Tangible Pathologies in Functional Dyspepsia
Publication date: Available online 16 August 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Marjorie M. Walker, Michael D. Potter, Nicholas J. TalleyAbstractFunctional dyspepsia (FD) is a common, costly and complex disease, currently defined by symptoms, directed by the Rome consensus on functional bowel disorders, which has evolved over the past two decades. Symptoms include abdominal pain, are often meal related and there are two major subtypes, postprandial distress syndrome and epigastric pain syndrome, not attributed to pathology.Increasingly it is recognised that tangible pathologies occ...
Source: Best Practice and Research Clinical Gastroenterology - August 17, 2019 Category: Gastroenterology Source Type: research

Utility of animal gastrointestinal motility and transit models in functional gastrointestinal disorders
Publication date: Available online 26 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Ahmad A-Saffar, Shota Takemi, HiwaK. Saeed, Ichiro Sakata, Takafumi SakaiAbstractAlteration in the gastrointestinal (GI) motility and transit comprises an important component of the functional gastrointestinal disorders (FGID). Available animal GI motility and transit models are to study symptoms (delayed gastric emptying, constipation, diarrhea) rather than biological markers to develop an effective treatment that target the underlying mechanism of altered GI motility in patients. Animal data generated f...
Source: Best Practice and Research Clinical Gastroenterology - July 26, 2019 Category: Gastroenterology Source Type: research

Helicobacter pylori eradication in dyspepsia: new evidence for symptomatic benefit
Publication date: Available online 22 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Leandra Koletzko, Lukas Macke, Christian Schulz, Peter MalfertheinerAbstractA causal relationship between Helicobacter pylori (H. pylori) infection and functional dyspepsia (FD) is well established in a subset of infected patients. In the Kyoto and Maastricht/Florence consensus reports H. pylori- associated dyspepsia is defined as an independent entity distinct from FD. H. pylori eradication is therefore the most cost- effective approach for infected patients with dyspeptic symptoms and superior to other ...
Source: Best Practice and Research Clinical Gastroenterology - July 23, 2019 Category: Gastroenterology Source Type: research

Pseudo-obstruction, enteric dysmotility and irritable bowel syndrome
Publication date: Available online 22 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Greger LindbergAbstractNew diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. At the severe end of the symptom spectrum enteric dysmotility marks the border at which IBS ceases ...
Source: Best Practice and Research Clinical Gastroenterology - July 23, 2019 Category: Gastroenterology Source Type: research

The pros and cons of Gastric Bypass surgery – the role of the Roux-limb
Publication date: Available online 23 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Per Björklund, Lars FändriksAbstractThe prevalence of overweight and obesity has exploded in the post-industrial era. Life style interventions like dieting and exercise can induce a marked weight loss, but the main problem for most patients is to maintain the reduced body weight over time. Gastric bypass surgery is a commonly performed and very effective method for achieving a pronounced and sustained weight loss including metabolic improvements in obese patients. Despite the therapeutic success...
Source: Best Practice and Research Clinical Gastroenterology - July 23, 2019 Category: Gastroenterology Source Type: research

Tests of intestinal mucosal hyperpermeability: many diseases, many biomarkers and a bright future
Publication date: Available online 20 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Dominic-Luc WebbAbstractThe number of disorders now linked to increased intestinal mucosal permeability implies that a substantial percent of the population is affected. Drug interventions targeting reduced tight junctional permeability are being pursued. Although hyper-permeability in itself is not a clinically recognized disease entity, its relationship to disease processes has driven interest in measuring, and even monitoring mucosal permeability in vivo. Along with improved knowledge of gut barrier ph...
Source: Best Practice and Research Clinical Gastroenterology - July 22, 2019 Category: Gastroenterology Source Type: research

Editorial Board
Publication date: February–April 2019Source: Best Practice & Research Clinical Gastroenterology, Volumes 38–39Author(s): (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - July 19, 2019 Category: Gastroenterology Source Type: research

