Evaluation and Management of Suspected Early Chronic Pancreatitis (ECP)
AbstractPurpose of ReviewChronic pancreatitis in the advanced stages leads to significant health care utilization because of the associated complications. Early-stage diagnosis could prevent the development of these complications by appropriate management. In this article, we reviewed the recent evidence pertaining to the diagnosis and management of early chronic pancreatitis (ECP).Recent FindingsThe working group for the International Consensus Guidelines for Chronic Pancreatitis has published consensus-based statements to streamline the diagnosis of ECP. There is no international consensus on the definition and diagnosis...
Source: Current Gastroenterology Reports - June 26, 2020 Category: Gastroenterology Source Type: research

The Treatment of Pediatric Inflammatory Bowel Disease with Biologic Therapies
AbstractPurpose of ReviewBiologics for the treatment of inflammatory bowel disease (IBD) have been transformative to the therapeutic goals in the pediatric population. We review the biologics used to treat IBD, highlighting the importance of patient selection, dosing considerations, and therapeutic drug monitoring in children.Recent FindingsInfliximab is well-established as a safe and efficacious therapy for Crohn ’s disease and ulcerative colitis. Both dose escalation strategies and therapeutic drug monitoring increase the likelihood of response to anti-TNFα therapies. Early real-world experience of vedolizuma...
Source: Current Gastroenterology Reports - June 15, 2020 Category: Gastroenterology Source Type: research

Current Perspectives in Atrophic Gastritis
AbstractPurpose of the ReviewAtrophic gastritis is a complex syndrome with gastric atrophy as a common trait.Helicobacter pylori infection and autoimmunity are the two main contexts in which it develops. It is slightly symptomatic, affects various aspects of general health, and remains a predisposing factor for gastric cancer. This review will update current knowledge and progress on atrophic gastritis.Recent FindingsAtrophic gastritis affects mostly adults with persistent dyspepsia, deficient anemia, autoimmunity disease, long-term proton pump inhibitor use, and a family history of gastric cancer. Gastric biopsies, expres...
Source: Current Gastroenterology Reports - June 15, 2020 Category: Gastroenterology Source Type: research

EMR/ESD: Techniques, Complications, and Evidence
AbstractPurpose of ReviewTo discuss endoscopic resection techniques of early gastrointestinal malignancy. The review will focus on the indications and outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).Recent FindingsEMR is indicated for upper GI lesions less than 20  mm provided they can be easily lifted and have a low risk of submucosal invasion (SMI). ESD should be considered for esophageal and gastric lesions that are bulky, show intramucosal carcinoma, or have a risk of superficial submucosal invasion. With regard to colonic polyps, EMR is acceptable for t he removal of larg...
Source: Current Gastroenterology Reports - June 15, 2020 Category: Gastroenterology Source Type: research

Barrett ’s Esophagus Management in the Elderly: Principles and Best Practice
AbstractPurpose of ReviewEndoscopic screening and surveillance for Barrett ’s esophagus (BE) as well as treatment of dysplastic BE is well established. A significant proportion of BE patients are older (geriatric age group,>  65 years age). There is relatively little information or recommendations in the literature with regards to evaluation and management of geriatric BE patients. The purpose of this review is to outline specific caveats and best practice recommendations to help manage the geriatric BE patient.Recent FindingsIn this review, we have attempted to summarize the latest evidence and guidel...
Source: Current Gastroenterology Reports - June 15, 2020 Category: Gastroenterology Source Type: research

Proctalgia Syndromes: Update in Diagnosis and Management
AbstractPurpose of ReviewFunctional anorectal pain syndromes are a neglected yet often disabling clinical entity resulting in significant economic and psychological burden to the patient. The aim of this review is to update the practicing gastroenterologist/coloproctologist on the diagnosis and management of these complicated disorders.Recent FindingsThe updated Rome foundation diagnostic criteria (Rome IV) for functional anorectal pain subgroups chronic proctalgia (levator ani syndrome and unspecified functional anorectal pain) and acute proctalgia (proctalgia fugax) on the basis of symptom duration and digital rectal exa...
Source: Current Gastroenterology Reports - June 9, 2020 Category: Gastroenterology Source Type: research

