Harmful and Beneficial Effects of Anticoagulants in Patients With Cirrhosis and Portal Vein Thrombosis
We read with great interest the recent publication by La Mura et  al1 that focused on the potential beneficial role of anticoagulants in the treatment of portal vein thrombosis (PVT) in cirrhotic patients. The investigators concluded that vitamin k anticoagulants (VKA) is highly effective in portal recanalization, without any evidence of an increased risk of ble eding, compared with untreated cirrhotic patients. In addition, La Mura et al1 successfully showed that achieving a complete recanalization of portal vein thrombosis (PVT) with VKA is associated with a significant reduction in the long-term risk of portal...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Chiara Mazzarelli, Marcello Vangeli, Aldo Airoldi Tags: Letter to the Editor Source Type: research

AGA Clinical Practice Update on Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: Expert Review
Description: The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in patients with inflammatory bowel disease (IBD).Methods: The evidence and best practices summarized in this manuscript are based on relevant scientific publications, systematic reviews, and expert opinion where applicable.Best practice advice 1: A stepwise approach to rule-out ongoing inflammatory activity should be followed in IBD patients with persistent GI symptoms (measurement of fecal calprotectin, endoscopy with biopsy, cross-sectional imaging). ...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Jean-Frederic Colombel, Andrea Shin, Peter R. Gibson Tags: Clinical Practice Update Source Type: research

Intestinal Spirochetosis Resembles Inflammatory Bowel Disease in a Patient With HIV Infection
A 45-year-old man with human immunodeficiency virus infection and undetectable viral load on antiretroviral therapy, who engaged in sex with men, was evaluated for 1 month of constipation, abdominal pain, and intermittent rectal bleeding. He reported a transient rash, which resolved at presentation. Colonoscopy (Figure A) showed aphthous ulcers, friability, and exudates in the rectosigmoid colon and cecum with normal intervening colon and terminal ileum. Colonic biopsies (Figure B) showed long, undulating bacteria attached vertically to the brush border, and stained black with Warthin –Starry stain, consistent with h...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Manasi Agrawal, Wei Zhang, Dana Lukin Tags: Electronic Image of the Month Source Type: research

Altered Microbiome in Patients With Cirrhosis and Complications
In patients with cirrhosis, the gut microbiome are affected by multiple gut and systemic alterations. These changes lead to dysbiosis in the microbiota of different parts of the body, resulting in inflammation. The constant immune stimulation resulting in part from dysbiosis is associated with morbidity in patients with cirrhosis. Dysbiosis as a dynamic event worsens with decompensation such as with hepatic encephalopathy, infections or acute-on-chronic liver failure (ACLF). These microbial patterns could be applied as diagnostic and prognostic measures in cirrhosis in the outpatient and inpatient setting. (Source: Clinica...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Chathur Acharya, Jasmohan S. Bajaj Tags: Microbiome in specific diseases Source Type: research

Herpes Esophagitis That Resembles Candidiasis
A 73-year-old man was admitted for health care –associated bilateral pneumonia and was treated with piperacillin/tazobactam. No microbiological agent was identified. Past medical history was relevant for 2 recent and long hospital admissions for severe depression with psychotic symptoms. The patient continued to refuse food and weight loss per sisted despite resolution of pneumonia. An upper digestive endoscopy was performed and the examination showed numerous scattered and coalescing white plaques in the distal two thirds of the esophagus (Figure A). (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Joyce Chivia, Pedro C. Figueiredo Tags: Electronic Image of the Month Source Type: research

Safety and Acceptability of a Nonendoscopic Esophageal Sampling Device – Cytosponge: A Systematic Review of Multicenter Data
Diagnosis and surveillance of Barrett ’s esophagus (BE) and eosinophilic esophagitis (EoE) have become emerging public health issues. Cytosponge® is a novel, minimally invasive esophageal cell collection device. We aimed to assess the data on safety and acceptability of this device. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Wladyslaw Januszewicz, Wei Keith Tan, Katie Lehovsky, Irene Debiram-Beecham, Tara Nuckcheddy, Susan Moist, Sudarshan Kadri, Massimiliano di Pietro, Alex Boussioutas, Nicholas J. Shaheen, David A. Katzka, Evan S. Dellon, Rebecca C. Fitzgerald, BEST1 and BE Source Type: research

Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease
Description: The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in patients with inflammatory bowel disease (IBD).Methods: The evidence and best practices summarized in this manuscript are based on relevant scientific publications, systematic reviews, and expert opinion where applicable.Best practice advice 1: A stepwise approach to rule-out ongoing inflammatory activity should be followed in IBD patients with persistent GI symptoms (measurement of fecal calprotectin, endoscopy with biopsy, cross-sectional imaging). ...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Jean-Frederic Colombel, Andrea Shin, Peter R. Gibson Source Type: research

Intramucosal Metastasis of Gastric Cancer to the Duodenum
A 74-year-old man received systemic chemotherapy for advanced gastric cancer for 11 months. After 4 courses of chemotherapy, the supraclavicular and para-aortic lymph node metastases had become smaller, and surgical resection of the primary tumor was scheduled. Fluorodeoxyglucose –positron emission tomography was performed for preoperative restaging of cancer. Fluorodeoxyglucose–positron emission tomography (Figure A) detected a significant accumulation of glucose analogues in the duodenum, in addition to the primary tumor of gastric cancer and lymph node metastasis. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Masako Mishima, Takaki Sakurai, Shin ’ichi Miyamoto Tags: Image of the Month Source Type: research

Porphyria Cutanea Tarda Improvement With Elbasvir/Grazoprevir in End-Stage Renal Disease
A 56-year-old woman with chronic hepatitis C virus (HCV), cirrhosis, and end-stage renal disease (ESRD) was referred for evaluation. On examination, she had multiple painful vesicular lesions that progressed to crusting (Figure A). Laboratory results showed HCV genotype 1a with a viral load of 92,200 IU/mL. Plasma porphyrin levels were increased as follows: hexacarboxylporphyrin, 6.1 ug/L; heptacarboxylporphyrin, 41.5 ug/L; coproporphyrin, 1.8 ug/L; uroporphyrin, 129.2 ug/L; and total plasma porphyrin, 181.4 ug/L. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Gurbir Sehmbey, Anil Seetharam Tags: Electronic Image of the Month Source Type: research

Sex-Based Differences in the Association Between Nonalcoholic Fatty Liver Disease and Mortality
We read with interest the study by Hwang et  al1 recently published in Clinical Gastroenterology and Hepatology. They performed a large cohort study, including 318,224 subjects in Korea, to evaluate the association between sex and clinical outcomes (including overall mortality, death from cancer, cardiovascular disease, and liver disease) of nonalcoholic fatty liver disease (NAFLD). They concluded that the relationship between NAFLD and clinical outcomes was different for men and women in Korea. NAFLD was associated with a higher risk of all-cause mortality, death from cancer, cardiovascular disease, and liver disease...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Zi-Liang Ye, Wen-Qin Guo, Lang Li Tags: Letter to the Editor Source Type: research

Quantification of Antibody to Hepatitis B Core Antigen to Predict Outcomes of Patients With HBV Infection
Patients with chronic hepatitis B (CHB) have highly variable outcomes with diverse clinical features and prognosis.1 Through long-term treatment with potent nucleos(t)ide analogues (NUC) that have high genetic barriers to drug resistance, the prevention of disease progression to end-stage liver disease and a reduction in the risk of hepatocellular carcinoma (HCC) is achievable in most patients with CHB.2 –4 However, functional cure (hepatitis B surface antigen [HBsAg] seroclearance) is very rarely achievable,5 and the optimal timing of treatment initiation and discontinuation remains debatable. (Source: Clinical Gast...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Young-Suk Lim Tags: Editorial Source Type: research