The Rome IV: irritable bowel syndrome - a functional disorder
Publication date: Available online 18 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Per M. Hellström, Peter BennoAbstractFunctional gastrointestinal disorders are the most common disorders encountered in the clinical gastroenterology setting. Over the years the Rome process has generated consensus definitions of functional gastrointestinal disorders, and given diagnostic criteria, based on various symptom patterns, that have evolved over the years. The latest Rome IV consensus was presented in May, 2016. This summary points out some of the important changes made from the Rome III 20...
Source: Best Practice and Research Clinical Gastroenterology - July 19, 2019 Category: Gastroenterology Source Type: research

Preface – Gastrointestinal bleeding
Publication date: Available online 9 July 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Vipul Jairath (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - July 10, 2019 Category: Gastroenterology Source Type: research

Publisher's note
Publication date: Available online 28 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Victoria Wetherell (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - June 29, 2019 Category: Gastroenterology Source Type: research

Is there still a role for the surgeon in the management of gastrointestinal bleeding ?
Publication date: Available online 14 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Claire L. Donohoe, Timothy A. RockallAbstractModern investigation of gastrointestinal bleeds allows for reliable source identification in most cases. Current treatment algorithms utilise therapeutic endoscopy or interventional radiology and surgery now plays a limited role in the treatment of gastrointestinal bleeds. Approximately 2–4% of patients admitted with GI bleeds, however, require surgery to control their haemorrhage. (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - June 20, 2019 Category: Gastroenterology Source Type: research

“Can Magnetic Resonance Enterography (MRE) replace ileo-colonoscopy for evaluating disease activity in Crohn's disease?”
Publication date: Available online 31 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Fumi Varyani, Sunil SamuelAbstractCrohn's disease is a form of chronic inflammatory bowel disease that can lead to structural bowel damage due to transmural inflammation. Ileo-colonosocopy is currently essential for initial diagnosis. Reassessment of disease burden is frequently needed during episodes of active disease and when evaluating treatment efficacy. This review compares the role of Magnetic Resonance Enterography (MRE) and ileocolonoscopy in Crohn's disease management and whether cross-sectional i...
Source: Best Practice and Research Clinical Gastroenterology - June 20, 2019 Category: Gastroenterology Source Type: research

Preface - Evolving approaches to the evaluation and management of Crohn’s Disease
Publication date: Available online 19 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Vipul Jairath (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - June 20, 2019 Category: Gastroenterology Source Type: research

Is there still a role for the surgeon in the management of gastrointestinal bleeding?
Publication date: Available online 14 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Claire L. Donohoe, Timothy A. RockallAbstractModern investigation of gastrointestinal bleeds allows for reliable source identification in most cases. Current treatment algorithms utilise therapeutic endoscopy or interventional radiology and surgery now plays a limited role in the treatment of gastrointestinal bleeds. Approximately 2-4% of patients admitted with GI bleeds, however, require surgery to control their haemorrhage. (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - June 16, 2019 Category: Gastroenterology Source Type: research

Interfering with leukocyte trafficking in Crohn's disease
Publication date: Available online 28 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Sujata Biswas, Robert V. Bryant, Simon TravisAbstractThe discovery of gut-specific leukocytes and the ability to modulate their function has been a groundbreaking development in the treatment of inflammatory bowel disease. Drugs target the interaction between lymphocytes and endothelial cells via integrins and their ligand cellular adhesion molecules. Safety, efficacy and sustainability of effect are key to this drug class, notwithstanding the association of natalizumab with fatal polyoma virus infection. ...
Source: Best Practice and Research Clinical Gastroenterology - June 11, 2019 Category: Gastroenterology Source Type: research

Network meta-analysis to inform positioning of biologics in patients with Crohn's disease: Promise and perils
Publication date: Available online 3 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Siddharth SinghAbstractWith availability of several different classes of biologic agents with variable efficacy and safety profiles for moderate-severe Crohn's disease (CD), positioning of different agents in treatment course is an important question for clinicians. Though in an ideal world, positioning would be personalized and driven by likelihood of response to different agents based on biomarkers in individual patients, that is still far from reality, and decisions are empiric. In the absence of head-t...
Source: Best Practice and Research Clinical Gastroenterology - June 10, 2019 Category: Gastroenterology Source Type: research