Maldigestion Versus Malabsorption in the Elderly
AbstractPurpose of ReviewTo evaluate recently published information about the frequency of maldigestion and malabsorption in older individuals, likely diagnoses causing these problems, and the diagnostic scheme when these diagnoses are being considered.Recent FindingsAlthough the prevalence of malnourishment and frank malnutrition may be increasing among older adults admitted to the hospital, this appears to be due to reduced food intake rather than maldigestion or malabsorption. The mechanisms of food digestion and absorption seem to be resilient, even in old age, but concurrent illness may produce malabsorption in older ...
Source: Current Gastroenterology Reports - June 4, 2020 Category: Gastroenterology Source Type: research

Endoscopic Ultrasound-Guided Management of Chronic Pancreatitis
AbstractPurpose of ReviewThe purpose of this review is to discuss the role of endoscopic ultrasound (EUS) in the diagnosis and treatment of chronic pancreatitis (CP).Recent FindingsEUS has evolved and become invaluable in diagnosing early CP with the use of elastography and contrast enhancement. Lumen-apposing metal stents have allowed for easier transmural drainage and necrosectomy for pancreatic pseudocyst and walled of necrosis. EUS-guided pancreatic duct drainage is being utilized for pancreatic duct complications including stenosis, stones, and duct disruptions that are not amendable to endoscopic retrograde cholangio...
Source: Current Gastroenterology Reports - June 4, 2020 Category: Gastroenterology Source Type: research

Hypnosis and Cognitive Behavioral Therapies for the Management of Gastrointestinal Disorders
AbstractPurpose of ReviewTo review the nature, current evidence of efficacy, recent developments, and future prospects for cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, the two best established psychological interventions for managing gastrointestinal (GI) disorders.Recent FindingsNew large randomized controlled trials are showing that cost-effective therapy delivery formats (telephone-based, Internet-based, fewer therapist sessions, or group therapy) are effective for treating GI disorders.SummaryCBT and hypnotherapy can produce substantial improvement in the digestive tract symptoms, psychological wel...
Source: Current Gastroenterology Reports - June 3, 2020 Category: Gastroenterology Source Type: research

Stool-Based Tests for Colorectal Cancer Screening: Performance Benchmarks Lead to High Expected Efficacy
AbstractPurpose of ReviewParticipation goals for colorectal cancer (CRC) screening in the USA have not been met. Non-invasive screening strategies may improve CRC screening participation. We highlight recent literature on stool-based screening performance and expectations for emerging non-invasive screening tests.Recent FindingsStool-based CRC screening detects screen-relevant colorectal neoplasia and outperforms a currently available plasma assay. Though modestly sensitive for CRC, adherence to annual fecal immunochemical testing (FIT) is sub-optimal. Multi-target stool DNA (MT-sDNA) has greater adherence, superior sensit...
Source: Current Gastroenterology Reports - June 3, 2020 Category: Gastroenterology Source Type: research

Radiofrequency Ablation of Barrett ’s Esophagus: Have We Gone Too Far, or Not Far Enough?
This report reviews clinically relevant evidence p ublished over the last 3 years regarding RFA for BE.Recent findingsOur use of this technology has simultaneously gone too far, in that many patients who may not derive a benefit from these treatments are receiving them, and not far enough, in that many patients who would be eligible for ablative therapy never undergo screening exams to assess them for dysplastic BE, or do not have endoscopic therapy considered part of the treatment of superficial invasive cancer.SummaryResearch to better identify patients with BE, risk stratify those patients, improve the quality of R...
Source: Current Gastroenterology Reports - May 7, 2020 Category: Gastroenterology Source Type: research

Management of Hepatolithiasis: Review of the Literature
AbstractPurpose of ReviewHepatolithiasis is a disease characterized by intrahepatic stone formation. In this article, we review the features of this disease and explore the established and emerging treatment modalities.Recent FindingsRecent reports show an increasing prevalence of hepatolithiasis, likely owed to increased immigration and shifts in the Western diet. New pharmacotherapy options are limited and are often only supportive. Endoscopic intervention still cruxes on removal of impacted stones, though new techniques such as bile duct exploratory lithotomy and lithotripsy continue to advance management. Although hepa...
Source: Current Gastroenterology Reports - May 7, 2020 Category: Gastroenterology Source Type: research

