Treatment of Pruritus Secondary to Liver Disease
AbstractPurpose of ReviewPruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders.Recent FindingsRecent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led ...
Source: Current Gastroenterology Reports - July 31, 2019 Category: Gastroenterology Source Type: research

Classifying Enteral Nutrition: Tailored for Clinical Practice
AbstractPurpose of ReviewTo discuss the different forms of enteral nutrition, while outlining available evidence for its use in specific conditions and how enteral nutrition composition may or may not influence relevant outcomes.Recent FindingsEnteral nutrition formulas were originally conceived as a liquid form of nutrition for individuals who otherwise could not consume adequate calories through solid food. Over time, the emergence of specialty formulas marketed to benefit specific diseases or conditions has led to a broad range of potentially confusing options. While most options have theoretical benefit for their marke...
Source: Current Gastroenterology Reports - July 31, 2019 Category: Gastroenterology Source Type: research

Liver Disease in Pregnancy and Transplant
AbstractPurpose of ReviewThe purpose of this review is to discuss current and new knowledge regarding liver disease in pregnancy and pregnancy post-liver transplantation.Recent FindingsSevere liver disease associated with pregnancy is rare. Liver biopsy is rarely needed for diagnosis but is safe in selected cases. Intrahepatic cholestasis of pregnancy (ICP) with serum bile acids level>  40 μmol/L is associated with adverse fetal outcomes. Ursodeoxycholic acid should be initiated at diagnosis. Portal hypertension can worsen during pregnancy and screening endoscopy should be performed in the 2nd trimester. ...
Source: Current Gastroenterology Reports - July 25, 2019 Category: Gastroenterology Source Type: research

Novel Screening Tests for Barrett ā€™s Esophagus
AbstractPurpose of ReviewThere has been an exponential increase in the incidence of esophageal adenocarcinoma (EAC) over the last half century. Barrett ’s esophagus (BE) is the only known precursor lesion of EAC. Screening for BE in high-risk populations has been advocated with the aim of identifying BE, followed by endoscopic surveillance to detect dysplasia and early stage cancer, with the intent that treatment can improve outcomes. We aimed to review BE screening methodologies currently recommended and in development.Recent FindingsUnsedated transnasal endoscopy allows for visualization of the distal esophagus, wi...
Source: Current Gastroenterology Reports - July 25, 2019 Category: Gastroenterology Source Type: research

Diverticular Disease in the Elderly
AbstractPurpose of ReviewWhile few diseases are limited solely to the elderly, diverticular disease is clearly more prevalent with increasing age and therefore the aim of this review is to focus on the clinical implications of diverticular disease in the elderly.Recent FindingsDiverticulitis in the elderly is best managed with an individualized treatment approach including considerations for selective antibiotic usage even in uncomplicated disease. Furthermore, due to the increased prevalence of ischemic colitis in the elderly and the similarities in presentation with diverticular hemorrhage, there needs to be a high index...
Source: Current Gastroenterology Reports - July 25, 2019 Category: Gastroenterology Source Type: research

Implications of the Opioid Epidemic for the Clinical Gastroenterology Practice
AbstractPurpose of ReviewThe opioid epidemic in the USA has led to a rise in opioid-related gastrointestinal (GI) side effects that are often difficult to diagnose and treat. The aim of this report is to discuss opioid pathophysiology, opioid-related GI side effects, clinical presentation, and diagnostic criteria and to review the current pharmacotherapy available.Recent FindingsOpioid-related GI disorders are increasingly recognized and include, but are not limited to, opioid-induced esophageal dysfunction (OIED), gastroparesis, opioid-induced constipation (OIC), narcotic bowel syndrome (NBS), acute post-operative ileus, ...
Source: Current Gastroenterology Reports - July 25, 2019 Category: Gastroenterology Source Type: research

Chronic Diarrhea Evaluation in the Elderly: IBS or Something Else?
AbstractPurpose of ReviewChronic diarrhea is a common problem in all age groups but is a particularly challenging diagnostic problem in the elderly, since many different conditions need to be considered. The purpose of this review is to discuss the evaluation of chronic diarrhea in older individuals. It highlights those conditions that seem to occur with increased frequency in the elderly, discusses the diagnostic tests that are of greatest value in sorting out these problems, and presents an approach to evaluation that is both practical and affordable.Recent FindingsThere appears to be little value in distinguishing irrit...
Source: Current Gastroenterology Reports - July 25, 2019 Category: Gastroenterology Source Type: research