▪▪▪
We read with great interest the recent publication by La Mura et  al1 that focused on the potential beneficial role of anticoagulants in the treatment of portal vein thrombosis (PVT) in cirrhotic patients. The investigators concluded that anticoagulant therapy (VKA) is highly effective in portal recanalization, without any evidence of an increased risk of bleedi ng, compared with untreated cirrhotic patients. In addition, La Mura et al1 successfully showed that achieving a complete recanalization of PVT with VKA is associated with a significant reduction in the long-term risk of PTH-related complication and death...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Chiara Mazzarelli, Marcello Vangeli, Aldo Airoldi Tags: Letter to the Editor Source Type: research

An Inflammatory Bowel Disease Mimic in a Patient With Human Immunodeficiency Virus
A 45-year-old man with human immunodeficiency virus infection and undetectable viral load on antiretroviral therapy, who engaged in sex with men, was evaluated for 1 month of constipation, abdominal pain, and intermittent rectal bleeding. He reported a transient rash, which resolved at presentation. A colonoscopy (Figure A) showed aphthous ulcers, friability, and exudates in the rectosigmoid colon and cecum with normal intervening colon and terminal ileum. A colonic biopsy (Figure B) showed long, undulating bacteria attached vertically to the brush border, and stained black with Warthin –Starry stain, consistent with...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Manasi Agrawal, Wei Zhang, Dana Lukin Tags: Electronic Image of the Month Source Type: research

Safety and acceptability of a non-endoscopic esophageal sampling device – Cytosponge®: a systematic review of multi-center data
Diagnosis and surveillance of Barrett ’s esophagus (BE) and eosinophilic esophagitis (EoE) have become emerging public health issues. Cytosponge® is a novel, minimally invasive esophageal cell collection device. We aimed to assess the data on safety and acceptability of this device. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Wladyslaw Januszewicz, Wei Keith Tan, Katie Lehovsky, Irene Debiram-Beecham, Tara Nuckcheddy, Susan Moist, Sudarshan Kadri, Massimiliano di Pietro, Alex Boussioutas, Nicholas J. Shaheen, David A. Katzka, Evan S. Dellon, Rebecca C. Fitzgerald, BEST 1 and B Source Type: research

Functional gastrointestinal symptoms in patients with inflammatory bowel disease: A clinical challenge
The purpose of this clinical practice update review is to describe key principles in the diagnosis and management of functional gastrointestinal (GI) symptoms in patients with inflammatory bowel disease (IBD). (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Jean-Frederic Colombel, Andrea Shin, Peter R. Gibson Source Type: research

Sex-Based Differences in the Association between Non-alcoholic Fatty Liver Disease and Mortality
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Zi-Liang Ye, Wen-Qin Guo, Lang Li Source Type: research

Anti-HBc Quantitation as a New Biomarker of Hepatitis B Virus Infection: Surrogate Markers Predicting Surrogate Endpoints
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Young-Suk Lim Source Type: research

Reply to “Harmful and beneficial effects of anticoagulants in patients with cirrhosis and portal vein thrombosis”
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Chiara Mazzarelli, Marcello Vangeli, Aldo Airoldi Source Type: research

Patient, Procedure, and Endoscopist Risk Factors for Perforation, Bleeding, and Splenic Injury After Colonoscopies
We investigated perforations, bleeding, and splenic injuries after screening or diagnostic colonoscopies to identify patient-, procedure-, endoscopist-, and facility-associated risk factors. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Moussa Laanani, Jo ël Coste, Pierre-Olivier Blotière, Franck Carbonnel, Alain Weill Source Type: research

Intramucosal metastasis to the duodenum from the gastric cancer
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Masako Mishima, Takaki Sakurai, Shin ’ichi Miyamoto Tags: Image of the Month Source Type: research

Erroneous use of endoscopic biopsy data in Crohn ’s disease
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: H.J. Van Kruiningen, R. Sura Source Type: research

