Early detection of pancreatic cancer
Purpose of review Pancreatic cancer is the third leading cause of cancer death and with a dismal 5-year survival of 10%. Poor survival of pancreatic cancer is mostly due to its presentation and diagnosis at a late stage. The present article aims to update clinicians with recent progress in the field of early detection of pancreatic cancer. Recent findings Pancreatic cancer screening is not recommended in the general population due to its low prevalence. In this review, we discuss high-risk groups for pancreatic cancer, including inherited predisposition to pancreatic cancer, new-onset diabetes, mucinous pancreatic cys...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Expanding indications for pancreatic islet cell transplantation
Purpose of review We aimed to summarize the current state of performing pancreatic islet autotransplantation (IAT) for indications other than total pancreatectomy for chronic pancreatitis. Recent findings The current article will review expanded indications for IAT including partial pancreatectomy for benign inflammatory disease, trauma, pancreatic islet cell tumor and pancreatic adenocarcinoma. In the context of more access for IAT as more centers are offering this clinical service, these expanded indications will continue to push the limits of our ability to make IAT accessible. Summary Pancreatic islet cell tran...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Panorama of mediators in postpancreatitis diabetes mellitus
Purpose of review To provide an overview of mediators involved in the pathogenesis of postacute pancreatitis diabetes mellitus. Recent findings The ‘holistic prevention of pancreatitis’ framework has brought to the fore the sequelae of not only end-stage chronic pancreatitis and extensive pancreatic necrosis but also mild acute pancreatitis. Insights from the DORADO project have provided a wealth of information on the signalling molecules that do and do not affect glucose metabolism in individuals after mild acute pancreatitis and have challenged conventional views of the pathogenesis of postpancreatitis d...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

New horizons in pancreatic genetics
Purpose of review Pancreatitis remains an intractable disease because no causative treatment is yet available. Recent studies have uncovered some of its underlying pathophysiology, a requirement for identifying potential treatment targets. These advancements were achieved by human genetic studies and by introducing genetic mechanisms into experimental pancreatitis models. Recent findings Cationic trypsin mutations are the most prominent genetic risk factor for pancreatitis. Investigators have now introduced genetically modified trypsin variants into transgenic animals. In this manner they characterized the role of cel...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Precision medicine for pancreatic diseases
We describe and contrast the strengths of precision medicine with Western medicine, and complex trait genetics with Mendelian genetics. Classic genetics focuses on highly penetrant pathogenic variants in a single gene believed to cause or confer a high risk for well-defined phenotypes. However, a minority of disorders have a single gene cause. Further, even individuals with identical Mendelian disease-associated genotypes may exhibit substantial phenotypic variability indicative of genetic and environmental modifiers. Still, most diseases are considered complex traits (or complex diseases). Recent findings New insights ...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Breath testing for the diagnosis of pancreatic disease
Purpose of review Pancreatic function tests are mainly used for the diagnosis of exocrine pancreatic insufficiency (EPI) in patients with pancreatic diseases or after pancreatic or gastric surgery. Breath tests evaluate not just pancreatic secretion but the digestion capacity of the pancreas. These tests are good candidates for the diagnosis of EPI as they are noninvasive, accurate and easy to apply to clinical practice. Recent findings The 13C-labelled mixed triglyceride (MTG) breath test has been optimized and validated against adequate reference methods for the diagnosis of EPI in patients with chronic pancreatitis...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Autoimmune pancreatitis type 2
Purpose of review Type 2 autoimmune pancreatitis (AIP) is a rare inflammatory disease of the pancreas. Very few data have been published on this particular subtype, which differs from the ‘classical’ IgG4-related type 1 AIP in terms of pathological features, epidemiology and risk of relapse. The aim of the current review is to summarize the available literature, suggesting a diagnostic and therapeutic approach to this disease. Recent findings Based on the International Consensus Diagnostic Criteria, to achieve a ‘definitive’ diagnosis of type 2 AIP, histology is required. If a definitive histol...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Intravenous fluid resuscitation in the management of acute pancreatitis
Purpose of review In the absence of proven effective pharmacologic therapy in acute pancreatitis, and given its simplicity, wide availability, and perceived safety, intravenous fluid resuscitation remains the cornerstone in the early treatment of acute pancreatitis. Herein, we will review the rationale of fluid therapy, critically appraise the published literature, and summarize recent studies. Recent findings Several observational studies and small clinical trials have raised concern about the efficacy and safety of aggressive fluid resuscitation. Early aggressive fluid therapy among acute pancreatitis patients with ...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: PANCREAS: Edited by Timothy B. Gardner Source Type: research