Salvage Options for Fundoplication Failure
AbstractPurpose of ReviewGastroesophageal reflux disease (GERD) affects millions of people worldwide. Many patients with medically refractory symptoms ultimately undergo antireflux surgery, most often with a laparoscopic fundoplication. Symptoms related to GERD may persist or recur. Revisional surgery is necessary in some patients.Recent FindingsA reoperative fundoplication is the most commonly performed salvage procedure for failed fundoplication. Although redo fundoplication has been reported to have increased risk of morbidity compared with primary cases, increasing experience with the minimally invasive approach to reo...
Source: Current Gastroenterology Reports - July 25, 2019 Category: Gastroenterology Source Type: research

Evolving Epidemiology of IBD
AbstractPurpose of ReviewOnce thought a disease of Western civilizations, the inflammatory bowel diseases (IBD) impose a global burden, now penetrating populations in Asia, Africa, and South America. We summarize similarities and differences in the epidemiology of IBD globally, highlighting gaps in knowledge where future study is needed.Recent FindingsWhile incidence of IBD is stabilizing (or even decreasing) in many westernized regions, prevalence continues to grow due to a young age of onset and low mortality. In newly westernized regions, IBD is beginning to penetrate populations comparable to the rapid increases seen i...
Source: Current Gastroenterology Reports - July 23, 2019 Category: Gastroenterology Source Type: research

Popular Remedies for Esophageal Symptoms: a Critical Appraisal
AbstractPurpose of ReviewPopular remedies are of ongoing interest to patients experiencing common esophageal symptoms, particularly as typical pharmacologic interventions have been subject to increased scrutiny. Herein we summarize the available data regarding potential risks and benefits of several such remedies.Recent FindingsWith emphasis on reflux and non-cardiac chest pain, research is ongoing into the clinical utility and diverse physiologic mechanisms underlying a variety of complementary and alternative modalities, including dietary manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal produ...
Source: Current Gastroenterology Reports - July 10, 2019 Category: Gastroenterology Source Type: research

Nutrition in Cirrhosis
AbstractPurpose of ReviewThis review discusses the prevalence of malnutrition in cirrhosis, metabolic functions of the liver and alterations in cirrhosis, malnutrition screening tools, and common macronutrient and micronutrient deficiencies encountered in individuals with chronic liver disease and their impact on morbidity and mortality.Recent FindingsSeveral meta-analyses and international society guidelines recommend malnutrition screening and nutrition interventions to improve outcomes in all patients with chronic liver disease given their high risk of malnutrition which is often under recognized.SummaryMalnutrition is ...
Source: Current Gastroenterology Reports - July 10, 2019 Category: Gastroenterology Source Type: research

The Rise of Colorectal Cancer in Asia: Epidemiology, Screening, and Management
AbstractPurpose of ReviewColorectal cancer (CRC) remains the third most commonly diagnosed cancer globally, and its incidence and mortality rates have been on the rise in Asia. In this paper, we summarize the recent trends and screening challenges of CRC in this region.Recent FindingsIn 2018, Asia had the highest proportions of both incident (51.8%) and mortality (52.4%) CRC cases (all genders and ages) per 100,000 population in the world. In addition, there has been a rising trend of this disease across Asia with some regional geographic variations. This rise in CRC can be attributed to westernized dietary lifestyle, incr...
Source: Current Gastroenterology Reports - July 10, 2019 Category: Gastroenterology Source Type: research

Gastroduodenal Injury: Role of Protective Factors
AbstractPurpose of ReviewThe gastroduodenal mucosal layer is a complex and dynamic system that functions in an interdependent manner to resist injury. We review and summarize the most updated knowledge about gastroduodenal defense mechanisms and specifically address (a) the mucous barrier, (b) membrane and cellular properties, and vascular, hormonal, and (c) gaseous mediators.Recent FindingsTrefoil factor family peptides play a crucial role in cellular restitution by increasing cellular permeability and expression of aquaporin channels, aiding cellular migration and tissue repair. Additionally, evidence suggests that the s...
Source: Current Gastroenterology Reports - July 10, 2019 Category: Gastroenterology Source Type: research