Optimal timing of endoscopy in patients with acute upper gastrointestinal bleeding
Publication date: Available online 3 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Sardar Chaudhary, Adrian J. StanleyAbstractEndoscopy is the gold standard for evaluating and treating acute upper gastrointestinal bleeding (UGIB). The optimal timing of endoscopy is a very important consideration in the overall management of UGIB, but there is on going uncertainty regarding timing of the procedure, particularly in those with more severe bleeding. This is reflected by inconsistencies between current guidelines. Although evidence suggests endoscopy should be undertaken within 24 h for all...
Source: Best Practice and Research Clinical Gastroenterology - June 4, 2019 Category: Gastroenterology Source Type: research

Network Meta-analysis to Inform Positioning of Biologics in Patients with Crohn’s Disease: Promise and Perils
Publication date: Available online 3 June 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Siddharth SinghAbstractWith availability of several different classes of biologic agents with variable efficacy and safety profiles for moderate-severe Crohn’s disease (CD), positioning of different agents in treatment course is an important question for clinicians. Though in an ideal world, positioning would be personalized and driven by likelihood of response to different agents based on biomarkers in individual patients, that is still far from reality, and decisions are empiric. In the absence of ...
Source: Best Practice and Research Clinical Gastroenterology - June 3, 2019 Category: Gastroenterology Source Type: research

Therapeutic potential of an anaerobic cultured human intestinal microbiota, ACHIM, for treatment of IBS
Publication date: Available online 29 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): P. Benno, E. Norin, T. Midtvedt, P.M. HellströmAbstractBy administering an anaerobic cultivated human intestinal microbiota (ACHIM) via upper gastrointestinal route using endoscopy we aimed to rectify intestinal dysbiosis and simultaneously achieve a treatment response in IBS patients. The study population fulfilled the Rome III IBS criteria and comprised 50 patients. During 10 days, patients recorded the irritable bowel syndrome symptom severity scale (IBS-SSS) along with the Bristol stool scale an...
Source: Best Practice and Research Clinical Gastroenterology - June 1, 2019 Category: Gastroenterology Source Type: research

“Can MRE replace ileo-colonoscopy for evaluating disease activity in Crohn’s Disease?”
Publication date: Available online 31 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Fumi Varyani, Sunil SamuelAbstractCrohn's disease is a form of chronic inflammatory bowel disease that can lead to structural bowel damage due to transmural inflammation. Ileo-colonosocopy is currently essential for initial diagnosis. Reassessment of disease burden is frequently needed during episodes of active disease and when evaluating treatment efficacy. This review compares the role of Magnetic Resonance Enterography (MRE) and ileocolonoscopy in Crohn's disease management and whether cross-sectional i...
Source: Best Practice and Research Clinical Gastroenterology - June 1, 2019 Category: Gastroenterology Source Type: research

Endoscopic scoring systems for the evaluation and monitoring of disease activity in Crohn's disease
Publication date: Available online 28 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Lara Hart, Talat BessissowAbstractCrohn's disease is a chronic relapsing idiopathic condition that can affect any part of the gastrointestinal tract. It has been shown that mucosal healing is associated with improved clinical outcomes such as reduced risk of surgery, hospitalization and complications. Nowadays mucosal healing is considered the optimal target of medical therapy. To evaluate the mucosa in an objective and standardized manner, it is important to rely on accurate and validated endoscopic score...
Source: Best Practice and Research Clinical Gastroenterology - May 29, 2019 Category: Gastroenterology Source Type: research

In the absence of head-to-head trials, what do real world studies tell us about the comparative effectiveness of biologics in Crohn’s disease
Publication date: Available online 29 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Joseph Meserve, Maria Barsky, Parambir S. Dulai (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - May 29, 2019 Category: Gastroenterology Source Type: research