The Microbiome in Cirrhosis and its Complications
The microbiome in cirrhosis is affected by multiple processes occurring at the level of the gut and systemically. This dysbiosis, or unfavorable microbiota profile, is present at several body sites and is associated with higher systemic inflammation, bacterial infections and poor outcomes. This increased morbidity in cirrhosis stems from an immune paralysis state that is partly related to the constant stimulation of the immune system by this dysbiosis. Dysbiosis as a dynamic event worsens with decompensation such as with hepatic encephalopathy, infections or acute-on-chronic liver failure (ACLF). (Source: Clinical Gastroen...
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Chathur Acharya, Jasmohan S. Bajaj Source Type: research

When to Resume Direct Oral Anticoagulants Following Gastrointestinal Bleeding
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Moe H. Kyaw, Francis K.L. Chan Source Type: research

Neuroendocrine Tumor Presenting as a Large Gastric Ulcer
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Ronald Samuel, Timothy Krill, Praveen Guturu Source Type: research

Gastric hamartomatous inverted polyp causing ball valve syndrome
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Gota Sudo, Tokuma Tanuma, Hiroshi Nakase Tags: Image of the Month Source Type: research

Herpes esophagitis mimicking Candidiasis
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Joyce Chivia, Pedro C. Figueiredo Tags: Image of the Month Source Type: research

A Rare Case of Asymptomatic Primary Gastric Localized Amyloidosis
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Yu ’e Ding, Yue Li, Leimin Sun Tags: Image of the Month Source Type: research

Porphyria Cutanea Tarda Improvement with Elbasvir/Grazoprevir in End Stage Renal Disease
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 9, 2018 Category: Gastroenterology Authors: Gurbir Sehmbey, Anil Seetharam Tags: Image of the Month Source Type: research

Splenic Artery Aneurysm Causing Gastric Extraluminal Compression With a Positive Pillow Sign
A 63-year-old woman with cirrhosis was transferred to our medical facility for higher-level care after outside hospitalization for dizziness, nausea, and right upper-quadrant pain. On arrival, she additionally reported nonbloody emesis, epigastric pain, and early satiety with postprandial discomfort. The patient underwent oral endoscopic ultrasonography (EUS) for a yellowish 4-cm submucosal tumor at the gastric body with a positive pillow sign (Figure A). On EUS, a vascular structure appeared at the bulge that was highly suggestive of a splenic artery aneurysm (SAA) based on Doppler readout (Figures B and C). (Source: Clin...
Source: Clinical Gastroenterology and Hepatology - August 6, 2018 Category: Gastroenterology Authors: Albert C. Chong, Laith H. Jamil Tags: Electronic Image of the Month Source Type: research

Pedunculated Upper Esophageal Adenocarcinoma in Lynch Syndrome
An 84-year-old woman was referred to our hospital for an esophageal polypoid lesion. Endoscopy showed a pedunculated polyp (Figure A, left) and heterotopic gastric mucosa (HGM) (Figure  A, right, arrow) in the upper esophagus, and histologic examination of the biopsy specimen showed adenocarcinoma (Figure B). Because magnetic resonance imaging showed metastatic brain tumors, polypectomy was not performed and the patient died 3 months later. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 6, 2018 Category: Gastroenterology Authors: Hajime Sasaki, Kentaro Yamashita, Hiroshi Nakase Tags: Image of the Month Source Type: research

A Case of Intentional Elemental Mercury Ingestion
A 22-year-old man ingested 2 tablespoons of elemental mercury from a home chemistry set in a suicide attempt. On presentation, he denied any symptoms. Vital signs and routine laboratory test results were unremarkable. His 24-hour urine mercury test result was 44 ug/L. An acute abdominal series showed scattered radiopaque material throughout the small bowel, large bowel, and right lower lung (Figure A). He was given 4 L polyethylene glycol to facilitate whole-bowel irrigation. Serial abdominal plain films showed improvement of radiopaque material and the patient remained asymptomatic. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 6, 2018 Category: Gastroenterology Authors: Zachary Neubert, Edward Stickle Tags: Electronic Image of the Month Source Type: research