Duodenal Chemosensing of Short-Chain Fatty Acids: Implications for GI Diseases
AbstractPurpose of ReviewShort-chain fatty acids (SCFAs), the main bacterial fermentation products in the hindgut of hindgut fermenters, are also present in the foregut lumen. We discuss the impact of SCFAs in the duodenal defense mechanisms and in the gastrointestinal (GI) pathogenesis.Recent FindingsLuminal SCFAs augment the duodenal mucosal defenses via release of serotonin (5-HT) and glucagon-like peptide-2 (GLP-2) from enteroendocrine cells. Released GLP-2 protects the small intestinal mucosa from nonsteroidal anti-inflammatory drug-induced enteropathy. SCFAs are also rapidly absorbed via SCFA transporters and interac...
Source: Current Gastroenterology Reports - July 10, 2019 Category: Gastroenterology Source Type: research

The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD)
AbstractPurpose of ReviewHere, we discuss how esophageal motor testing plays important roles in patients with suspected gastroesophageal reflux disease (GERD). In addition to guiding appropriate placement of catheters for ambulatory reflux monitoring, esophageal high-resolution manometry (HRM) rules out confounding diagnoses, such as achalasia spectrum disorders, that can present with symptoms similar to that of GERD, but are managed very differently.Recent FindingsHRM performed with impedance in the post-prandial setting (PP-HRIM) can assess for rumination syndrome or supragastric belching, which should be directed toward...
Source: Current Gastroenterology Reports - July 10, 2019 Category: Gastroenterology Source Type: research

Colonic and Anorectal Manifestations of Systemic Sclerosis
AbstractPurpose of ReviewSystemic sclerosis is a chronic autoimmune disorder commonly involving the gastrointestinal tract, including the colon and anorectum. In this review, we summarize major clinical manifestations and highlight recent developments in physiology, diagnostics, and treatment.Recent FindingsThe exact pathophysiology of systemic sclerosis is unclear and likely multifactorial. The role of the microbiome on gastrointestinal manifestations has led to a better understanding of potential pathogenic gut flora. Carbohydrate malabsorption is common. Evaluation using fecal calprotectin and high-resolution anorectal ...
Source: Current Gastroenterology Reports - July 8, 2019 Category: Gastroenterology Source Type: research

Evaluation and Management of Cirrhotic Patients Undergoing Elective Surgery
AbstractPurpose of ReviewCirrhotic patients have an increased risk of surgical complications and higher perioperative morbidity and mortality based on the severity of their liver disease. Liver disease predisposes patients to perioperative coagulopathies, volume overload, and encephalopathy. The goal of this paper is to discuss the surgical risk of cirrhotic patients undergoing elective surgeries and to discuss perioperative optimization strategies.Recent FindingsLiterature thus far varies by surgery type and the magnitude of surgical risk. CTP and MELD classification scores allow for the assessment of surgical risk in cir...
Source: Current Gastroenterology Reports - June 15, 2019 Category: Gastroenterology Source Type: research

Extraintestinal Manifestations of Inflammatory Bowel Disease: Epidemiology, Etiopathogenesis, and Management
AbstractPurpose of ReviewExtraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) represent a complex array of disease processes with variable epidemiologic penetrance, genetic antecedents, and phenotypic presentations. The purpose of this review is to provide an overview of primary and secondary EIMs as well as salient treatment strategies utilized.Recent FindingsWhile the genetic antecedents remain incompletely understood, the treatment armamentarium for EIMs has expanded with new pharmaceutical drug classes that effectively treat IBD.SummaryEIMs are an increasingly recognized complication of IBD that re...
Source: Current Gastroenterology Reports - May 16, 2019 Category: Gastroenterology Source Type: research