The Role of Colonoscopy and Endotherapy in the Management of Lower Gastrointestinal Bleeding
Publication date: Available online 29 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Neil SenguptaAbstractColonoscopy is an integral diagnostic and therapeutic tool in the management of patients with lower gastrointestinal bleeding (LGIB). After resuscitation, reversal of coagulopathy, and exclusion of a proximal source of bleeding, colonoscopy should be performed in most patients with LGIB. Bowel preparation, typically with polyethylene glycol based solutions, is needed to closely inspect the colonic mucosa for bleeding sources. Colonoscopy within 24 hours is recommended for high-risk pat...
Source: Best Practice and Research Clinical Gastroenterology - May 29, 2019 Category: Gastroenterology Source Type: research

Interfering with leukocyte trafficking in Crohn’s Disease
Publication date: Available online 28 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Sujata Biswas, Robert V. Bryant, Simon TravisAbstractThe discovery of gut-specific leukocytes and the ability to modulate their function has been a groundbreaking development in the treatment of inflammatory bowel disease. Drugs target the interaction between lymphocytes and endothelial cells via integrins and their ligand cellular adhesion molecules. Safety, efficacy and sustainability of effect are key to this drug class, notwithstanding the association of natalizumab with fatal polyoma virus infection. ...
Source: Best Practice and Research Clinical Gastroenterology - May 29, 2019 Category: Gastroenterology Source Type: research

Pathophysiology of the irritable bowel syndrome – reflections of today
Publication date: Available online 24 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Per M. HellströmAbstractIrritable bowel syndrome (IBS) is a chronic gastrointestinal symptom complex defined by abdominal pain and disturbed bowel habits over 3 months within a period of 6 months, in absence of any identifiable organic pathology. Over the years, speculations of the pathophysiology of IBS has moved from elusive central nervous symptoms impinging on psychosomatic disease, to objective signs of intestinal fermentation with abdominal bloating and intestinal dysmotility. The specific subgr...
Source: Best Practice and Research Clinical Gastroenterology - May 25, 2019 Category: Gastroenterology Source Type: research

PREFACE - Functional Gastrointestinal Disorders
Publication date: Available online 16 May 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Per M. Hellström (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - May 17, 2019 Category: Gastroenterology Source Type: research

Therapeutic potential of an anaerobic cultured human intestinal microbiota, ACHIM for treatment of IBS
Publication date: Available online 29 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): P. Benno, E. Norin, T. Midtvedt, P.M. HellströmAbstractBy administering an anaerobic cultivated human intestinal microbiota (ACHIM) via upper gastrointestinal route using endoscopy we aimed to rectify intestinal dysbiosis and simultaneously achieve a treatment response in IBS patients. The study population fulfilled the Rome III IBS criteria and comprised 50 patients. During 10 days, patients recorded the irritable bowel syndrome symptom severity scale (IBS-SSS) along with the Bristol stool scale an...
Source: Best Practice and Research Clinical Gastroenterology - April 30, 2019 Category: Gastroenterology Source Type: research

Proton pump inhibitors for upper gastrointestinal bleeding
Publication date: Available online 17 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Omar Kherad, Sophie Restellini, Myriam Martel, Alan BarkunSummaryAcute upper gastrointestinal bleeding (UGIB) remains a public health burden with a persistent high mortality despite advances in modern day management. Proton pump inhibitors (PPI) as medical therapy is an attractive adjuvant to endoscopic treatment in UGIB but the method and dose of PPI therapy remains controversial. This chapter aims to describe the current evidence addressing acute PPI use in the management of UGIB. It will explore the e...
Source: Best Practice and Research Clinical Gastroenterology - April 18, 2019 Category: Gastroenterology Source Type: research

Changing epidemiology and etiology of upper and lower gastrointestinal bleeding
Publication date: Available online 17 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Kathryn OaklandAbstractUpper gastrointestinal bleeding (UGIB) develops in the oesophagus, stomach or duodenum and has an incidence of 47/100,000. Lower GIB (LGIB) develops in the small bowel, colon or anorectum and has an incidence of 33/100,000. Where the incidence of UGIB has fallen, driven by helicobacter pylori eradication and the use of proton pump inhibitors, the incidence of LGIB may be increasing. Interventions such as early endoscopy, risk assessment and national guidelines have improved clinica...
Source: Best Practice and Research Clinical Gastroenterology - April 18, 2019 Category: Gastroenterology Source Type: research