Bowel Preparation for Colonoscopy in 2020: A Look at the Past, Present, and Future
ConclusionsOngoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years. (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - May 6, 2020 Category: Gastroenterology Source Type: research

Endoscopic Ultrasound-Guided Treatment of Pancreatic Cancer
AbstractPurpose of ReviewThe aim of this review is to evaluate the emerging role of endoscopic ultrasound (EUS) in the guidance of tumor-targeted therapies for patients with pancreatic cancer (PC).Recent FindingsEUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described to date. EUS-guided fiducial placement for SBRT in pancreatic cancer has entered the clinical practice and is performed at many centers clinically without a research protocol. EUS-guided brachytherapy and RFA have been shown to be feasible and safe procedures, and potentially offer local disease control....
Source: Current Gastroenterology Reports - April 30, 2020 Category: Gastroenterology Source Type: research

Postoperative Complications After Colorectal Surgery: Where Are We in the Era of Enhanced Recovery?
AbstractPurpose of ReviewIndividual elements in enhanced recovery pathways may be associated with specific complication risks. In this review, we highlight three areas of controversy surrounding complications in enhanced recovery: (1) whether enhanced recovery is associated with increased rates of acute kidney injury, (2) whether NSAID use is associated with anastomotic leaks, and (3) whether early urinary catheter removal is justified following colorectal surgery.Recent FindingsAcute kidney injury has been reported at several institutions following implementation of enhanced recovery pathways highlighting the importance o...
Source: Current Gastroenterology Reports - April 13, 2020 Category: Gastroenterology Source Type: research

Strategy for Food Reintroduction Following Empiric Elimination and Elemental Dietary Therapy in the Treatment of Eosinophilic Gastrointestinal Disorders
AbstractPurpose of ReviewThis review presents the available data regarding efficacy of nutritional therapy, highlighting clinical decision points and a strategy for reintroduction of foods following an elemental diet for treatment of eosinophilic gastrointestinal disorders.Recent FindingsElemental and empiric elimination diets are highly effective treatments for eosinophilic gastrointestinal diseases. Standardization in the reintroduction phase, after utilizing the diet for disease remission, is lacking.SummaryClinicians are confronted with multiple challenges regarding the best practice for food reintroduction and identif...
Source: Current Gastroenterology Reports - March 28, 2020 Category: Gastroenterology Source Type: research

Gastroparesis in the 2020s: New Treatments, New Paradigms
AbstractPurpose of ReviewThis review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp).Recent FindingsMajor current advancements in the pathophysiology of Gp, include recognition of the SIP syncytium as the pacemaking unit rather than ICC alone and that Gp may be part of a pan-enteric autoimmune and/or autonomic disorder with macrophage imbalance. The development of newer techniques to assess gastric emptying (gastric emptying breath test and wireless motility capsule) and pyloric distensibility (EndoFLIP ®) are allowing clinicians better characterizati...
Source: Current Gastroenterology Reports - March 19, 2020 Category: Gastroenterology Source Type: research

Update on the Treatment of Behcet ’s Disease of the Small Bowel with Biologic Agents
AbstractPurpose of ReviewThe treatment of intestinal Behcet ’s disease (BD) is challenging, and one-third of patients require surgery due to failure of conventional therapies. Anti-tumor necrosis factor-α (TNF-α) and other new biologics have been actively investigated for managing intestinal BD. In this article, we review the updated experiences and up-t o-date clinical data on anti-TNF-α and other biologics for the management of intestinal BD.Recent FindingsRecent prospective studies have proved the efficacy and safety of infliximab and adalimumab for treating intestinal BD. Recent studies with oth...
Source: Current Gastroenterology Reports - March 19, 2020 Category: Gastroenterology Source Type: research

