid secretion, there are slight differences among PPIs relating to their pharmacokinetic properties, metabolism, and Food and Drug Administration (FDA)-approved clinical indications. Nevertheless, each is effective in managing gastroesophageal reflux disease and uncomplicated or complicated peptic ulcer disease...
January 15, 2017: Gut and Liver
https://www.readbyqxmd.com/read/27866880/efficacy-of-sterile-fecal-filtrate-transfer-for-treating-patients-with-clostridium-difficile-infection
#20
Stephan J Ott, Georg H Waetzig, Ateequr Rehman, Jacqueline Moltzau-Anderson, Richa Bharti, Juris A Grasis, Liam Cassidy, Andreas Tholey, Helmut Fickenscher, Dirk Seegert, Philip Rosenstiel, Stefan Schreiber
BACKGROUND & AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (CDI). However, transferring undefined living bacteria entails uncontrollable risks for infectious and metabolic or malignant diseases, particularly in immunocompromised patients. We investigated whether sterile fecal filtrates (containing bacterial debris, proteins, antimicrobial compounds, metabolic products, and oligonucleotides/DNA), rather than intact microorganisms, are effective in patients with CDI...
November 17, 2016: Gastroenterology
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