Role of endoscopic ultrasonography guided fiducial marker placement in gastrointestinal cancer
Purpose of review Dose escalation radiation therapy such as those delivered by stereotactic body radiation therapy (SBRT) has shown to improve local disease control in multiple types of malignancies. This requires fiducial placement to improve accuracy of treatment and avoid adverse events to adjacent radiosensitive organs during respiration phases. The purpose of this review is to provide updates of recent high-quality articles related to endoscopic ultrasonography (EUS)-guided fiducial placement for gastrointestinal malignancies, particularly in pancreatic cancer, which is expected to be the second leading cause of can...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

The importance of anal cancer screening and high-resolution anoscopy to gastroenterology practice
Purpose of review Although human papillomavirus (HPV)-related anal squamous cell cancer (ASCC) is rare, its incidence has been rising and in high-risk populations exceeds the incidence of cancers for which screening programs are implemented. Therefore, targeted screening techniques are being evaluated with high-resolution anoscopy (HRA) as the current gold standard because of its ability to detect anal intraepithelial dysplasia (AIN) and premalignant high-grade squamous intraepithelial lesions (HSILs). However, a scarcity of trained providers presents a barrier to screening. Recent findings ASCC incidence is rising es...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Best techniques for endoscopic ampullectomy
Purpose of review Endoscopic ampullectomy has proven its safety and efficacy in multiple studies, making it the favorable option for the management of endoscopic ampullectomy. In this review, we plan to review the basic steps every endoscopist should be familiar with before undertaking endoscopic ampullectomy. Recent findings In this review, we plan to discuss the indications, preresection evaluation process including endoscopic ultrasound, endoscopic ampullectomy techniques with side-viewing endoscope and endoscopist experience/comfort with the management of the endoscopic ampullectomy complications. Summary Thing...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Flexible endoscopic strategies for the difficult esophageal stricture
Purpose of review Benign strictures of the esophagus, caused by various causes, are frequently encountered in clinical practice. Although endoscopic dilation is still the standard and first-line therapy, complex and difficult esophageal strictures are still encountered and remain a challenge to endoscopists. The main scope of this review article is to offer a closer look at the different endoscopic modalities and approaches to complex and difficult esophageal strictures. Recent findings In the past few years, endoscopic dilatation, stents including self-expandable and biodegradable types, incisional therapy, and pharm...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Robotics in flexible endoscopy: current status and future prospects
Purpose of review Advanced endoscopy procedures are technically challenging and require extensive training. Recent technological advances made in computer science and robotics have the potential to enhance the performance of complex intraluminal and transluminal interventions and potentially optimize precision and safety. This review covers the different technologies used for robot-assisted interventions in the gastrointestinal tract, organized according to their clinical availability, and focusing on flexible endoscopy-based systems. Recent findings In the curvilinear gastrointestinal anatomy, robotic technology can ...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Endoscope infection transmission state-of-the-art: beyond duodenoscopes to a culture of infection prevention
Purpose of review The elevator mechanism of the duodenoscope was the focus of endoscopically transmitted infections prior to the COVID-19 pandemic. Since that time, the ‘suspicious suspects’ in the endoscopy unit have grown in number in the eyes of both patients and endoscopists. Recent findings This review summarizes the existing guidelines related to infection control in the endoscopy unit and emerging technologies to address gaps, identifies recommendations proposed during the COVID-19 pandemic, and reminds the reader that infection prevention has not changed since the emergence of COVID-19, only the im...
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Editorial: Gastrointestinal endoscopy in the face of the corona virus disease-19 pandemic
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 4, 2020 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Approaches to diet therapy for eosinophilic esophagitis
Purpose of review The aim of this review is to highlight recent advances in dietary therapy for eosinophilic esophagitis (EoE). Recent findings An empiric elimination diet step-up strategy is now well established as the initial approach for dietary treatment. The most common food triggers are by far cow's milk, followed by wheat and egg. Legumes seem to be important solely in Spain and other Mediterranean countries, where they are regularly consumed. Retrospective efficacy data on cow's milk elimination diet in children vary from 25 to 65%. The recently described esophageal prick test did not detect local reaction to ...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Endoscopic eradication therapy for Barrett's oesophagus: state of the art
Purpose of review Barrett's oesophagus is the only identifiable precursor lesion to oesophageal adenocarcinoma. The stepwise progression of Barrett's oesophagus to dysplasia and invasive carcinoma provides the opportunity to intervene and reduce the morbidity and mortality associated with this lethal cancer. Several studies have demonstrated the efficacy and safety of endoscopic eradication therapy (EET) for the management of Barrett's oesophagus related neoplasia. The primary goal of EET is to achieve complete eradication of intestinal metaplasia (CE-IM) followed by enrolment of patients in surveillance protocols to det...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Opioid-induced esophageal dysfunction
Purpose of review Chronic opioid use is common and can cause opioid-induced esophageal dysfunction (OIED). We will discuss the pathophysiology, diagnosis, and management of OIED. Recent findings OIED is diagnosed based on symptoms, opioid use, and manometric evidence of distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, or jackhammer esophagus. Chronic opioid use appears to interfere with inhibitory signals involved in control of esophageal motility, allowing for unchecked excitatory stimuli, and leading to spastic contractility and impaired esophagogastric junction relaxation. ...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Management of regurgitation in patients with gastroesophageal reflux disease
Purpose of review Precision treatment of medically-refractory regurgitation differs from that of heartburn. Regurgitation is an often-overlooked symptom characterized as a bitter taste in the mouth or a sense of fluid moving up from the stomach occurring in approximately 80% of gastroesophageal reflux disease (GERD) patients with varying severity. Its response to standard medical therapy is significantly less than heartburn while significantly lessening quality of life in 10–20% of GERD patients. Recent findings The therapeutic gain of proton pump inhibitors (PPIs) above placebo averages 17% for regurgitation co...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