Acceptability, Accuracy, and Safety of Disposable Transnasal Capsule Endoscopy for Barrett's Esophagus Screening
Screening for Barrett ’s esophagus (BE) with conventional esophagogastroduodenoscopy (C-EGD) is expensive. We assessed the performance of a clinic-based, single use transnasal capsule endoscope (EG Scan II) for the detection of BE, compared to C-EGD as the reference standard. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 3, 2018 Category: Gastroenterology Authors: Sarmed S. Sami, Prasad G. Iyer, Prachi Pophali, Magnus Halland, Massimiliano di Pietro, Jacobo Ortiz-Fernandez-Sordo, Jonathan R. White, Michele Johnson, Indra Neil Guha, Rebecca C. Fitzgerald, Krish Ragunath Source Type: research

Involution of Portal Hypertensive Gastric and Duodenal Polyps Following Liver Transplantation
A 49 year-old man with alcoholic cirrhosis presented with upper gastrointestinal bleeding and ascites. Endoscopy showed grade 2 esophageal varices with innumerable sessile polyps of the stomach and duodenum with diffuse hemorrhage (Figures A and B), which were treated with epinephrine injection and hemostatic clips. Over the following months, the patient had frequent hospitalizations for recurrent bleeding from the polyps and refractory ascites. Endoscopic biopsy of the polyps showed hyperplastic duodenal mucosa with vascular ectasia (Figure C, arrows) and patchy erosion (Figure C, arrowheads). (Source: Clinical Gastroente...
Source: Clinical Gastroenterology and Hepatology - August 3, 2018 Category: Gastroenterology Authors: Helen S. Te, John Renz, Claus Fimmel Tags: Electronic Image of the Month Source Type: research

Lymphogranuloma Venereum Proctitis
A 47-year-old man with a medical history of human immunodeficiency virus infection, primary syphilis, hepatitis A, typhoid fever, and tubercular polyneuritis presented with rectorrhagia and anal flowing. The patient was homosexual and reported unprotected anal intercourse 3 weeks before. The human immunodeficiency virus infection was controlled by antiretroviral  therapy (elvitegravir, emtricitabine, tenofovir alafenamide, cobicistat), with an undetectable viral load and a normal CD4 T-cell count. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 3, 2018 Category: Gastroenterology Authors: Cl émentine Riault, Mathurin Fumery, Jean-Philippe Le Mouel Tags: Electronic Image of the Month Source Type: research

Acceptability, Accuracy and Safety of Disposable Transnasal Capsule Endoscopy for Barrett ’s Esophagus Screening
Screening for Barrett ’s esophagus (BE) with conventional esophagogastroduodenoscopy (C-EGD) is expensive. We assessed the performance of a clinic-based, single use transnasal capsule endoscope (EG Scan II) for the detection of BE, compared to C-EGD as the reference standard. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 3, 2018 Category: Gastroenterology Authors: Sarmed S. Sami, Prasad G. Iyer, Prachi Pophali, Magnus Halland, Massimiliano di Pietro, Jacobo Ortiz-Fernandez-Sordo, Jonathan R. White, Michele Johnson, Indra Neil Guha, Rebecca C. Fitzgerald, Krish Ragunath Source Type: research

Normal values of esophageal distensibility and distension-induced contractility measured by functional luminal imaging probe panometry
Functional luminal imaging probe (FLIP) panometry provides a comprehensive evaluation of esophageal functional at the time of endoscopy, including assessment of esophageal distensibility and distension-induced esophageal contractility. However, the few and inconsistent findings from healthy individuals pose challenges to application of FLIP to research and clinical practice. We performed FLIP panometry in asymptomatic volunteers. (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 3, 2018 Category: Gastroenterology Authors: Dustin A. Carlson, Wenjun Kou, Zhiyue Lin, Monique Hinchcliff, Anjali Thakrar, Sophia Falmagne, Jacqueline Prescott, Emily Dorian, Peter J. Kahrilas, John E. Pandolfino Source Type: research