Colorectal Cancer in the Young: Does Screening Make Sense?
AbstractPurpose of ReviewColorectal cancer (CRC) screening is recommended to reduce CRC mortality. This review outlines key factors to consider when recommending screening, including disease burden, screening benefits and harms, and remaining knowledge gaps.Recent FindingsIn response to increasing rates of CRC incidence among younger (age
Source: Current Gastroenterology Reports - May 16, 2019 Category: Gastroenterology Source Type: research

Clinical Aspects of Thickeners for Pediatric Gastroesophageal Reflux and Oropharyngeal Dysphagia
AbstractPurpose of ReviewThe purpose of this review is to discuss current knowledge and recent findings regarding clinical aspects of thickeners for pediatric gastroesophageal reflux and oropharyngeal dysphagia. We review evidence for thickener efficacy, discuss types of thickeners, practical considerations when using various thickeners, and risks and benefits of thickener use in pediatrics.Recent FindingsThickeners are effective in decreasing regurgitation and improving swallowing mechanics and can often be used empirically for the treatment of infants and young children. Adverse effects have been reported, but with caref...
Source: Current Gastroenterology Reports - May 16, 2019 Category: Gastroenterology Source Type: research

The Status of SEMS Versus Plastic Stents for Benign Biliary Strictures
AbstractPurpose of ReviewBenign biliary strictures can be treated with plastic stents and self-expandable metal stents (SEMS). This review article delineates the latest scientific evidence for their usage.Recent FindingsDespite evolving literature on both type of stents as treatment modalities of benign biliary strictures, which encompass mainly anastomotic strictures and strictures related to chronic pancreatitis, no final conclusions can be drawn regarding the superiority of a particular stent. SEMS tend to have higher stricture resolution rates and fewer procedural requirements which are partly offset by higher stent mi...
Source: Current Gastroenterology Reports - May 16, 2019 Category: Gastroenterology Source Type: research

Acute and Chronic Ischemic Disorders of the Small Bowel
AbstractPurpose of ReviewIschemic disorders of the small bowel represent a rare but highly morbid disease process which is often difficult to diagnose and has a complex management course involving multidisciplinary care. Given recent advances in radiologic modalities and surgical/endovascular techniques, this review seeks to provide a disease overview as well as a summary of emerging management strategies.Recent FindingsIn cases of acute mesenteric ischemia without evidence of frank bowel necrosis, an endovascular-first strategy employing thrombolysis, pharmacomechanical thrombectomy, and/or adjunctive angioplasty/stenting...
Source: Current Gastroenterology Reports - May 7, 2019 Category: Gastroenterology Source Type: research

Bariatric Surgery in Children: Indications, Types, and Outcomes
AbstractPurpose of ReviewThe purpose of this review is to discuss the current state of surgical intervention for obesity in children and adolescents. Specifically, this review will discuss the different types of metabolic and bariatric surgery (MBS) procedures, guidelines for patient selection, and recent findings regarding surgical outcomes and complications.Recent FindingsMBS is safe in adolescents and has also demonstrated sustainable long term weight loss and improvement in obesity-associated comorbidities. A recent prospective multi-institutional trial demonstrated BMI reductions of 3.8  kg/m2 (8%) to 15.1  ...
Source: Current Gastroenterology Reports - April 25, 2019 Category: Gastroenterology Source Type: research

Controversies in the Management of Functional Constipation in Children
AbstractPurpose of reviewFunctional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5  years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre- and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrou nding them.Recent findingsPre- and probiotics and prucalopride are not effective in the tre...
Source: Current Gastroenterology Reports - April 25, 2019 Category: Gastroenterology Source Type: research

Islet Transplantation in Children
AbstractPurpose of ReviewTransplantation of the islets of Langerhans or the pancreas aims to restore blood sugar control. We review both forms of transplantation in children.Recent FindingsAllogenic islet transplantation typically in to the liver via the portal vein may be a potential alternative to pancreas transplantation in the future. Autologous islet transplantation after total pancreatectomy is effective for debilitating symptoms of recurrent and chronic pancreatitis. Chronic pancreatitis in children is most often related to genetic mutations but is otherwise similar to adults with eventual exocrine and endocrine fai...
Source: Current Gastroenterology Reports - April 25, 2019 Category: Gastroenterology Source Type: research

