Excluding irritable bowel syndrome in the inflammatory bowel disease patient: how far to go?: Erratum
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ERRATUM Source Type: research

Rumination syndrome: when to suspect and how to treat
Purpose of review Rumination syndrome is a gastrointestinal disorder characterized by effortless regurgitation of recently ingested food. The disorder is rare, but likely under-recognized and leads to impaired quality of life among those affected. This review discusses recent studies which examined the pathophysiology, diagnoses and therapy of rumination syndrome. Recent findings The pathogenesis of rumination syndrome remains incompletely understood. Therapeutic options, which appear effective, include behavioral therapy with diaphragmatic breathing and pharmacotherapy with baclofen. A randomized trial of behavioral ...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Esophagitis in patients without gastroesophageal reflux disease or eosinophilic esophagitis: diagnostic considerations
Purpose of review A multitude of inflammatory diseases other than gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can affect the esophagus. Despite the deceptively simple organization of squamous mucosa and its limited number of inflammatory responses, a wide array of histologic patterns can be seen in inflammatory disorders involving the esophagus. Each such histologic pattern is associated with a limited number of underlying conditions, and the clinician can use this information to narrow the differential diagnosis. The purpose of this review is to review and discuss the pathologic diagnosis of esop...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

How to choose among fundoplication, magnetic sphincter augmentation or transoral incisionless fundoplication
Purpose of review To examine current trends and research in nonmedical approaches to the treatment of gastroesophageal reflux disease (GERD). Recent findings Long-term studies of GERD patients treated with transoral incisionless fundoplication (TIF) have found that a large portion of patients resume proton pump inhibitor therapy. In patients with uncomplicated GERD, magnetic sphincter augmentation (MSA) shows excellent short-term results in both patient satisfaction and physiologic measures of GERD, with fewer postoperative side-effects than fundoplication, although dysphagia can be problematic. Summary Fundoplicat...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

The cyclical hit model: how paligenosis might establish the mutational landscape in Barrett's esophagus and esophageal adenocarcinoma
Purpose of review In this review, we explore a paligenosis-based model to explain Barrett's esophagus development and progression: ‘the cyclical hit model.’ Recent findings Genomic analyses have highlighted the high mutational burden of esophageal adenocarcinoma, Barrett's esophagus, and even normal esophageal epithelium. Somatic mutations in key genes including TP53 occur early in the neoplastic progression sequence of Barrett's esophagus, whereas chromosomal amplification resulting in oncogene activation occurs as a critical late event. Paligenosis is a shared injury response mechanism characterized by a...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Management of achalasia in 2019
Purpose of review The purpose of this review is to discuss the efficacy, morbidity and side-effects of innovative management strategies for achalasia that include high-resolution manometry (HRM), pneumatic dilatation, laparoscopic Heller's myotomy (LHM), injection of botulinum toxin into the lower esophageal sphincter and peroral endoscopic myotomy (POEM). Recent findings HRM has enabled identification of achalasia subtypes that have important prognostic implications. Pneumatic dilatation is a commonly-used and cost-effective method of treating achalasia but has shown poor longevity of symptom relief compared with oth...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

The potential role of potassium-competitive acid blockers in the treatment of gastroesophageal reflux disease
Purpose of review Gastroesophageal reflux disease (GERD) is primarily a motor disorder, but its pathogenesis is multifactorial. Although gastric acid secretion is usually normal in GERD patients, treatment with proton pump inhibitors (PPIs) has become the standard of care, despite increasing awareness of their shortcomings. In this article, a new class of antisecretory drugs (namely potassium-competitive acid blockers, P-CABs), developed to overcome these limitations, is discussed. Recent findings P-CABs block the K+ exchange channel of the proton pump, resulting in rapid, competitive, reversible inhibition of acid se...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