When all else fails - radiological management of severe gastrointestinal bleeding
Publication date: Available online 17 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Romaric Loffroy, Nicolas Falvo, Motoki Nakaï, Lorenzo Pescatori, Marco Midulla, Olivier ChevallierAbstractAlthough most cases of acute nonvariceal gastrointestinal bleeding (GIB) either spontaneously resolve or respond to medical management and endoscopic therapy, there are still a significant proportion of severe patients who require emergency angiography and endovascular treatment. Over the past three decades, transcatheter arterial embolization (TAE) has become the first-line therapy for the mana...
Source: Best Practice and Research Clinical Gastroenterology - April 18, 2019 Category: Gastroenterology Source Type: research

Risk stratification in upper and upper and lower GI bleeding: which scores should we use?
Publication date: Available online 17 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Dr Kathryn OaklandABSTRACTRisk assessment is widely used in upper gastrointestinal bleeding (UGIB) however no score accurately predicts all important clinical outcomes. This review discusses the performance of the Rockall score, pre-endsocopy Rockall score, Glasgow-Blatchford score, AIMS-65 and newer scores such as Progetto Nazionale Emorragia Digestiva and CANUKA scores. The quality of external validation varies considerably for each score. There is a relative lack of risk scores available for use in lo...
Source: Best Practice and Research Clinical Gastroenterology - April 18, 2019 Category: Gastroenterology Source Type: research

Endoscopic management of nonvariceal upper gastrointestinal bleeding
Publication date: Available online 17 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Pablo Cañamares, Francis K.L. ChanAbstractEndoscopic therapy is the mainstay of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB). Injection plus mechanical or thermal therapy continues to be the most widely used option. New endoscopic devices such as the use of an inert powder or a new class of over-the-scope clip system have demonstrated encouraging results as a rescue therapy for difficult hemostasis. Emerging data suggest that Doppler ultrasound- guided endoscopic therapy may ...
Source: Best Practice and Research Clinical Gastroenterology - April 18, 2019 Category: Gastroenterology Source Type: research

Optimal management of the patient presenting with small bowel bleeding
Publication date: Available online 17 April 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Michael Sai Lai Sey, Brian Michael YanAbstractThe management of small bowel bleeding, also known as obscure gastrointestinal bleeding, has changed substantially over the past two decades due to revolutionary technological advances in small intestinal endoscopy. This clinical review will summarize the evolving definition of small bowel bleeding, how to perform a detailed initial assessment of patients with the condition, the strengths and limitations of small bowel endoscopy, and the treatment of small bo...
Source: Best Practice and Research Clinical Gastroenterology - April 18, 2019 Category: Gastroenterology Source Type: research

Pharmacology, Efficacy and Safety of JAK Inhibitors in Crohn’s Disease
Publication date: Available online 6 March 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Ma Christopher, Jairath Vipul, Vande Casteele NielsAbstractOrally bioavailable inhibitors of the tyrosine kinases (TYKs), also referred to as Janus kinases (JAKs), are being evaluated for the treatment of patients with Crohn’s disease (CD), ulcerative colitis (UC), and other chronic inflammatory disorders. To date, three JAK inhibitors have been tested in patients with moderate-to-severe CD: tofacitinib (pan-JAK inhibitor), filgotinib (JAK1 inhibitor) and upadacitinib (JAK1 inhibitor). Clinical deve...
Source: Best Practice and Research Clinical Gastroenterology - March 7, 2019 Category: Gastroenterology Source Type: research

What is the role of C-reactive protein and fecal calprotectin in evaluating Crohn's disease activity?
Publication date: Available online 22 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Christopher Ma, Robert Battat, Reena Khanna, Claire E. Parker, Brian G. Feagan, Vipul JairathAbstractHistorically, the evaluation of patients with Crohn's disease (CD) has centered on use of subjective symptom-based assessment. However, patients with CD experience a broad spectrum of non-specific symptoms that may not directly correlate with objective measures of inflammation. Endoscopy has been the gold standard for evaluating the burden and severity of mucosal disease. However, use of ileocolonoscop...
Source: Best Practice and Research Clinical Gastroenterology - March 1, 2019 Category: Gastroenterology Source Type: research

