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
Non-acid Reflux: When It Matters and Approach to Management
AbstractPurpose of ReviewThis narrative review focuses on the presentation, contributing factors, diagnosis, and treatment of non-acid reflux. We also propose algorithms for diagnosis and treatment.Recent FindingsThere is a paucity of recent data regarding non-acid reflux. The recent Porto and Lyon consensus statements do not fully address non-acid reflux or give guidance on classification. However, recent developments in the lung transplantation field, as well as older data in the general population, argue for the importance of non-acid reflux.SummaryExtrapolating from the Porto and Lyon consensus, we generally classify p...
Source: Current Gastroenterology Reports - July 9, 2020 Category: Gastroenterology Source Type: research
Flip Technology for Assessing Esophageal Structural and Motor Disorders: a Skeptic ’s View
AbstractPurpose of ReviewFunctional lumen impedance (FLIP) technology has become commercially available to assess structural and motor abnormalities of the esophagus. Increasing numbers of papers have described novel findings with this technology. This review examines the validity of the FLIP technique, how it compares with existing diagnostic modalities, and evidence to date on diagnostic accuracy.Recent FindingsFLIP studies require deep sedation at the time of endoscopy to complete. They assess a simulated state of esophageal obstruction in only a distal part of the esophagus rather than deglutitive motor function of the...
Source: Current Gastroenterology Reports - July 9, 2020 Category: Gastroenterology Source Type: research
Reflux Hypersensitivity: How to Approach Diagnosis and Management
AbstractPurpose of ReviewThis paper aims to review the definition and diagnostic criteria for reflux hypersensitivity and comment on the present and future management of this condition.Recent FindingsIn 2016, the Rome IV criteria redefined reflux hypersensitivity as characterized by typical reflux symptoms, absence of endoscopic mucosal disease, absence of pathologic gastroesophageal reflux, and positive symptom correlation between reflux and heartburn episodes. Though uncertain, TPRV1 receptors have been implicated in the pathophysiology of reflux hypersensitivity. Recent studies have shown neuromodulators like SSRIs, SNR...
Source: Current Gastroenterology Reports - July 9, 2020 Category: Gastroenterology Source Type: research
Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans
AbstractPurpose of ReviewColorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population.Recent FindingsAt its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on...
Source: Current Gastroenterology Reports - July 8, 2020 Category: Gastroenterology Source Type: research
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 25, 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 vedolizumab and ust...
Source: Current Gastroenterology Reports - June 14, 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 14, 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 large co...
Source: Current Gastroenterology Reports - June 14, 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 guideline-based rec...
Source: Current Gastroenterology Reports - June 14, 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 8, 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 3, 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 3, 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 2, 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 2, 2020 Category: Gastroenterology Source Type: research