Involution of Portal Hypertensive Gastric and Duodenal Polyps  Following Liver Transplantation
A 49 year-old man with alcoholic cirrhosis presented with upper gastrointestinal bleeding and ascites. Endoscopy showed grade 2 esophageal varices with innumerable sessile polyps of the stomach and duodenum with diffuse hemorrhage (Figures A and B), which were treated with epinephrine injection and hemostatic clips. Over the following months, the patient had frequent hospitalizations for recurrent bleeding from the polyps and refractory ascites. Endoscopic biopsy of the polyps showed hyperplastic duodenal mucosa with vascular ectasia (Figure C, arrows) and patchy erosion (Figure C, arrowheads). (Source: Clinical Gastroente...
Source: Clinical Gastroenterology and Hepatology - August 3, 2018 Category: Gastroenterology Authors: Helen S. Te, John Renz, Claus Fimmel Tags: Electronic image of the month Source Type: research

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States
Endoscopic submucosal dissection (ESD) is an established endoscopic resection method in Asian countries, which is increasingly practiced in Europe and by early adopters in the United States for removal of early cancers and large lesions from the luminal gastrointestinal tract. The intent of this expert review is to provide an update regarding the clinical practice of ESD with a particular focus on its use in the United States. This review is framed around the 16 best practice advice points agreed upon by the authors, which reflect landmark and recent published articles in this field.  This expert review also reflects ...
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Peter V. Draganov, Andrew Y. Wang, Mohamed O. Othman, Norio Fukami Tags: Clinical practice update: Expert review Source Type: research

American Gastroenterological Association Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States
Endoscopic submucosal dissection (ESD) is an established endoscopic resection method in Asian countries, which is increasingly practiced in Europe and by early adopters in the United States for removal of early cancers and large lesions from the luminal gastrointestinal tract. The intent of this expert review is to provide an update regarding the clinical practice of ESD with a particular focus on its use in the United States. This review is framed around the 16 best practice advice points agreed upon by the authors, which reflect landmark and recent published articles in this field.  This expert review also reflects ...
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Peter V. Draganov, Andrew Y. Wang, Mohamed O. Othman, Norio Fukami Source Type: research

Coexistence of Complete Pancreas Divisum and Anomalous  Pancreaticobiliary Junction in a Patient With Type IA Choledochal Cyst
A 29-year-old woman was admitted to our hospital with jaundice for 1 month. Laboratory findings showed an increased total bilirubin level (4.4 mg/dL) and direct bilirubin level (3.9 mg/dL). Magnetic resonance cholangiopancreatography showed dilated intrahepatics and cystic dilatation of the extrahepatic bile duct (Figure A). Subsequent endoscopic retrograde cholangiopancreatography (ERCP) via the major papilla confirmed a markedly dilated intrahepatic biliary tree  with saccular dilation of the common bile duct (Figure B). (Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Jun Cao, Lei Wang, Xiaoping Zou Tags: Image of the Month Source Type: research

Primary gastrointestinal stromal tumor of the liver
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Hai-Jie Hu, Yi-Yun Fu, Fu-Yu Li Tags: Image of the Month Source Type: research

Coexistence of Complete Pancreas Divisum and Anomalous Pancreaticobiliary junction in a Patient with Type IA Choledochal Cyst
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Jun Cao, Lei Wang, Xiaoping Zou Tags: Image of the Month Source Type: research

Importance of Evaluating Cardiovascular Risk and Hepatic Fibrosis in Patients With Newly Diagnosed Nonalcoholic Fatty Liver Disease
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Maria Cristina Moreno-del Castillo, Alain Sanchez-Rodriguez, Javier Jose Hernandez-Buen Abad, Jonathan Aguirre-Valadez, Isaac Ruiz, Ricardo Garcia-Buen Abad, Kassandra Oliva, Joey Piccolo, Esteban De Icaza-del Rio, Jose Ramon Mena-Ramirez, Maria Emilia Me Source Type: research