The emerging role of immunotherapy for esophageal cancer
Purpose of review The management of esophageal cancer has not changed significantly over the last decade. Survival rates remain poor in locally advanced and metastatic disease. Newer treatment modalities are desperately needed if we are to improve 5-year overall survival rates. Immunotherapeutic strategies hold great promise, but a much greater understanding of the immune microenvironment underlying squamous cell and esophageal adenocarcinoma is needed if we are to exploit the inherent cancer fighting capabilities of each patient's immune system. Recent findings Here we describe current and future predictive biomarker...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Diagnosis and treatment of dermatologic diseases in inflammatory bowel disease
Purpose of review Dermatologic manifestations in patients with inflammatory bowel disease (IBD) are increasingly recognized as related disorders, secondary to specific therapies used to treat IBD, or complications of IBD itself. These dermatologic manifestations can be difficult to manage. Recent findings We summarize three categories of dermatologic manifestations in this review: extraintestinal cutaneous disorders, paradoxical manifestations to biologic therapies, and other drug-induced cutaneous manifestations. In particular, we provide current data surrounding clinical characteristics, epidemiology, and treatment ...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

The ABC's of re-do ileoanal pouches, what every gastroenterologist should know
Purpose of review To describe the development of re-do pouch surgery, what it entails, its indications and role in the management of patients with inflammatory bowel disease. Recent findings Re-do pouch surgery has very good outcomes and excellent patient satisfaction when performed on carefully selected patients in specialized centers. Summary The ileal pouch anal anastomosis (IPAA) procedure, which was developed 40 years ago, is a mainstay in the reconstruction of patients who undergo a proctoclectomy for ulcerative colitis and familial adenomatous polyposis (FAP). It allows these patients to avoid a permanent il...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Stem cell therapy for perianal Crohn's
Purpose of review Perianal Crohn's disease is a morbid and disabling condition, notoriously difficult to successfully treat with conventional medical and surgical therapies. Mesenchymal stem cells (MSCs) are an emerging novel therapy for perianal Crohn's disease. Recent findings Over 300 patients with perianal Crohn's disease have now been treated with MSCs in the context of clinical trials. All trials have demonstrated safety, and efficacy superior to conventional therapy with biologics and surgical intervention. This was consistent despite the heterogeneity in study protocols including variability in cell dosing, mo...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Therapeutic drug monitoring in inflammatory bowel disease: for every patient and every drug?
Purpose of review The current review provides an updated overview on the role of therapeutic drug monitoring (TDM) of biological therapies in inflammatory bowel disease (IBD). We examine the data behind TDM for the antitumor necrosis factor agents, vedolizumab and ustekinumab, in patients with IBD. In addition, we discuss reactive vs. proactive TDM. Recent findings There is a positive correlation between biologic drug concentrations and favorable therapeutic outcomes in IBD, although the majority of data refer to antitumor necrosis factor therapy. Reactive TDM has rationalized the management of patients with IBD with ...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Positioning biologics and new therapies in the management of inflammatory bowel disease
Purpose of review Since the advent of anti-tumour necrosis factor agents, knowledge of their optimal use and their pitfalls has grown exponentially. However, the range of therapeutic agents available to clinicians and patients is expanding, creating challenging decisions about which drugs to use at any given time point. The present review aims to provide a framework within which positioning decisions can be made in the context of limited comparative effectiveness data. Recent findings The present review will summarize the current literature emphasizing how best to use biologic agents, and will provide suggestions as t...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Beyond pregnancy, women's health in inflammatory bowel disease
Purpose of review Women's health includes comprehensive physical, mental and preventive care. This section will provide an overview of some of the most common disorders that can impact the health and quality of life (QOL) of women with inflammatory bowel diseases (IBDs). Recent findings Women with IBD are at higher risk for cervical dysplasia compared to healthy controls with most cases preventable with vaccination. Current rates of cervical cancer screening and human papilloma virus vaccination remain low. Irritable bowel syndrome is highly prevalent among women with IBD and may present with similar symptoms. In addi...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Inflammatory bowel disease during pregnancy: management of a disease flare or remission
Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (IBD) are women of reproductive age. Caring for women with IBD who are also pregnant can be challenging, particularly if with a disease flare or in remission, as there are special considerations needed. Recent findings Despite older studies concluding potential risks associated with IBD medical therapies, more recent literature reports healthier maternal and birth outcomes associated with disease control and reduction in the inflammatory burden. Most IBD therapies should generally be continued throughout all three trimester...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

