Determining the Indeterminate Biliary Stricture: Cholangioscopy and Beyond
AbstractPurpose of ReviewIndeterminate biliary strictures (IDBS) continue to be an area of frustration for clinicians. Standard endoscopic retrograde cholangiopancreatography (ERCP) with conventional brush cytology and/or forceps biopsy has a low sensitivity for distinguishing benign from malignant biliary strictures. A delay in diagnosis of malignancy has consequences for subsequent therapy or surgery. In this article, we review current and emerging technologies that may aid in this diagnostic dilemma.Recent FindingsSeveral technologies have been utilized in IDBS to establish a diagnosis which include peroral cholangiosco...
Source: Current Gastroenterology Reports - November 3, 2020 Category: Gastroenterology Source Type: research
Inflammatory Bowel Disease Environmental Risk Factors: Diet and Gut Microbiota
AbstractPurpose of reviewThis review specifically explores the affect that diet has on the gut microbiota and its role on the increasing incidence of IBD around the world in developing countries.Recent findingsThis is a The emergence of IBD is consistently observed as a society becomes developed and westernized implicating the critical role that environmental factors play. Environmental factors that could play a significant role in the pathogenesis of IBD include westernization of diet and improved hygiene statust.SummaryWesternization of diet is associated with changes in the gastrointestinal microbiota, which could affec...
Source: Current Gastroenterology Reports - October 12, 2020 Category: Gastroenterology Source Type: research
Causes and Management of Non-cirrhotic Portal Hypertension
AbstractPurpose of the ReviewNon-cirrhotic portal hypertension (NCPH) includes a heterogeneous group of conditions. The aim of this paper is to make an overview on the denominations, diagnostical features and management of porto-sinusoidal vascular disease (PSVD) and chronic portal vein thrombosis (PVT) being the main causes of NCPH in the Western world.Recent FindingsThe management of NCPH consists in the treatment of associated diseases and of portal hypertension (PH). PH due to PSVD or PVT is managed similarly to PH due to cirrhosis. TIPS placement and liver transplantation are considerable options in patients with refr...
Source: Current Gastroenterology Reports - September 16, 2020 Category: Gastroenterology Source Type: research
The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry
This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test.SummaryThe London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of prac...
Source: Current Gastroenterology Reports - September 14, 2020 Category: Gastroenterology Source Type: research
Constipation and Fecal Incontinence in the Elderly
AbstractPurpose of ReviewTo review the epidemiology, pathogenesis, clinical features, and management of primary constipation and fecal incontinence in the elderly.Recent FindingsAmong elderly people, 6.5%, 1.7%, and 1.1% have functional constipation, constipation-predominant IBS, and opioid-induced constipation. In elderly people, the number of colonic enteric neurons and smooth muscle functions is preserved; decreased cholinergic function with unopposed nitrergic relaxation may explain colonic motor dysfunction. Less physical activity or dietary fiber intake and postmenopausal hormonal therapy are risk factors for fecal i...
Source: Current Gastroenterology Reports - August 23, 2020 Category: Gastroenterology Source Type: research
Does the Intestinal Microbiome Impact Athletic Performance?
AbstractPurpose of ReviewTo analyze current research involving elite athletes and the gut microbiome, with the goal to expand knowledge of potential sports performance strategies and interventions.Recent FindingsMost of the current research focuses on theoretical applications from microbiome research and known characteristics of performance, as few studies have actually been conducted in elite athletes. However, of the studies that have been conducted, the research is promising that dietary strategies may provide targeted interventions in the future.SummaryThe majority of sports nutrition takes an external approach to diet...
Source: Current Gastroenterology Reports - August 21, 2020 Category: Gastroenterology Source Type: research
Emerging New Diagnostic Modalities and Therapies of Nonalcoholic Fatty Liver Disease
AbstractPurpose of ReviewNonalcoholic fatty liver disease (NAFLD) has emerged as the leading cause of chronic liver disease in both adults and children. In this article, we review recent developments in the screening, diagnosis, and treatment of pediatric NAFLD.Recent FindingsAlthough alanine aminotransferase (ALT) remains the best screening test for NAFLD in children, and liver biopsy is still required for the diagnosis of nonalcoholic steatohepatitis (NASH), other noninvasive biomarker/imaging studies (MRI-PDFF and VCTE) have emerged as diagnostic methods for pediatric NAFLD. Two large clinical therapeutic trials testing...