EsoFLIP for esophageal dilation: proposed advantages
Purpose of review The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric distension while providing real-time visualization and objective measurement during the dilation procedure, potentially negating the need for fluoroscopy. This review aims to describe the use and application of EsoFLIP and the potential advantages this novel technology may afford. Recent findings Small pilot and retrospective studies demonstrate EsoFLIP feasibility and safety, but larger studies are needed to understand its impact on clinica...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: pros and cons
This study demonstrated equivalency over many different operative outcomes, with MSA patients having less bloating while also retaining the ability to belch and vomit. Furthermore, independent research teams found a modest cost savings for MSA over laparoscopic fundoplication with budget analysis. Summary MSA is a safe and efficacious procedure originally approved for patients with medically refractory, uncomplicated gastroesophageal reflux disease. The accumulating body of evidence suggests patients with intestinal metaplasia or hiatal hernias can safely and effectively undergo MSA, whereas further research will be req...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

How to advise patients on the risk of chronic proton pump inhibitor therapy
Purpose of review Proton pump inhibitors (PPIs) are widely prescribed and have excellent short-term tolerability. Administrative database studies have highlighted that many diseases are associated with PPI therapy including pneumonia, fracture, cardiovascular disease, and all-cause mortality. This review therefore reviews the evidence of the risks and benefits of these drugs. Recent findings There is high-to-moderate quality evidence that PPIs are effective at treating many acid-related disorders. Recent randomized trials have suggested that the associations between PPIs and various diseases are likely to be related t...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