The role of the transition clinic from pediatric to adult inflammatory bowel disease care
Purpose of review The transition of patients from pediatric to adult centered care represents not only the means to transfer medical care to a group of providers who specialize in adult care but also is part of the process of the transfer of healthcare responsibility from the family to a patient. The intent of this review is to provide a summary of some of the important studies published in the past 2 years that advance this knowledge. Recent findings Progress has been made in the recognition of the process of transition, including developing tools to assess transition readiness, improving routes of communication alon...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Pediatric inflammatory bowel disease: continuous lessons for adult inflammatory bowel disease
Purpose of review Prospective and inception inflammatory bowel disease (IBD) cohorts offer excellent opportunities to develop risk stratification strategies, use relevant tissue to explore the biology of IBD progression, and study the natural history of IBD in the era of biological therapy. Adult IBD care can learn important lessons from recent pediatric IBD studies. Recent findings A recent multicenter inception cohort of pediatric IBD patients examining genetic, serologic, and microbiome data at diagnosis has been able to create a model for prediction of disease complications, describe compositional changes in gut m...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

The globalization of inflammatory bowel disease: the incidence and prevalence of inflammatory bowel disease in Brazil
The objective of the present review is to describe in detail the available data on the incidence and prevalence of Crohn's disease and ulcerative colitis in Brazil. Recent findings The authors identified the single four population-based studies which refer to incidence and prevalence of IBD in the country (two from São Paulo, one from Espírito Santo and one from the state of Piauí). These studies demonstrate a remarkable growth in the incidence and estimated prevalence of IBD in Brazil, with higher number of cases in more developed regions. Summary The increase in incidence over time and the high...
Source: Current Opinion in Gastroenterology - June 11, 2019 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

Editorial: Clinical challenges and practical information for the inflammatory bowel disease clinician today
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - June 11, 2019 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 11, 2019 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Management of small bowel polyps: from small to big
Purpose of review Benign small bowel polyps or mass are clinically poorly distinguishable from malignant small bowel masses, and the diagnostic conditions are almost the same. The important point for clinicians is first to take advantage of the different available diagnostic tools to optimize the diagnostic algorithm of a small bowel polyp or mass. Next, according to the clinical situation, associated disease or sporadic situation, the difficulty is to adapt the treatment decision to the patient situation. Recent findings The last 20 years have been marked by the development of major diagnostic tools for small bowel d...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Demystifying autoimmune small bowel enteropathy
In conclusion, there is an emerging body of literature about autoimmune enteropathy and small-bowel atrophy. The herein presented practical review on autoimmune enteropathy can be of help to clinicians in their daily practice. (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Small bowel strictures
Purpose of review Strictures of the small bowel are an underdiagnosed entity with significant morbidity because of obstruction and risk of perforation and penetrating disease. Recent findings Recent advances in imaging, enteroscopy, and therapeutic advances particularly in Crohn's disease have enabled gastroenterologists to target and individualize management of small bowel strictures, preventing untimely surgery and complications. Summary All patients with obstructive symptoms, suspected small bowel disease, and negative panendoscopy should be evaluated for small intestinal strictures with cross-sectional imaging ...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