Update on Pharmacotherapy for Irritable Bowel Syndrome
AbstractPurpose of ReviewIrritable bowel syndrome (IBS) is a functional GI disorder that affects a large percentage of the population and presents a significant socio-economic burden on the society. In this article, we reviewed the evidence supporting various pharmacological treatment options for IBS.Recent FindingsRifaximin, eluxadoline, and alosetron have demonstrated that they reduce symptom severity improving quality of life in patients with IBS –diarrhea. Ramosetron is a promising agent in development. Peppermint oil has also demonstrated a positive impact on some symptoms of IBS. For IBS with constipation, trad...
Source: Current Gastroenterology Reports - April 25, 2019 Category: Gastroenterology Source Type: research

Maneuvering Clinical Pathways for Crohn ā€™s Disease
AbstractPurpose of ReviewCrohn ’s disease management has changed significantly with increasing use of biologics. We review the recent literature on the clinical management of Crohn’s disease and new approaches in selecting and optimizing therapy.Recent FindingsRecent studies have addressed the efficacy of proactive anti-TNF α trough level monitoring, the efficacy of biosimilars, and the efficacy and immunogenicity of newer biologics including anti-integrin therapy and anti-IL12/23 therapy. Optimizing anti-TNFα therapy according to trough concentrations correlates with improved remission rates. Patie...
Source: Current Gastroenterology Reports - April 23, 2019 Category: Gastroenterology Source Type: research

Novel Non-biologic Targets for Inflammatory Bowel Disease
AbstractPurpose of ReviewThe biologic era revolutionized the medical management of inflammatory bowel disease (IBD) and allowed for a paradigm shift away from a therapeutic strategy that traditionally relied on corticosteroids and immunomodulators. IBD treatment has now further evolved to encompass novel non-biologic agents.Recent FindingsAn electronic database search, spanning up to September 2018, was conducted using PubMed, Web of Science, Google Scholar, and Scopus. Abstracts were also reviewed from Digestive Diseases Week, European Crohn ’s and Colitis Organization congress, Canadian Digestive Diseases Week, and...
Source: Current Gastroenterology Reports - April 23, 2019 Category: Gastroenterology Source Type: research

EUS-Guided Pancreatic Cyst Ablation: a Clinical and Technical Review
AbstractPurpose of ReviewPancreatic cystic lesions represent a growing public health dilemma, particularly as our population ages and cross-sectional imaging becomes more sensitive. Mucinous cysts carry a clinically significant risk of developing pancreatic cancer, which carries an extremely poor prognosis. Determining which cysts will develop cancer may be challenging, and surgical resection of the pancreas carries significant morbidity. The goal of this paper is to review the rationale for cyst ablation and discuss prior and current research on cyst ablation techniques and efficacy. Indications, contraindications, and fa...
Source: Current Gastroenterology Reports - April 23, 2019 Category: Gastroenterology Source Type: research

A Practical Guide to Biofeedback Therapy for Pelvic Floor Disorders
AbstractPurpose of ReviewBiofeedback therapy (BFT) is effective for managing pelvic floor disorders (i.e., defecatory disorders and fecal incontinence). However, even in controlled clinical trials, only approximately 60% of patients with defecatory disorders experienced long-term improvement. The review serves to update practitioners on recent advances and to identify practical obstacles to providing biofeedback therapy.Recent FindingsThe efficacy and safety of biofeedback therapy have been evaluated in defecatory disorders, fecal incontinence, and levator ani syndrome. Recent studies looked at outcomes in specific patient...
Source: Current Gastroenterology Reports - April 23, 2019 Category: Gastroenterology Source Type: research

Rectal Endoscopic Ultrasound in Clinical Practice
AbstractPurpose of ReviewEndoscopic ultrasound (EUS) is routinely utilized for evaluation of disorders of the lower gastrointestinal tract. In this review, we summarize the current status of rectal EUS in clinical practice and describe recent developments in diagnostic and therapeutic rectal EUS.Recent FindingsRecent guidelines recommend rectal EUS for rectal cancer staging as a second line modality in cases where MRI is contraindicated. Forward-viewing echoendoscopes and through the scope EUS miniprobes allow for EUS imaging of lesions through the entire colon and for evaluation beyond stenoses or luminal narrowings. EUS ...
Source: Current Gastroenterology Reports - April 12, 2019 Category: Gastroenterology Source Type: research