The burden of cost in inflammatory bowel disease: a medical economic perspective
Purpose of review The cost of care for inflammatory bowel disease (IBD) has nearly doubled over the last two decades. With evolving treatment paradigms utilizing costly but efficacious biologic agents earlier and more often, the cost burden is only expected to worsen. The purpose of this review is to explore the current economic landscape and drivers of IBD healthcare costs along with potential mechanisms for improving value and cost-effectiveness of IBD care. Recent findings The prevalence of IBD continues to rapidly expand with costs following suit. As compensation models change, the medical community is more incent...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Integration of telemedicine into clinical practice for inflammatory bowel disease
Purpose of review In the context of the rising incidence and complexity of inflammatory bowel disease (IBD), telehealth offers new ways to support remote and efficient delivery of healthcare services. The aim of this review is to assess the current status of telehealth services in the management of IBD and challenges to adopting telehealth in clinical practice. Recent findings Different modalities of telehealth such as virtual clinics and remote patient monitoring have been studied in many IBD centers. They are found to be associated with high patient acceptance, decreased healthcare costs, improved quality of life, t...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Gaining resilience and reducing stress in the age of COVID-19
This article will review the stress, provide a theoretical layout to predict upcoming response, and offer clinicians some practical interventions to employ as the stress of the COVID-19 pandemic continues. (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Fatigue in inflammatory bowel disease: a problematic ailment
Purpose of review Fatigue, a protean complaint encompassing both physical, mental exhaustion but also demotivation, has shown to effect quality of life in patients with inflammatory bowel disease (IBD). Here we present a review of the literature as it relates to IBD-associated fatigue. Moreover, we present the common causes attributed to fatigue and present an algorithmic approach to the assessment of fatigue. Finally, we report data regarding potential management strategies for IBD-associated fatigue. Recent findings Unfortunately, owing to its multidimensional nature and multifactorial causes, patients with IBD may ...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Postoperative Crohn's disease management
Purpose of review Despite multiple advances in the medical treatment of Crohn's disease, it is recognized that a significant proportion of patients will ultimately require surgical resection at some point during their disease course. This review focuses on the postoperative management of patients with Crohn's disease, with the goal of preventing endoscopic and clinical recurrence, and future surgery. Recent findings Surgery is an integral part of the multidisciplinary approach to the management of patients with Crohn's disease. Recent literature and guidelines have focused on a standardized and evidence-based approach...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

The management of the hospitalized ulcerative colitis patient: the medical-surgical conundrum
Purpose of review In this review article, we address emerging evidence for the medical and surgical treatment of the hospitalized patient with ulcerative colitis. Recent findings Ulcerative colitis is a chronic inflammatory disease involving the colon and rectum. About one-fifth of patients will be hospitalized from ulcerative colitis, and about 20–30%, experiencing an acute flare will undergo colectomy. Because of the significant clinical consequences, patients hospitalized need prompt evaluation for potential complications, stratification of disease severity, and a multidisciplinary team approach to therapy, w...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Safety considerations with biologics and new inflammatory bowel disease therapies
Purpose of review The safety profile of therapies is an important issue that should always be shared with patients when choosing their treatment. The introduction of biologics over the past 2 decades represented a breakthrough in the management of inflammatory bowel diseases (IBDs). With better understanding of the pathophysiology of the disease, emerging therapies targeting different mechanisms of action have been developed including targeted monoclonal antibodies and small molecules. However, increasing concerns about the safety and side effects of these drugs have been challenging clinicians in clinical practice. Rec...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