IL12/23 or selective IL23 inhibition for the management of moderate-to-severe Crohn's disease?
Publication date: Available online 19 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Christopher Ma, Remo Panaccione, Reena Khanna, Brian G. Feagan, Vipul JairathAbstractThe interleukin (IL)-12 family of cytokines, including IL12 and IL 23, play an important role in driving aberrant Th1 and Th17 immune responses in patients with Crohn's disease (CD). Targeting this pathway has opened new avenues for therapeutic intervention. The approval of ustekinumab, a monoclonal antibody blocking the common p40 subunit of IL12 and IL23, marked an important evolution in medical management for CD: t...
Source: Best Practice and Research Clinical Gastroenterology - February 26, 2019 Category: Gastroenterology Source Type: research

What is the role of histopathology in the evaluation of disease activity in Crohn's disease?
Publication date: Available online 15 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Rish K. Pai, Vipul JairathAbstractAssessment of disease activity is essential for developing and determining appropriate therapy in patients with Crohn's disease. Currently, clinical and endoscopic treatment targets have been proposed, whereas histologic assessment of disease activity is not recommended in expert guidelines. Histologic assessment of disease activity has emerged as an important tool in ulcerative colitis as persistent histological inflammation is associated with clinical relapse, corti...
Source: Best Practice and Research Clinical Gastroenterology - February 22, 2019 Category: Gastroenterology Source Type: research

What is the role of C-reactive protein and fecal calprotectin in evaluating Crohn’s disease activity?
Publication date: Available online 22 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Christopher Ma, Robert Battat, Reena Khanna, Claire E. Parker, Brian G. Feagan, Vipul JairathAbstractHistorically, the evaluation of patients with Crohn’s disease (CD) has centered on use of subjective symptom-based assessment. However, patients with CD experience a broad spectrum of non-specific symptoms that may not directly correlate with objective measures of inflammation. Endoscopy has been the gold standard for evaluating the burden and severity of mucosal disease. However, use of ileocolo...
Source: Best Practice and Research Clinical Gastroenterology - February 22, 2019 Category: Gastroenterology Source Type: research

IL12/23 or Selective IL23 Inhibition for the Management of Moderate-to-Severe Crohn’s Disease?
Publication date: Available online 19 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Christopher Ma, Remo Panaccione, Reena Khanna, Brian G. Feagan, Vipul JairathAbstractThe interleukin (IL)-12 family of cytokines, including IL12 and IL 23, play an important role in driving aberrant Th1 and Th17 immune responses in patients with Crohn’s disease (CD). Targeting this pathway has opened new avenues for therapeutic intervention. The approval of ustekinumab, a monoclonal antibody blocking the common p40 subunit of IL12 and IL23, marked an important evolution in medical management for...
Source: Best Practice and Research Clinical Gastroenterology - February 19, 2019 Category: Gastroenterology Source Type: research

What is the role of histopathology in the evaluation of disease activity in Crohn’s Disease?
Publication date: Available online 15 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Rish K. Pai, Vipul JairathAbstractAssessment of disease activity is essential for developing and determining appropriate therapy in patients with Crohn’s disease. Currently, clinical and endoscopic treatment targets have been proposed, whereas histologic assessment of disease activity is not recommended in expert guidelines. Histologic assessment of disease activity has emerged as an important tool in ulcerative colitis as persistent histological inflammation is associated with clinical relapse,...
Source: Best Practice and Research Clinical Gastroenterology - February 16, 2019 Category: Gastroenterology Source Type: research

Evolution of treatment targets in Crohn’s Disease
Publication date: Available online 16 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Jonathan R. White, Gordon W. Moran, Vipul JairathAbstractCrohn’s disease is a chronic relapsing and remitting inflammatory disorder of the gastrointestinal tract, associated with significantly morbidity due to both symptoms and complications that have a considerable detrimental impact on a patient’s quality of life. An early treat to target approach with disease modifying agents has been shown to significantly improve long term outcomes, demonstrated by a number of therapeutic targets in a...
Source: Best Practice and Research Clinical Gastroenterology - February 16, 2019 Category: Gastroenterology Source Type: research