The Epidemiology of Hepatocellular Carcinoma in the USA
AbstractPurpose of ReviewTo discuss current knowledge and recent findings regarding the epidemiology of hepatocellular carcinoma (HCC) in the USA.Recent FindingThe US incidence rate of HCC is increasing, although the pace may have somewhat slowed since 2010. In 2012, incidence rates of HCC in Hispanics surpassed those of Asians. The recent epidemiological changes in major risk factors for HCC include increasing hepatitis C virus post-sustained virologic response, suppressed hepatitis B virus on nucleoside analogues, and alcoholic and non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease has the greatest prop...
Source: Current Gastroenterology Reports - April 11, 2019 Category: Gastroenterology Source Type: research

Stem Cell Therapies for Inflammatory Bowel Disease
AbstractPurpose of ReviewStem cell therapies have demonstrated safety and efficacy in the treatment of perianal Crohn ’s disease as compared to conventional therapy. Thus, an understanding of their place in the treatment algorithm for inflammatory bowel disease has become imperative as we move into an era of regenerative medicine.Recent FindingsThere have now been over a dozen clinical trials highlighting stem cells as a useful therapeutic in Crohn ’s disease. Due to the success in the local treatment for perianal Crohn’s disease, investigation is continuing in the space of targeted systemic delivery for ...
Source: Current Gastroenterology Reports - April 6, 2019 Category: Gastroenterology Source Type: research

Obesity, Motility, Diet, and Intestinal Microbiota ā€”Connecting the Dots
AbstractPurpose of ReviewThe goal of the present review is to explore the relationship between dietary changes and alterations in gut microbiota that contribute to disorders of gut motility and obesity.Recent FindingsWe review the microbiota changes that are seen in obesity, diarrhea, and constipation and look at potential mechanisms of how dysbiosis can predispose to these. We find that microbial metabolites, particularly short chain fatty acids, can lead to signaling changes in the host enterocytes. Microbial alteration leading to both motility disorders and obesity may be mediated by the release of hormones including gl...
Source: Current Gastroenterology Reports - March 18, 2019 Category: Gastroenterology Source Type: research

Brain-Gut Therapies for Pediatric Functional Gastrointestinal Disorders and Inflammatory Bowel Disease
AbstractPurpose of ReviewThe purpose of this review is to discuss current knowledge of brain-gut therapies (BGT) in pediatric functional gastrointestinal disorders (FGID) and inflammatory bowel disease (IBD), including their evidence base, the common psychopathology that they address, and the integration of this knowledge into medical settings.Recent FindingsCognitive behavioral therapy (CBT), hypnotherapy (HT), mindfulness-based therapy (MBT), and exposure-based therapy (EBT) have the most data supporting their use in children, particularly in FGID, more so than in IBD. This difference is most likely because of the increa...
Source: Current Gastroenterology Reports - March 12, 2019 Category: Gastroenterology Source Type: research

Barrett ā€™s Esophagus and Esophageal Carcinoma: Can Biomarkers Guide Clinical Practice?
AbstractPurpose of ReviewDespite gastrointestinal societal recommendations for endoscopic screening and surveillance of Barrett ’s esophagus, the rates of esophageal adenocarcinoma continue to rise. Furthermore, this current practice is costly to patients and the medical system without clear evidence of reduction in cancer mortality. The use of biomarkers to guide screening, surveillance, and treatment strategies might all eviate some of these issues.Recent FindingsIncredible advances in biomarker identification, biomarker assays, and minimally-invasive modalities to acquire biomarkers have shown promising results.Su...
Source: Current Gastroenterology Reports - March 12, 2019 Category: Gastroenterology Source Type: research