The treatment approach to inflammatory bowel disease in 2020
Purpose of review Multiple new medications with novel mechanisms of action are now available to treat inflammatory bowel disease (IBD). Identifying the appropriate patients in whom to use these therapies is critical in maximizing benefit and reducing unnecessary risks. Once the appropriate therapy is selected, using a treat-to-target algorithm including symptomatic, biochemical, and endoscopic monitoring can improve clinical outcomes. If symptoms recur, these same principles, coupled with therapeutic drug monitoring, should be considered to confirm inflammation and determine next therapeutic steps. Recent findings Mul...
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Editorial: Hot topics in inflammatory bowel diseases, today and tomorrow
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - June 9, 2020 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Protein-losing enteropathy
Purpose of review The present review offers its readers a practical overview of protein-losing enteropathy, particularly with regard to diagnostic and therapeutic approaches. The aim is to support clinicians in their daily practice with a practical tool to deal with protein-losing enteropathy. Recent findings The literature covering protein-losing enteropathy does not appear to be quite recent and also guidelines are scanty. The main innovations during the last decade probably regard the introduction of enteroscopic techniques in the diagnostic flowchart. The use of video-capsule and device-assisted enteroscopy has en...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Update on chronic intestinal pseudo-obstruction
Purpose of review Chronic intestinal pseudo-obstruction (CIPO) is the most severe and disabling form of gastrointestinal dysmotility characterized by an impairment of coordinated propulsive activity in the gastrointestinal tract mimicking mechanical intestinal obstruction. Over the last few years, major advances have been made in the diagnostic and therapeutic management of this rare disorder. Recent findings The present narrative review aims to summarize the current literature about the management of CIPO focusing on significant novelties about definition, epidemiology, diagnosis, and therapeutic options. The most si...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Advances in chronic intestinal failure management and therapies
Purpose of review To summarize changes and recent advances in therapies for chronic intestinal failure (CIF). Recent findings In the last few years, the management of CIF has significantly improved through better prevention and treatment of catheter-related bloodstream infections (CRBSIs) and intestinal failure-associated liver disease (IFALD), as well as improved enteral autonomy by using small bowel growth factors in selected patients. This may have been reflected by a recent reduction in small bowel transplantations. Summary Although CIF management has become more established and effective, the long-term implica...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Refractory coeliac disease: what should we be doing different?
Purpose of review The aim of this review is to provide insight into the diagnosis and management of patients with refractory coeliac disease (RCD) and highlight recent advances in this field. Recent findings The diagnosis of RCD can be more accurately confirmed with flow cytometry in addition to immunohistochemistry. Dietary input and excretion of gluten immunogenic peptides can help rule out gluten contamination, and therefore, substantiate a diagnosis of RCD type I. Small bowel capsule endoscopy (SBCE) is important at diagnosis and follow-up in addition to duodenal histology. Apart from ruling out complications, it ...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Radiation enteritis: from diagnosis to management
Purpose of review As cancer treatments improve more patients than ever are living for longer with the side effects of these treatments. Radiation enteritis is a heterogenous condition with significant morbidity. The present review aims to provide a broad overview of the condition with particular attention to the diagnosis and management of the condition. Recent findings Radiation enteritis appears to be more prevalent than originally thought because of patient underreporting and a lack of clinician awareness. Patient-related and treatment-related risk factors have now been identified and should be modified where possi...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Editorial: The ‘ailing small bowel’
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Signatures in drug-induced liver injury
Purpose of review Drug-induced liver injury (DILI) can be induced by a myriad of drugs. Assessing whether the patient has DILI and assessing which drug is the most likely culprit are challenging. There has been too little attention paid to the concept that certain drugs appear to have unique clinical features or ‘phenotypes’. Recent findings Several case series of DILI because of various drugs have been published, and analysis of these case series points to the fact that individual drugs have characteristic DILI signatures. These clinical phenotypes can be characterized by latency, biochemical features (R-...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Hepatic manifestations of cystic fibrosis
Purpose of review Liver disease in cystic fibrosis (CF) usually develops before puberty, is often asymptomatic and slowly progressive. Multilobular cirrhosis develops in approximately 5–10% of patients by the age of 18, and is a significant contributor to the morbidity and mortality. No therapy, including ursodeoxycholic acid and cystic fibrosis transmembrane conductance regulator correctors or potentiators, has proven effective to prevent or halt the progression of liver disease towards cirrhosis and portal hypertension. This review provides the current knowledge in the epidemiology of CF liver disease and develop...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

