An Approach to Drug-Induced Liver Injury from the Geriatric Perspective
AbstractPurpose of ReviewWith its high variability in both presentation and severity, drug-induced liver injury (DILI) is a complex condition increasingly confronting all providers. DILI has an even more muddled presentation among the geriatric population due to age-related changes in liver physiology and biochemistry as well as polypharmacy common in the geriatric population.Recent FindingsMost cases of DILI are idiosyncratic and unpredictable. DILI, especially related to herbal and dietary supplement (HDS) use, is increasingly recognized as a leading cause of acute liver failure and need for liver transplantation. Unfort...
Source: Current Gastroenterology Reports - April 12, 2021 Category: Gastroenterology Source Type: research
Management of Non-Variceal Upper GI Bleeding in the Geriatric Population: An Update
AbstractPurpose of ReviewUpper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality in the geriatric (age > 65 years) population and presents a unique management challenge in the context of multiple medical comorbidities, polypharmacy, and increased risk of adverse outcomes and is confounded by an increased prevalence of obscure GI bleeds. A review of relevant guidelines, literature, and personal obse rvations will enhance management strategies in the elderly.Recent FindingsNon-variceal bleeding represents a significant proportion of upper GI bleeding (UGIB) in geriatric patients. Pept...
Source: Current Gastroenterology Reports - March 25, 2021 Category: Gastroenterology Source Type: research
Luminal Gastrointestinal Manifestations of Cystic Fibrosis
AbstractPurpose of ReviewPeople with cystic fibrosis (CF) are living longer. General age-related and CF-specific gastrointestinal symptoms are increasingly recognized. In this article, we review the latest data on luminal gastrointestinal manifestations in CF.Recent FindingsPeople with CF have increased incidence of gastroesophageal reflux disease symptoms and often prescribed proton-pump inhibitors (PPI). PPI use may increase risk of pulmonary exacerbations. Evidence to support gastric fundoplication to improve pulmonary outcomes is limited. Features of intestinal dysmotility are common. There are distinct differences in ...
Source: Current Gastroenterology Reports - March 23, 2021 Category: Gastroenterology Source Type: research
TRANSITION of Pediatric Liver Transplant Patients to Adult Care: a Review
AbstractPurpose of ReviewMany pediatric liver transplant patients are surviving to adulthood, and providers have come to recognize the importance of effectively transitioning these patients to an adult hepatologist. The review aims to analyze the most recent literature regarding patient outcomes after transition, barriers to successful transition, recommendations from clinicians and medical societies regarding transition programs, and to provide personal insights from our experience in transitioning liver transplant recipients.Recent FindingsWhile results were variable between studies, many recent reports show significant ...
Source: Current Gastroenterology Reports - January 29, 2021 Category: Gastroenterology Source Type: research
Gastric Electrical Stimulation for Treatment of Refractory Gastroparesis: the Current Approach to Management
AbstractPurpose of ReviewGastroparesis is one of the more challenging entities in the landscape of gastroenterology, posing difficulties for both patients and physicians with regard to effective management and therapies. In this article, we reviewed various gastroparesis treatment options, with an emphasis on gastric electrical stimulation (GES).Recent FindingsGES has demonstrated a significant reduction of cardinal symptoms in refractory gastroparetic patients, particularly nausea and vomiting, across multiple studies. However, GES has not been shown to conclusively decrease gastric emptying time in these patients. Such f...
Source: Current Gastroenterology Reports - January 22, 2021 Category: Gastroenterology Source Type: research
The Role of Endoscopic Ultrasound (EUS) in the Management of Gastric Varices
AbstractPurpose of ReviewGastric varices (GV) are an important complication of portal hypertension, and the current recommendation for management is beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt (TIPS) for active bleeding or secondary prophylaxis. Direct endoscopic injection of cyanoacrylate (CYA) glue has been investigated but has drawbacks including limited endoscopic characterization of GV and possible distal glue embolism. To this end, endoscopic ultrasound (EUS) has been pursued to help in characterization of GV, visualization of treatment in real time, and confirmation...
Source: Current Gastroenterology Reports - January 2, 2021 Category: Gastroenterology Source Type: research
Endoscopic Eradication Therapy for Barrett ’s Neoplasia: Where Do We Stand a Decade Later?
AbstractPurpose of ReviewBarrett ’s esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), a cancer associated with increasing incidence and poor survival. Early identification and effective treatment of BE-related neoplasia prior to the development of invasive adenocarcinoma are essential to limiting the morbidity and mortality associated with this cancer. In this review, we summarized the recent evidence guiding endoscopic eradication therapies (EET) for neoplastic BE.Recent FindingsNew sampling technologies and the application of artificial intelligence (AI) systems have potential to revolution...
Source: Current Gastroenterology Reports - December 4, 2020 Category: Gastroenterology Source Type: research
Advances in Biliary Access
AbstractPurpose of ReviewBile duct cannulation using conventional techniques fails in up to 16% of endoscopic retrograde cholangiopancreatography (ERCP) procedures. Advanced techniques to gain biliary access include ERCP-based maneuvers, and newer endoscopic ultrasound (EUS) –guided interventions. In this article, we review the evidence supporting the use of various ERCP and EUS techniques for biliary access, as well as studies comparing these different techniques.Recent FindingsIn comparative studies, biliary access after failed conventional cannulation was more successful with EUS-rendezvous compared to precut papillot...
Source: Current Gastroenterology Reports - December 4, 2020 Category: Gastroenterology Source Type: research
Endoscopic Eradication Therapy for Barrett ’s Neoplasia: Where Do We Stand a Decade Later?
AbstractPurpose of ReviewBarrett ’s esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), a cancer associated with increasing incidence and poor survival. Early identification and effective treatment of BE-related neoplasia prior to the development of invasive adenocarcinoma are essential to limiting the morbidity and mortality associated with this cancer. In this review, we summarized the recent evidence guiding endoscopic eradication therapies (EET) for neoplastic BE.Recent FindingsNew sampling technologies and the application of artificial intelligence (AI) systems have potential to revolution...
Source: Current Gastroenterology Reports - December 4, 2020 Category: Gastroenterology Source Type: research