The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice
AbstractPurpose of ReviewTo evaluate the impact of the implementation of the Rome IV criteria on pediatric gastrointestinal practice.Recent FindingsIn 2016, the Rome IV criteria were published, providing an update of symptom-based criteria to diagnose children with functional gastrointestinal disorders (FGIDs).SummaryFor neonates and toddlers, Wessel ’s criteria for diagnosing infant colic were abandoned, and a differentiation was made between toilet-trained and non-toilet-trained children in the diagnosis of functional constipation. For children and adolescents, two new disorders (functional nausea and functional vo...
Source: Current Gastroenterology Reports - March 19, 2020 Category: Gastroenterology Source Type: research

Advances in Diagnostic Imaging in Pediatric Gastroenterology
AbstractPurpose of ReviewThe purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research.Recent FindingsNew magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis. Magnetic resonance enterography is a method for non-invasively diagnosing and following various GI conditions, predominantly inflammatory bowel disease. Contrast-enhanced ultrasound uses ...
Source: Current Gastroenterology Reports - March 19, 2020 Category: Gastroenterology Source Type: research

Review Article: Mesenteric Ischemia
AbstractPurpose of ReviewMesenteric ischemia (MI), both acute (AMI) and chronic (CMI), is a challenging diagnosis to make, and early diagnosis and treatment are vital to improve outcomes. This manuscript summarizes the most up to date information on diagnosis and treatment of these disorders.Recent FindingsThere have been several significant advancements in the computed tomography (CT) diagnostic imaging as well as medical and endovascular management of AMI and CMI. In appropriate populations, endovascular interventions appear superior to open surgical management with lower mortality, morbidity, and cost of care.SummaryEff...
Source: Current Gastroenterology Reports - March 17, 2020 Category: Gastroenterology Source Type: research

Role of Diet in the Development and Management of Crohn ’s Disease
This article provides an updated review on the role of diet in the risk of developing Crohn ’s disease (CD) and CD management, areas of ongoing study.Recent FindingsHigher intake of dietary fiber (fruit fiber) has been associated with a reduced risk for CD. The exclusive enteral nutrition (EEN) diet remains the most validated nutritional recommendation for inducing remission in CD. The specific carbohydrate diet (SCD) has demonstrated reductions in CD severity scores in conjunction with medical therapies, and larger trials on its efficacy are ongoing. Several new exclusion diets modeled after EEN and SCD have shown p...
Source: Current Gastroenterology Reports - March 17, 2020 Category: Gastroenterology Source Type: research

Managing Pain and Psychosocial Care in IBD: a Primer for the Practicing Gastroenterologist
AbstractPurpose of ReviewThis review focuses on the relationship between trauma and pain in inflammatory bowel disease (IBD), and offers effective treatment strategies.Recent FindingsRecent evidence points to bidirectional pathways between psychiatric disorders and IBD. The impact of trauma and development of post-traumatic stress symptoms on IBD disease course is beginning to be appreciated including its relationship with pain. First-line treatments for both psychiatric and chronic pain disorders include behavioral interventions such as cognitive behavioral therapy, hypnosis, and mindfulness, and there is emerging evidenc...
Source: Current Gastroenterology Reports - March 17, 2020 Category: Gastroenterology Source Type: research

Novel Therapies for Gastroesophageal Reflux Disease: Beyond Proton Pump Inhibitors
AbstractPurpose of ReviewDespite the many areas of unmet needs in gastroesophageal reflux disease (GERD), proton pump inhibitors (PPIs) remain the cornerstone of medical therapy. However, since their introduction, the therapeutic limitations of PPIs in GERD management have been increasingly recognized.Recent FindingsIn this review we discuss the new medical, endoscopic, and surgical therapeutic modalities that have been developed over the last decade. They include the potassium-competitive acid blockers (P-CABs) which provide a rapid onset, prolonged, and profound acid suppression, mucosal protectants which promote the phy...
Source: Current Gastroenterology Reports - March 17, 2020 Category: Gastroenterology Source Type: research

Refractory Celiac Disease
AbstractPurpose of ReviewTo review the epidemiology, pathophysiology, diagnosis, management, and prognosis of refractory celiac disease, with a specific emphasis on recent literature.Recent FindingsWhile the pathophysiology of type I refractory celiac disease remains unclear, there have been advances in the understanding of the pathophysiology of type II refractory celiac disease. This has included recognition of the significant role of interleukin-15 and somatic mutations in JAK1 or STAT3 in the proliferation of aberrant T cells. This in turn has led to potential novel therapies targeting these factors, one of which has r...
Source: Current Gastroenterology Reports - March 17, 2020 Category: Gastroenterology Source Type: research