Unusual Masquerader of an Adenomatous Colorectal Polyp
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Tiffany Rui Xuan Gan, Lawrence Khek-Yu Ho, Choon Seng Chong Tags: Image of the Month Source Type: research

Clinical practice of endoscopic submucosal dissection in the United States
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 2, 2018 Category: Gastroenterology Authors: Peter V. Draganov, Andrew Y. Wang, Mohamed O. Othman, Norio Fukami Source Type: research

A Typical Presentation of Tuberculosis in Cirrhosis
A 44-year old woman with Child –Pugh A cirrhosis presented with large-volume ascites. Laboratory indices showed an international normalized ratio of 1.7, a bilirubin level of 90 umol/L, WCC of 8.4 × 109/L, and an albumin level of 29 g/dL. Ascitic fluid analysis showed a WCC of 35 cells/mm3, culture and cytology were negative, and the serum albumin-ascites gradient was 9 g/dL. Cross-sectional imaging showed no hepatocellular carcinoma or pathologic lymphadenopathy. A computed tomography–positron-emission tomography scan (Figure A) showed intense uptake of a thickened peritoneum consistent wi...
Source: Clinical Gastroenterology and Hepatology - August 1, 2018 Category: Gastroenterology Authors: Kohilan Gananandan, Ian Cropley, Rachel Westbrook Tags: Image of the Month Source Type: research

A typical presentation of TB in cirrhosis
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 1, 2018 Category: Gastroenterology Authors: Kohilan Gananandan, Ian Cropley, Rachel Westbrook Tags: Image of the Month Source Type: research

Common Gastrostomy Feeding Tube Complications and Troubleshooting
(Source: Clinical Gastroenterology and Hepatology)
Source: Clinical Gastroenterology and Hepatology - August 1, 2018 Category: Gastroenterology Authors: Robert Jay Sealock, Khushboo Munot Source Type: research

Mantle Cell Lymphoma Presenting as Colonic Lymphomatous Polyposis
A 60-year-old man presented with a 2-month duration of intermittent hematochezia and weight loss. There was no similar illness among family members. The physical examination was essentially normal. Laboratory tests showed essentially normal study with the exception of mild anemia and a high lactate dehydrogenase level  (765 U/L; normal range, 125–300 U/L). Colonoscopy showed multiple nodular lesions in the rectum (Figure A), sigmoid colon, and cecum. A computed tomography of the abdomen showed irregular, nonenhancing, mucosal thickening in the rectum, sigmoid colon (Figure B), and ileocecal region. (Source:...
Source: Clinical Gastroenterology and Hepatology - July 27, 2018 Category: Gastroenterology Authors: Hemanta K. Nayak, C.R. Lokesh, Samir Mohindra Tags: Electronic image of the month Source Type: research

Early Initiation of Tumor Necrosis Factor Antagonist –Based Therapy for Patients With Crohn’s Disease Reduces Costs Compared With Late Initiation
Antagonists of tumor necrosis factor (TNF) are effective for induction and maintenance of remission of Crohn ’s disease (CD) and are generally prescribed when patients do not respond to conventional, less-costly medical therapies. Early initiation of anti-TNF therapy reduced rates of surgery and dose escalation due to loss of response. However, these drugs are expensive, so studies are needed on the cost effectiveness of early initiation. We aimed to determine the cost effectiveness of initiating treatment early in the disease course (within 2 years of CD diagnosis) vs later in the disease course (more than 2 years a...
Source: Clinical Gastroenterology and Hepatology - July 26, 2018 Category: Gastroenterology Authors: Candace L. Beilman, Erin Kirwin, Christopher Ma, Christopher McCabe, Richard N. Fedorak, Brendan Halloran Source Type: research