The role of small bowel endoscopy for Crohn's disease
Purpose of review The review discusses the roles of small bowel capsule endoscopy and deep enteroscopy in patients with Crohn's disease. It highlights recent advances in the field and identifies areas where evidence is lacking. Recent findings Small bowel capsule endoscopy has an important role in the follow-up of patients with Crohn's disease after escalation of therapy and in the postoperative assessment period following surgical resection. Device-assisted enteroscopy offers the therapeutic advantage of small bowel dilatation, which may result in a reduction in the number of surgical resections required, thus avoidi...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Small bowel ulcers: when is it not inflammatory bowel disease ?
Purpose of review Increasing use of small bowel endoscopy unravels ulcers in a relevant number of patients. Although often attributed to inflammatory bowel disease (IBD), these ulcers may be unspecific or caused by a variety of other diseases. This review summarizes the recent literature related to differential diagnosis of small bowel ulcers. Recent findings NSAID enteropathy is the major differential diagnosis to IBD in patients with small bowel ulcers. Intestinal tuberculosis must be considered in patients at risk. Rare causes for small bowel ulcers are autoinflammatory, neoplastic, vascular diseases, or nontubercu...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Chronic diarrhoea in adults: what not to miss
Purpose of review Chronic diarrhoea remains a diagnostic challenge, with numerous causes and few effective symptomatic treatments. This review focuses on new methods for diagnosis of common disorders and alerts readers to rarer causes through a systematic approach to the underlying mechanisms. Recent findings New strategies are emerging to stratify the need for endoscopic investigation. Faecal immunochemical testing, combined with standard blood tests, shows promise in excluding colorectal cancers, adenoma and inflammatory bowel disease, challenging the current use of faecal calprotectin. Serum analysis for markers of...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

The overlap of irritable bowel syndrome and noncoeliac gluten sensitivity
Purpose of review There has been significant interest in gluten over the last decade, with an increase in interest of gluten-related disorders outside coeliac disease. Particularly, there has been a focus on the role of gluten in noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). There is significant overlap between both of these conditions, with the aim of this review to explore their complex relationship. Recent findings Gluten has been demonstrated to generate symptoms in individuals with NCGS. However, there appears to be an increasing role for gluten in symptom generation in patients with IB...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Editorial: Delving deeper: every day small bowel diseases to difficult to treat entities
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

Obeticholic acid in primary biliary cholangitis: where we stand
Purpose of review This review will summarize the use of obeticholic acid (OCA) in treatment of primary biliary cholangitis (PBC). It seeks to discuss the mechanism of action, evidence for use, appropriate clinical use, and common adverse effects of OCA. Recent findings PBC is a chronic, progressive cholestatic liver disease that is a chronic progressive that may lead to end-stage liver disease and need for liver transplantation. Ursodeoxycholic acid (UDCA) has been the mainstay of therapy for PBC for decades. Recent research has led to the discovery that bile acids act as hormones and have many effects, one of which i...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Tools for causality assessment in drug-induced liver disease
Purpose of review There are three liver-specific causality assessment tools currently available to guide clinical diagnosis of Drug-Induced Liver Injury (DILI): Roussel-Uclaf Causality Assessment Method (RUCAM), Digestive-Disease-Week Japan 2004 scale (DDW-J), and Clinical Diagnostic Scale (CDS). The purpose of this review is to assess these tools and discuss how to improve the causality assessment process as a whole. Recent findings Existing DILI-specific causality assessment tools are surprisingly similar and exhibit only minor differences in point allocation. But difference in threshold for likelihood of being DILI...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Population-based screening of hepatitis C virus in the United States
Purpose of review This review summarized the recent evidence on the performance of population-based hepatitis C virus (HCV) screening, published and indexed to PubMed, in the Unite States during the 2-year window from 1 January 2017 to 31 December 2018. Recent findings A majority of the selected articles in this review focused on the birth cohort 1945–1965 because of the HCV screening recommendations released after August 2012. However, the articles for the high-risk population applied to all ages because the recommendations for this specific population have remained largely unchanged since 1998. The reported ra...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Current treatment options for nonalcoholic fatty liver disease
Purpose of review Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the United States and is strongly associated to the metabolic syndrome. In this review, we will discuss the evidence behind the current recommendations on lifestyle modifications and available treatment options for NAFLD. Recent findings The unrelenting rise in obesity and diabetes epidemic has led to a large healthcare burden from NAFLD and it is projected to continue to grow over the next two decades. Lifestyle modification that leads to weight loss is effective at treating NAFLD, but these modifications require a mul...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Controversies in anticoagulation therapy in patients with cirrhosis
This article aims to review the latest literature on prophylactic and therapeutic anticoagulation and the safety profile of anticoagulants in patients with cirrhosis. Recent findings The understanding of hematological hemostasis is cirrhotic patients has changed drastically in recent years. Although in the past, cirrhotic patients were often considered to be ‘auto-anticoagulated’ and at higher risk of bleeding, recent studies have demonstrated that there may be a rebalance in procoagulation and anticoagulation factors in patients with cirrhosis. This, and clinical experience, suggest that cirrhotic patients ...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Palliative care and end-stage liver disease: a critical review of current knowledge
Purpose of review End-stage liver disease (ESLD) is associated with high symptom burden, poor quality of life, and significant healthcare costs. Palliative care, which is not synonymous with hospice or end-of-life care, is a multidisciplinary model of care that focuses on patient-centered goals with the intent of improving quality of life and reducing suffering. This review will summarize current literature supporting the benefits of early integration of palliative care in patients in this population. Recent findings Advance care planning (ACP) and goals of care discussions have been associated with improved quality o...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Updates on the pathophysiology and therapeutic targets for hepatic encephalopathy
Purpose of review Hepatic encephalopathy is one of the most debilitating clinical manifestations of cirrhosis and associated with increased morbidity and mortality. Treatment modalities available include the nonabsorbable disaccharides (lactulose) and the nonabsorbable antibiotics (rifaximin). Recent findings Newer therapeutic targets under evaluation include ammonia scavengers (ornithine phenylacetate) and modulation of gut microbiota (fecal microbiota transplantation). Summary This review will focus on the pathophysiology of hepatic encephalopathy along with an update on therapeutic targets under investigation. (...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Fibrosis reversal after hepatitis C virus elimination
Purpose of review Hepatitis C virus (HCV) infection has been the leading cause of cirrhosis in the United States now for the last several decades. With the introduction of highly effective direct acting antiviral (DAA) drugs, cure rates are now almost 100%. With this explosion of effective therapy, it is possible that many patients with HCV may have reversion in fibrosis. The purpose of this review is, therefore, to report on recent findings in this field. Recent findings Older data that examined the effect of interferon-based HCV therapy indicate that fibrosis reverses after HCV eradication. More recent work in the D...
Source: Current Opinion in Gastroenterology - April 6, 2019 Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research