Gastrointestinal and Hepatic Complications of Immunotherapy: Current Management and Future Perspectives
AbstractPurpose of ReviewCheckpoint inhibitor (CPI) immunotherapy has transformed the treatment of multiple cancers over the past decade, leading to durable remissions, but also to severe inflammatory toxicities. These toxicities, termed immune-related adverse events (irAEs), can affect any organ system in the body, but commonly induce inflammation in barrier organs. Gastrointestinal (GI) and hepatic irAEs are among the most frequent and most severe from contemporary immunotherapies, with inflammation in the colon and or small intestines (entero)colitis as the single most common GI irAE. The aim of this review is to descri...
Source: Current Gastroenterology Reports - March 17, 2020 Category: Gastroenterology Source Type: research

Small Bowel Dysmotility, Pseudoobstruction, and Functional Correlation with Histopathology: Lessons Learned
AbstractPurpose of ReviewSmall bowel dysmotility is a broad heterogeneous term that encompasses a wide range of gastrointestinal disorders resulting from abnormal gut motility. Chronic intestinal pseudo-obstruction (CIPO) is a severe, rare, and complex small bowel motility disorder at the extreme end of this spectrum. It is characterized by failure of the intestinal tract to propel contents, which results in signs and symptoms of bowel obstruction albeit in the absence of any obstructive lesion(s). In this article, we discuss up-to-date diagnostic techniques, management options, and histopathological findings in CIPO.Recen...
Source: Current Gastroenterology Reports - February 20, 2020 Category: Gastroenterology Source Type: research

The Complex Interplay Between Inflammatory Bowel Disease and Malignancy
AbstractPurpose of ReviewBoth the chronic inflammation in inflammatory bowel disease (IBD), and its treatment, can increase the risk of malignancy. There is also an increasing number of patients with current and prior cancer who require IBD treatment. Thus, there is a complex interplay between immunosuppressive treatment and monitoring for new and recurrent cancer.Recent FindingsVedolizumab and ustekinumab have not been shown to increase the risk of malignancy. Transplant data shows a potential risk with tofacitinib although rheumatoid arthritis data does not. IBD patients have been shown to tolerate chemotherapy, specific...
Source: Current Gastroenterology Reports - February 13, 2020 Category: Gastroenterology Source Type: research

Remote Monitoring and Telemedicine in IBD: Are We There Yet?
AbstractPurpose of ReviewTelehealth is the delivery of health care using the most recent technological advances. With the growing complexity of inflammatory bowel disease (IBD) care, telehealth allows for delivery of specialty services to an extended population. We reviewed the most recent literature on telehealth modalities, including patient-reported and disease outcomes associated with use of telehealth.Recent FindingsCurrent methods of telemedicine include telehealth, remote patient monitoring, and the use of mobile applications. Remote patient monitoring via web applications has been studied with improvement in patien...
Source: Current Gastroenterology Reports - February 10, 2020 Category: Gastroenterology Source Type: research

The Management of the Hospitalized Ulcerative Colitis Patient: the Medical –Surgical Conundrum
In this study, we present the evidence-based management for patients hospitalized for ulcerative colitis (UC) with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon.Recent FindingsFocused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized UC patients is advocated. The colectomy rate has not changed over the years. Moreover, delayed surgery after admission is burden by increase complication and mortality rates. Thus, it is pivotal to identify the pa...
Source: Current Gastroenterology Reports - February 10, 2020 Category: Gastroenterology Source Type: research

Applying the Functional Luminal Imaging Probe to Esophageal Disorders
AbstractPurpose of ReviewThe functional luminal imaging probe (FLIP) uses high-resolution planimetry to provide a three-dimensional image of the esophageal lumen by measuring diameter, volume, and pressure changes. The goal of this review is to summarize the most recent advances in applying the (FLIP) to esophageal disorders.Recent FindingsThe FLIP has been studied in esophageal disease states including gastroesophageal reflux disease (GERD), achalasia, and eosinophilic esophagitis. It has also been used in the investigation of dysphagia.SummaryThe FLIP is a valuable tool for the diagnosis of esophageal diseases as well as...
Source: Current Gastroenterology Reports - February 10, 2020 Category: Gastroenterology Source Type: research