Targeting anti-fibrotic pathways in Crohn’s Disease – the final frontier?
Publication date: Available online 16 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Christopher Ma, Vipul Jairath, Benjamin Click, Simon A. Hirota, Cathy Lu, Claire E. Parker, Florian Rieder, Stenosis Therapy and Anti-Fibrotic Research (STAR) ConsortiumABSTRACTIntestinal fibrosis with stricture formation affects up to half of patients with Crohn’s disease (CD), resulting in impaired quality of life, increased risk of surgical intervention, and associated patient morbidity. The underlying pathophysiologic mechansisms responsible for initiating and perpetuating intestinal fibrosi...
Source: Best Practice and Research Clinical Gastroenterology - February 16, 2019 Category: Gastroenterology Source Type: research

The optimal use of blood components in the management of gastrointestinal bleeding
Publication date: Available online 16 February 2019Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Killian Donovan, Simon Stanworth, Vipul JairathAbstractAcute gastrointestinal bleeding accounts for 5,000 deaths per annum in the UK and is the second-most common indication for transfusion of blood components. Transfusion of blood components is integral to management of these patients. Recent years have seen an expansion in the evidence base for their use in this population and this review aims to provide up-to-date guidance on the use of red cells, plasma, platelets, sources of concentrated fibrinog...
Source: Best Practice and Research Clinical Gastroenterology - February 16, 2019 Category: Gastroenterology Source Type: research

Editorial Board
Publication date: October–December 2018Source: Best Practice & Research Clinical Gastroenterology, Volumes 36–37Author(s): (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - December 12, 2018 Category: Gastroenterology Source Type: research

Preface “Oesophageal cancer”
Publication date: October–December 2018Source: Best Practice & Research Clinical Gastroenterology, Volumes 36–37Author(s): Bas Wijnhoven, Andrew Davies (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - December 12, 2018 Category: Gastroenterology Source Type: research

Peri-operative patient optimization for oesophageal cancer surgery – From prehabilitation to enhanced recover
Publication date: Available online 30 November 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): J. Zylstra, P. Boshier, G.P. Whyte, D.E. Low, A.R. Davies (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - December 5, 2018 Category: Gastroenterology Source Type: research

The management of mid & proximal oesophageal squamous cell carcinoma
Publication date: Available online 30 November 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Ian Wong, Simon LawAbstractDespite the rise in incidence of adenocarcinoma, squamous cell cancer of the oesophagus remains the commonest cell type worldwide and is predominant in the East. Except for very early tumours where endoscopic therapy can be performed with curative intent, in more advanced but potentially curative cancers, treatment for mid and upper third tumours is primarily surgery with extended lymphadenectomy, together with multimodal therapies such as preoperative chemotherapy or chemor...
Source: Best Practice and Research Clinical Gastroenterology - December 1, 2018 Category: Gastroenterology Source Type: research

Robot assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer
Publication date: Available online 29 November 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Pieter Christiaan van der Sluis, Richard van HillegersbergAbstract:Worldwide, the standard treatment for locally advanced esophageal cancer with curative intent is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE) with gastric conduit reconstruction. Minimally invasive esophagectomy (MIE) was developed to improve the postoperative outcome by reducing the surgical trauma, with comparable short-term oncologic results. However, MIE is a highly...
Source: Best Practice and Research Clinical Gastroenterology - December 1, 2018 Category: Gastroenterology Source Type: research

Peri-operative patient optimization for oesophageal cancer surgery – From prehabilitation to enhanced recover
Publication date: Available online 30 November 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): J. Zylstra, P. Boshier, G.P. Whyte, D.E. Low, A.R. Davies (Source: Best Practice and Research Clinical Gastroenterology)
Source: Best Practice and Research Clinical Gastroenterology - December 1, 2018 Category: Gastroenterology Source Type: research