Editorial: Advances in Hepatology: 2019
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 6, 2019 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 6, 2019 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Genetics in biliary atresia
Purpose of review Biliary atresia is a poorly understood deadly disease. Genetic predisposition factors are suspected albeit not firmly established. This review summarizes recent evidence of genetic alterations in biliary atresia. Recent findings Whole-genome association studies in biliary atresia patients identified four distinct predisposition loci with four different genes potentially involved in the disease occurrence. Variations in these genes were searched for, but none were found in patients with biliary atresia suggesting complex mechanisms. Summary Despite decades since its description and decades of inten...
Source: Current Opinion in Gastroenterology - March 1, 2019 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Intestinal failure-associated liver disease: causes, manifestations and therapies
Purpose of review The goal of this review is to provide updates on the causes, manifestations and therapies IFALD in adults with an emphasis on recent discoveries on pathways of pathogenesis and interventions to reduce the incidence of IFALD. Recent findings IFALD is a multifactorial complication of long-term home parenteral therapy. Although exact pathways are unknown, altered bile acid metabolism, microbiome dysbiosis impact on the gut–liver axis and soybean-based lipid formulations are major drivers of IFALD development. Summary IFALD contributes to morbidity and mortality in patients on parenteral nutriti...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Monitoring long-term parenteral nutrition
Purpose of review This review discusses the monitoring aimed at achieving good long-term outcomes in people dependent on home parenteral nutrition (HPN). Recent findings There have been recent studies highlighting the importance of treating low bone mineral density in HPN-dependent patients, methods of screening for liver disease, assessment of quality of life (QoL) and the need for early assessment for intestinal transplantation and growth factor therapy. Summary High-quality HPN services require expert multidisciplinary teams with a focus on strict aseptic catheter care protocols alongside regular monitoring and ...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Food allergy: what it is and what it is not?
Purpose of review Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food. Food intolerance, certain gastrointestinal or systemic diseases are often confused with or mislabeled as food allergy because of symptomatic similarity and general improvement from food avoidance. The differences between these diseases are crucial. Recent findings Compared with many food-related diseases that are isolated to gastrointestinal organs, food allergy can affect not only local but the whole immune system and may lead to a life-threatening allergi...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Alcohol and gastrointestinal cancers
Purpose of review Alcohol is a type I carcinogen and the WHO stated that it caused 5% of all deaths in 2016, of which 13% because of cancers. Among digestive tract cancers, this association is clear for esophageal, liver and colorectal cancer, and more debated for gastric and pancreatic cancer. The present review will revise recent evidence on epidemiologic association and mechanisms linking alcohol with the risk of esophageal, gastric, colorectal and pancreatic cancers. Recent findings Moderate alcohol intake increases the risk of esophageal squamous cell carcinoma and colorectal cancer. Heavy alcohol intake is assoc...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Diet and colon: what matters?
Purpose of review Colorectal cancer (CRC) is one of the most common cancers and the fourth leading cause of cancer-related deaths worldwide. Diet has a significant impact on the risk of developing CRC, but though processed meat is a known positive contributor, the effects of other dietary components are largely mixed. This review focuses on dietary patterns to describe the complexity of dietary diversity and overall food consumption and to examine the relationship between dietary patterns and risk of CRC. Recent findings After searching human studies published in 2017–2018, we selected and evaluated 30 articles,...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Editorial: Thought for food: diet and gut health
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