Esophagogastric Junction Outflow Obstruction: Current Approach to Diagnosis and Management
AbstractPurpose of ReviewWe summarize the current epidemiology, presentation, diagnostic workup, and treatment of esophagogastric junction outflow obstruction (EGJOO). We also propose a treatment algorithm based upon the literature and our personal clinical experience.Recent FindingsEGJOO can be caused by functional obstruction (akin to achalasia), mechanical obstruction, medications, or artifact. High-resolution esophageal manometry is currently the gold standard of diagnosis. Recent research on FLIP (functional lumen imaging probe) and timed barium support use as adjunctive testing. The diagnostic yield of cross-sectiona...
Source: Current Gastroenterology Reports - February 5, 2020 Category: Gastroenterology Source Type: research

First-Line Biologics or Small Molecules in Inflammatory Bowel Disease: a Practical Guide for the Clinician
AbstractPurpose of ReviewTreating moderate-to-severe inflammatory bowel disease has become increasingly complex as the array of available biologics increases. Moreover, tofacitinib, the first small molecule approved for IBD, is available for use in ulcerative colitis. Choosing the right biologic, for the right patient, at the right time, can be a confusing and daunting task for clinicians.Recent FindingsIn this review, we summarize the evidence for first-line use of the available biologics by disease state. Special circumstances for consideration including rapidity of action, safety, comparative effectiveness, postoperativ...
Source: Current Gastroenterology Reports - January 30, 2020 Category: Gastroenterology Source Type: research

Sleep and Fatigue in IBD: an Unrecognized but Important Extra-intestinal Manifestation
AbstractPurpose of ReviewThe bidirectional relationship between sleep disorders and inflammatory bowel disease (IBD) has gained considerable attention in recent years. It has been suggested that poor sleep and fatigue are extra-intestinal manifestations of IBD. This review reports recent studies exploring subjective and objective assessments of sleep in the adult IBD population.Recent FindingsIn ulcerative colitis patients, poor sleep has been independently linked to depression and poorer IBD-related quality of life. Using home polysomnography, IBD patients were shown to have less rapid eye movement sleep and Crohn ’...
Source: Current Gastroenterology Reports - January 30, 2020 Category: Gastroenterology Source Type: research

The Burden of Cost in Inflammatory Bowel Disease: A Medical Economic Perspective and the Future of Value-Based Care
AbstractPurpose of ReviewTo examine the quantifiable economic impact of inflammatory bowel disease (IBD), key cost drivers and determinants, and the impact of value-based care in IBD. Finally, we prognosticate on future directions and opportunities on healthcare economics in IBD.Recent FindingsNew value-based initiatives, technologically driven interventions, and quality improvement programs have demonstrated reductions in healthcare utilization and enhanced patient outcomes, and several have realized cost of care reductions.SummaryIBD is a costly, chronic illness with unbalanced spending by a small proportion of individua...
Source: Current Gastroenterology Reports - January 30, 2020 Category: Gastroenterology Source Type: research

The Management Approach to the Adolescent IBD Patient: Health Maintenance and Medication Considerations
AbstractPurpose of ReviewInflammatory bowel disease (IBD) is often diagnosed during adolescence and can have a deep impact on the physical, hormonal, developmental, and psychosocial changes associated with this life period. The purpose of this review is to address the particular manifestations of IBD (such as growth and pubertal delay), health maintenance issues, and treatment considerations in the adolescent.Recent FindingsThe need for a multidisciplinary approach to recognize and address growth and pubertal delay, bone health, as well as the psychosocial impact of IBD on the adolescent has been increasingly recognized as...
Source: Current Gastroenterology Reports - January 29, 2020 Category: Gastroenterology Source Type: research