Source: Current Gastroenterology Reports - August 18, 2020 Category: Gastroenterology Source Type: research
Clinicopathological Features of Gastroesophageal Neuroendocrine Neoplasms
AbstractPurpose of ReviewGastroesophageal neuroendocrine neoplasms (NENs) are a rare entity. Recent 2019 WHO classifications reflect our understanding of tumor biology, namely, that distinct molecular characteristics underline tumor behavior and prognosis. Here, we reviewed the evidence for linking molecular findings with the clinicopathological features and treatment of gastroesophageal NENs.Recent FindingsDegree of differentiation and Ki-67 proliferation index are required for accurate classification of neuroendocrine tumors and carcinomas but not sufficient to distinguish between the two entities. Resection remains the ...
Source: Current Gastroenterology Reports - August 13, 2020 Category: Gastroenterology Source Type: research
Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders
AbstractPurpose of ReviewFunctional dyspepsia (FD) is a chronic functional gastrointestinal disorder characterised by upper gastrointestinal symptoms. Here, we aimed to examine the evidence for immune responses to food in FD and overlap with food hypersensitivity conditions.Recent FindingsA feature of FD in a subset of patients is an increase in mucosal eosinophils, mast cells, intraepithelial cytotoxic T cells and systemic gut-homing T cells in the duodenum, suggesting that immune dysfunction is characteristic of this disease. Rates of self-reported non-celiac wheat/gluten sensitivity (NCW/GS) are higher in FD patients. F...
Source: Current Gastroenterology Reports - August 13, 2020 Category: Gastroenterology Source Type: research
High-Resolution Manometry —Observations After 15 Years of Personal Use—Has Advancement Reached a Plateau?
AbstractPurpose of ReviewIn the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau.Recent FindingsHRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting p...
Source: Current Gastroenterology Reports - August 6, 2020 Category: Gastroenterology Source Type: research
Low Anterior Resection Syndrome
AbstractPurpose of ReviewLow anterior resection syndrome is a highly prevalent condition that can develop after anal sphincter-sparing surgery for rectal cancer and impair quality of life. In this review, we summarize the major features and pathophysiology of this syndrome and discuss treatment approaches.Recent FindingsQuality of life correlates significantly with severity of low anterior resection syndrome. Prompt assessment and initiation of therapy are essential to rehabilitating damaged mechanical and neural structures. Anorectal manometry demonstrates a global decrease in sphincteric function postoperatively, though ...
Source: Current Gastroenterology Reports - August 3, 2020 Category: Gastroenterology Source Type: research
Hepatotoxicty of Agents Used in the Management of Inflammatory Bowel Disease: a 2020 Update
AbstractPurpose of ReviewAs treatment options for inflammatory bowel disease (IBD) continue to expand, the opportunity for hepatotoxicity remains a clinical concern. This review looks to update the current literature on drug-induced liver injury (DILI) and liver-related complications from current and emerging treatments for Crohn ’s disease (CD) and ulcerative colitis (UC).Recent FindingsAn extensive literature review on currently used medications to treat IBD and their liver-related side effects that includes mesalamine, thiopurines, certain antibiotics, methotrexate, anti-TNF agents including recently introduced biosim...
Source: Current Gastroenterology Reports - July 14, 2020 Category: Gastroenterology Source Type: research
A Comprehensive Approach to the Management of Benign and Malignant Ampullary Lesions: Management in Hereditary and Sporadic Settings
AbstractPurpose of ReviewThe purpose of this review was to examine the historical roots of endoscopic management of ampullary lesions and explore emerging data on improved techniques, technologies, and outcomes. Of specific interest was answering whether there exists a reasonable body of data to support one resection technique or strategy above others.Recent FindingsReview of recent literature suggests the continued use of endoscopic ampullectomy is a safe and effective means of curative treatment of ampullary adenomas. Complications are relatively infrequent and complete endoscopic resection is possible in a majority of c...
Source: Current Gastroenterology Reports - July 10, 2020 Category: Gastroenterology Source Type: research
Cirrhotic Cardiomyopathy
AbstractPurpose of ReviewCirrhotic cardiomyopathy is a syndrome of depressed cardiac function in patients with cirrhosis. We aimed to review the historical background, pathophysiology and pathogenesis, diagnostic definitions, clinical relevance, and management of this syndrome.Recent FindingsAn inflammatory phenotype underlies the pathogenesis: gut bacterial translocation with endotoxemia stimulates cytokines and cardiodepressant factors, such as nitric oxide and endocannabinoids. Cardiomyocyte plasma membrane biochemical and biophysical changes also play a pathogenic role. These factors lead to impaired beta-adrenergic fu...
Source: Current Gastroenterology Reports - July 9, 2020 Category: Gastroenterology Source Type: research