Gastric Neuroendocrine Tumors (Carcinoids)
AbstractPurpose of ReviewThe diagnosis of gastric neuroendocrine tumors (NETs) is being made with increased frequency likely as a result of more upper endoscopies being done for unrelated reasons. It is therefore vital that gastroenterologists become familiar with the basic work-up and management of patients found to have these tumors. This review describes the classification, pathophysiology, clinical characteristics, and treatment options of the different gastric NETs.Recent FindingsIn addition to the three traditional subtypes of gastric NETs, additional cases associated with achlorhydria and appropriate hypergastrinemi...
Source: Current Gastroenterology Reports - March 12, 2019 Category: Gastroenterology Source Type: research

The Current Role of Robotics in Colorectal Surgery
AbstractPurpose of ReviewDespite the growth in laparoscopic surgery, comparable oncological outcomes, and reduced complication rates, the majority of colorectal surgery is still performed via an open approach. Reasons for this may include technical difficulties associated with operating in narrow spaces such as in the pelvis and inadequate experience. Robotic surgery provides potential solutions to some of these challenges. This review will summarize the state of the literature regarding robotic colorectal surgery.Recent FindingsThe most consistent benefit of robotic surgery is decreasing operative conversions, specificall...
Source: Current Gastroenterology Reports - March 6, 2019 Category: Gastroenterology Source Type: research

Clinical Review on the Utility of Fecal Microbiota Transplantation in Immunocompromised Patients
AbstractFecal microbiota transplantation (FMT) represents a promising management modality forClostridium difficile infection (CDI). In immunocompromised patients, FMT is utilized for CDI as well as emerging non-CDI indications such as inflammatory bowel disease and graft versus host disease.Purpose of ReviewThis review aims to shed light on the safety and efficacy of FMT in immunocompromised patients, including patients suffering for human immunodeficiency virus infection, solid organ and hematopoietic stem cell transplant recipients, cancer patients, and patients on immunosuppressive therapies.Recent FindingsThough the bo...
Source: Current Gastroenterology Reports - February 28, 2019 Category: Gastroenterology Source Type: research

Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?
AbstractPurpose of ReviewColorectal cancer (CRC) is largely preventable with colonoscopy and other screening modalities. However, the effectiveness of screening and surveillance depends on the quality of the colonoscopy exam. Adenoma detection rate (ADR) is the best-validated metric by which we measure individual physicians ’ performance.Recent FindingsRecent evidence suggests that ADR benchmarks may be inappropriately low. There is proof that improving ADR leads to significant reductions in post-colonoscopy CRC (PCCRC). Two studies have demonstrated that when a colonoscopy is performed by physicians with higher ADRs...
Source: Current Gastroenterology Reports - February 28, 2019 Category: Gastroenterology Source Type: research

Inflammation and Neoplasia of the Pouch in Inflammatory Bowel Disease
AbstractPurpose of ReviewIleal pouch-anal anastomosis (IPAA) is the standard restorative procedure after proctocolectomy in patients with inflammatory bowel disease who require colectomy. The ileal pouch is susceptible to a variety of adverse outcomes including mechanical insult, ischemia, and infectious agents. There is also a risk for developing low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even adenocarcinoma in the pouch. The purpose of this review is to highlight risk factors, clinical presentation, surveillance, and treatment of pouch neoplasia.Recent FindingsPatients with pre-colectomy colitis-associated...
Source: Current Gastroenterology Reports - February 28, 2019 Category: Gastroenterology Source Type: research

The Art of Selective Cannulation at ERCP
AbstractPurpose of ReviewERCP is undergoing its 50th anniversary with a steady conversion from a diagnostic procedure to a therapeutic procedure. This paper shows a reflection of my 42  years of experience in the accession of biliary and pancreatic ducts and how the techniques have evolved to achieve a high rate of primary duct cannulation.Recent FindingsThere has been an increase in the primary approach to cannulation involving different cannulation catheters and guidewires, and we will review some of those available, realizing that the selection may vary depending on operator preference and team approach. Different ...
Source: Current Gastroenterology Reports - February 11, 2019 Category: Gastroenterology Source Type: research