Small Bowel Diverticulosis: Pathogenesis, Clinical Management, and New Concepts
AbstractPurpose of ReviewSmall bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel ’s diverticula are covered elsewhere in this volume.Recent FindingsCT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention rema...
Source: Current Gastroenterology Reports - January 15, 2020 Category: Gastroenterology Source Type: research

Probiotics, Nutrition, and the Small Intestine
AbstractPurpose of ReviewProbiotics are promising remedial treatments for symptoms of small intestine (SI) diseases and promoters of overall good health. Probiotics play an important role in supporting a healthy SI microbiome (eubiosis), and in preventing establishment of unhealthy microbiota. SI eubiosis promotes optimal nutrient uptake, and optimal nutritional status maintains a healthy SI, reducing the likelihood of SI diseases. It is important to understand the advantages and limitations of probiotic therapies.Recent FindingsMicrobial dysbiosis decreases the capacity of the small bowel to utilize and absorb dietary com...
Source: Current Gastroenterology Reports - January 13, 2020 Category: Gastroenterology Source Type: research

The Many Faces of Meckel ’s Diverticulum: Update on Management in Incidental and Symptomatic Patients
AbstractPurpose of ReviewMeckel ’s diverticulum may be detected incidentally or present with symptoms from infancy and to old age. The presentation may be acute, with several complications associated with the condition. We aim to review the many faces with which a Meckel’s diverticulum may present, either symptomatically or as an incidental finding.Recent FindingsDue to its rarity, recent studies mainly include small retrospective series or case reports. Emphasis in the recent literature is on clinical presentation, the pathology of symptomatic cases, management options and risks of neoplasia. Symptoms are main...
Source: Current Gastroenterology Reports - January 13, 2020 Category: Gastroenterology Source Type: research

Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness: Do We Need an Objective Scoring System?
AbstractPurpose of ReviewEfforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provi...
Source: Current Gastroenterology Reports - January 7, 2020 Category: Gastroenterology Source Type: research

Pediatric Intestinal Pseudo-obstruction in the Era of Genetic Sequencing
AbstractPurpose of ReviewThe purpose of this review is to discuss current knowledge on pediatric intestinal pseudo-obstruction. We will also review new mutations that have been identified through advancement in genetic testing, allowing for a better understanding of the underlying mechanisms of intestinal dysmotility and potential etiologies.Recent FindingsWith the advancements in genetic testing, new mutations have been identified in the diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS), a disorder leading to pediatric pseudo-obstruction. MYLK, LMOD1, MYL9, and MYH11 encode for various protein...
Source: Current Gastroenterology Reports - December 17, 2019 Category: Gastroenterology Source Type: research

Gastrointestinal Motility Issues in Cancer Patients
AbstractPurpose of ReviewThis paper seeks to highlight GI motility disorders that are frequently present in patients with a malignancy. GI dysmotility can occur due to the cancer itself or as a consequence of medical and surgical treatments. Often, symptoms are nonspecific and the diagnosis requires a high index of suspicion. The goal of the paper is to review the common motility problems seen in patients with cancer, their clinical manifestations, and options for management.Recent FindingsStudies show that newer endoscopy techniques such as endoscopic mucosal dissection can cause esophageal dysmotility. Opioid-induced con...
Source: Current Gastroenterology Reports - December 10, 2019 Category: Gastroenterology Source Type: research

EUS-Guided Portal Venous Sampling of Circulating Tumor Cells
AbstractPurpose of ReviewAlthough liquid biopsies hold significant promise in the management of patients with cancer, peripheral blood analyses remain dependent on the degree of tumor burden with prohibitively low yields until the cancer is widely metastatic. Multiple lines of evidence support a dynamic, spatiotemporal localization of circulating tumor cells (CTCs) supporting specific targeting of vascular compartments, such as the portal vein. This review discusses the literature evaluating the possibility of portal venous blood as a new, potentially higher yield liquid biopsy and the current devices and techniques for en...
Source: Current Gastroenterology Reports - December 7, 2019 Category: Gastroenterology Source Type: research

Tips for the Budding Esophagologist
This article discusses in detail multiple options for developing skills in diagnosis and treatment of esophageal disease with “tips for the budding esophagologist.” (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - December 7, 2019 Category: Gastroenterology Source Type: research