The utility of liver biopsy in 2020
Purpose of review Over the past decade, imaging modalities and serological tests have emerged as important tools in the evaluation of liver diseases, in many cases supplanting the use of liver biopsy and histological examination. Nonetheless, the accuracy and diagnostic value of these methods may not always be conclusive and the assessment of liver histology often remains the gold standard for diagnostic evaluation. The purpose of this review is to summarize the current role of liver biopsy in contemporary hepatology practice. Recent findings Technical factors were found to influence the diagnostic value of liver biop...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

New systemic agents for hepatocellular carcinoma: an update 2020
Purpose of review Despite major therapeutic improvements in most cancer entities, hepatocellular carcinoma (HCC) has remained a dismal disease. In fact, incidence and mortality are increasing in many parts of the world, including the United States. Given that a number of systemic agents has recently been tested positive in phase 3 clinical trials, the objective of this review is to summarize the current treatment landscape for advanced HCC. Recent findings Following the positive SHARP trial in 2008, sorafenib has been the only systemic agent for advanced HCC for almost a decade. However, in first line, lenvatinib was ...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Coagulation testing and management in liver disease patients
Purpose of review The present article aims to provide clinicians with an overview of coagulation testing in individuals with liver disease, to discuss available procoagulants and the rationale for their use, and to provide management strategies in a variety of common clinical scenarios. Recent findings Clinicians and researchers are gaining an increased understanding of the shortfalls of assessing bleeding risk using traditional tests of coagulation. The use of global tests of clot formation, including viscoelastic testing and thrombin generation analysis, continues to evolve and guide the management of these patients...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

The natural history of alcohol-related liver disease
Purpose of review This review will describe the natural history of alcohol-related liver disease (ArLD) in light of recent data that have synthesized existing knowledge on this topic and described new research cohorts to improve our understanding of progression and outcomes in ArLD. Recent findings ArLD occurs after a threshold of alcohol consumption, but this threshold is lowered by the presence of comorbid factors of which obesity is the most common. The most common stage of ArLD is alcohol-related steatosis: this is associated with a low rate of progression to cirrhosis (3%/year) and nonliver-related morbidity is m...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Liver transplantation for alcoholic hepatitis: update
Purpose of review Alcoholic liver disease continues to be a major public health concern in the United States and around the world. Alcoholic liver disease remains the third most common indication for liver transplantation in the United States. Mortality has been reported in up to 30–50% of patients with severe alcoholic hepatitis. Liver transplantation can be lifesaving for patients with alcoholic hepatitis. Liver transplantation for alcoholic liver disease was traditionally only considered in patients who have achieved 6 months of abstinence. The majority of patients with severe alcoholic hepatitis who fail medica...
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Editorial: Advances in hepatology – 2020
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 8, 2020 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

The gut microbiome as a predictor of low fermentable oligosaccharides disaccharides monosaccharides and polyols diet efficacy in functional bowel disorders
Purpose of review Fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) dietary restriction ameliorates irritable bowel syndrome (IBS) symptoms; however, not all individuals with IBS respond. Given the gut microbiome's role in carbohydrate fermentation, investigators have evaluated whether the gut microbiome may predict low FODMAP diet efficacy. Recent findings Gut microbiome fermentation, even to the same carbohydrate, is not uniform across all individuals with several factors (e.g. composition) playing a role. In both children and adults with IBS, studies are emerging suggesting the gut mic...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Cancer cachexia: a multifactoral disease that needs a multimodal approach
Purpose of review Cancer cachexia is a complex condition that occurs in approximately 50% of cancer patients and in 80% of those with advanced cancer. It is characterized by lean body mass loss, adipose tissue loss, altered metabolism, increased inflammation, and a decrease in quality of life. Cancer cachexia is a frustrating condition to manage and treatment requires an innovative approach. The purpose of this article is to review the current treatments for cancer cachexia and how they could be used in a multimodal approach. Recent findings Cancer cachexia has many causes, but is primarily a result of reduced energy-...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research