The Role of EUS in Liver Biopsy
AbstractPurpose of ReviewEUS-guided liver biopsy (EUS-LB) is being used with increased frequency to perform parenchymal liver biopsy. Evolution of the technique can now achieve excellent liver tissue cores. This review covers important developments in this procedure.Recent FindingsClinical studies have recently demonstrated that the 19G EUS core biopsy needle is superior to non-core needles for liver tissue acquisition. In addition, wet suction provides more robust tissue samples than dry suction. Heparin priming of the needle (instead of saline) can prevent blood clogging within the needle lumen. A 1-hour recovery time af...
Source: Current Gastroenterology Reports - January 31, 2019 Category: Gastroenterology Source Type: research

Back to the Colorectal Cancer Consensus Molecular Subtype Future
AbstractPurpose of ReviewThis review seeks to provide an informed prospective on the advances in molecular profiling and analysis of colorectal cancer (CRC). The goal is to provide a historical context and current summary on how advances in gene and protein sequencing technology along with computer capabilities led to our current bioinformatic advances in the field.Recent FindingsAn explosion of knowledge has occurred regarding genetic, epigenetic, and biochemical alterations associated with the evolution of colorectal cancer. This has led to the realization that CRC is a heterogeneous disease with molecular alterations of...
Source: Current Gastroenterology Reports - January 30, 2019 Category: Gastroenterology Source Type: research

The Microbiome-Host Interaction as a Potential Driver of Anastomotic Leak
AbstractPurpose of ReviewThe goal of this paper is to review current literature on the gut microbiome within the context of host response to surgery and subsequent risk of developing complications, particularly anastomotic leak. We provide background on the relationship between host and gut microbiota with description of the role of the intestinal mucus layer as an important regulator of host health.Recent FindingsDespite improvements in surgical technique and adherence to the tenets of creating a tension-free anastomosis with adequate blood flow, the surgical community has been unable to decrease rates of anastomotic leak...
Source: Current Gastroenterology Reports - January 26, 2019 Category: Gastroenterology Source Type: research

The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO)
AbstractPurpose of ReviewTo critically review recent (past 3  years) literature on the definition, diagnosis, and management of small intestinal bacterial overgrowth (SIBO).Recent FindingsWhile various series continue to illustrate the occurrence of SIBO in disease states where well-known risk factors for its occurrence are present (hypochlorhydria, disorders of intestinal structure or motor function, pancreatic insufficiency, and chronic liver disease, for example), the current challenge is in defining the limits of SIBO. Is SIBO truly common among those with “functional” gastrointestinal symptoms where t...
Source: Current Gastroenterology Reports - January 15, 2019 Category: Gastroenterology Source Type: research

Managing Risks with Biologics
AbstractPurpose of ReviewWith a rapidly evolving complement of advanced targeted therapies in inflammatory bowel disease, additional safety and side effect concerns emerge. It is the purpose of this review to consider various risks with biologic therapies in inflammatory bowel disease and discuss mitigating strategies.Recent FindingsTwo recently approved monoclonal antibodies (vedolizumab and ustekinumab) and a Janus kinase inhibitor small molecule (tofacitnib) have introduced a number of novel safety and risk considerations. We review the clinical trial and real-world safety data to date on these agents as well as review ...
Source: Current Gastroenterology Reports - January 11, 2019 Category: Gastroenterology Source Type: research

Cannabis and Turmeric as Complementary Treatments for IBD and Other Digestive Diseases
AbstractPurpose of ReviewComplementary therapies for inflammatory bowel disease (IBD) have earned growing interest from patients and investigators alike, with a dynamic landscape of research in this area. In this article, we review results of the most recent studies evaluating the role of cannabis and turmeric for the treatment of IBD and other intestinal illnesses.Recent FindingsCannabinoids are well-established modulators of gut motility and visceral pain and have demonstrated anti-inflammatory properties. Clinical trials suggest that there may be a therapeutic role for cannabinoid therapy in the treatment of IBD, irrita...
Source: Current Gastroenterology Reports - January 11, 2019 Category: Gastroenterology Source Type: research

A Brief Update on the Management of Hepatitis Delta
(Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - December 14, 2018 Category: Gastroenterology Source Type: research

Dietary Fiber and Gastrointestinal Disease: an Evolving Story
(Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - November 8, 2018 Category: Gastroenterology Source Type: research