Principles and Practice of Oral Rehydration
This report reviews the scientific rationale and modifications of ORS and barriers to universal application.Recent FindingsSolutions with osmolality and electrolyte composition different from original ORS for routine and unique pathophysiology such as in malnutrition have met with varying success. Following the conceptual rationale of sodium-glucose cotransportation to facilitate water absorption, other cotransporters and formulations have been explored with the aim to improve ORS efficacy and acceptance.SummaryORS remains the anchor of acute watery diarrhea and dehydration management worldwide. Despite development of diff...
Source: Current Gastroenterology Reports - December 7, 2019 Category: Gastroenterology Source Type: research

Proton Pump Inhibitors in the Elderly, Balancing Risk and Benefit: an Age-Old Problem
AbstractPurpose of ReviewProton pump inhibitors (PPIs) are one of the most prescribed drugs in the developed world and elderly patients are particularly likely to be prescribed acid suppression. There have been reports of many diseases being associated with PPI therapy and the elderly would be particular at risk of any harms these drugs may cause. This review therefore reviews the evidence of the risks and benefits of these drugs.Recent FindingsPPIs are very effective at treating acid-related disorders. Recent randomized trials have suggested that the associations between PPI and various diseases are likely to be related t...
Source: Current Gastroenterology Reports - December 5, 2019 Category: Gastroenterology Source Type: research

Controversy in Nutrition Recommendations for Short Bowel Syndrome: How Type of SBS Impacts Response
AbstractPurpose of ReviewThis review examines the current recommendations for dietary management of patients living with short bowel syndrome (SBS) and outlines the need for future research to provide optimal care for this unique group of patients.Recent FindingsProviders caring for patients with SBS lack sufficient data to help guide recommendations regarding diet. The majority of studies are conducted at a single medical institution on a small number of anatomically diverse patients. Multi-center studies would allow for inclusion of a larger number of patients and may lead to more individualized dietary recommendations.S...
Source: Current Gastroenterology Reports - December 5, 2019 Category: Gastroenterology Source Type: research

Management of Pancreatic Duct Stones
AbstractPurpose of ReviewPancreatic duct stones are sequela of chronic pancreatitis. They can cause pancreatic duct obstruction which is the most important cause of pain in chronic pancreatitis. Stone resolution has shown to improve pain. The goal of this review is to highlight recent endoscopic and surgical advancements in treatment of pancreatic duct stones.Recent FindingsStone fragmentation by extracorporeal shock wave lithotripsy has become first line and the mainstay of treatment for majority of patients with pancreatic duct stones. Introduction of digital video pancreatoscopy in the last few years with the capability...
Source: Current Gastroenterology Reports - December 4, 2019 Category: Gastroenterology Source Type: research

Increased Use of Emulsifiers in Processed Foods and the Links to Obesity
AbstractPurpose of ReviewThe purpose of this review is to discuss the implications of the increased prevalence of emulsifiers in processed foods in daily consumption, the links to obesity both in mice and in vitro studies, and how those findings correlate with humans.Recent FindingsThere is rising interest in understanding the contributors to the obesity epidemic. One potential component recently studied has been the consumption of processed foods causing inflammatory changes leading to metabolic syndrome. This phenomenon has been shown in several mice and in vitro studies with changes in microbiome composition, elevated f...
Source: Current Gastroenterology Reports - December 2, 2019 Category: Gastroenterology Source Type: research

Fiber, Fat, and Colorectal Cancer: New Insight into Modifiable Dietary Risk Factors
AbstractPurpose of ReviewTo review recent data on the role and interactions of fiber and fat as dietary risk factors associated with colorectal cancer (CRC) risk in humans.Recent FindingsFiber intake shows convincing and linear dose-response negative correlation with CRC risk. Dietary fiber stimulates butyrogenic activity of the gut microbiota, providing high amounts of butyrate that shows extensive anti-neoplastic effects. A high-fat diet promotes CRC risk through stimulated bile acid metabolism, facilitating bile acid conversion by the gut microbiota to tumor-promoting deoxycholic acid. Comprehensive interactions of thes...
Source: Current Gastroenterology Reports - December 2, 2019 Category: Gastroenterology Source Type: research