The genetics of primary biliary cholangitis
Purpose of review Primary biliary cholangitis (PBC) is a female predominant chronic autoimmune disease of the intrahepatic bile ducts and with a long latent period. It is crucial to understand how genetics contribute to the disease. Recent findings Geo-epidemiological studies in PBC have provided evidence of familial risk; case–control studies and genome wide association studies have identified various human leukocyte antigen (HLA) and non-HLA alleles that are associated with PBC. However, these alleles are non-PBC specific and most of the identified non-HLA loci were also found to be susceptible genes in other ...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Modifier genes in cystic fibrosis-related liver disease
Purpose of review Cystic fibrosis (CF; OMIM 219700) is caused by variations in the cystic fibrosis transmembrane conductance regulator gene. CF-related liver disease (CFLD) affects approximately one-third of patients with CF, but the severity of CFLD is highly variable. This review provides the latest knowledge in the pathophysiology and CF genetic modifier research in CFLD. Recent findings So far, the only modifier gene validated in CFLD is SERPINA1 (α-1-antitrypsin) Z allele. Recent studies support the view that cholangiopathy arising in CF is the result of an ill-adapted innate immune response to endotoxins c...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Genetics of gallstone disease revisited: updated inventory of human lithogenic genes
Purpose of review Gallstone disease is one of the most frequent diseases in gastroenterology and treatment by endoscopy and surgery causes high costs in our health-care systems. Family and twin studies have demonstrated that gallstones are, in part, genetically determined. Here we review all recent genome-wide and phenome-wide studies of gallstones in humans and provide an updated ‘inventory of human lithogenic genes.’ Recent findings The largest population attributable risk is conferred by the common variant (p.D19H) of the hepatic and intestinal cholesterol transporter ABCG5/G8. A second ABC transporter,...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Genetics in biliary atresia
Purpose of review Biliary atresia is a poorly understood deadly disease. Genetic predisposition factors are suspected albeit not firmly established. This review summarizes recent evidence of genetic alterations in biliary atresia. Recent findings Whole-genome association studies in biliary atresia patients identified four distinct predisposition loci with four different genes potentially involved in the disease occurrence. Variations in these genes were searched for, but none were found in patients with biliary atresia suggesting complex mechanisms. Summary Despite decades since its description and decades of inten...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Genetics of polycystic liver diseases
Purpose of review This review provides an outline of the most recent insights and significant discoveries regarding the genetic mechanisms involved in polycystic liver disease. Recent findings Polycystic liver disease includes a heterogeneous group of genetic disorders characterized by multiple hepatic cysts. Isolated liver cysts are caused by mutations in Protein Kinase C Substrate 80K-H (PRKCSH), SEC63, and LDL Receptor Related Protein 5 (LRP5), whereas Polycystic Kidney Disease (PKD)1, PKD2, and PKHD1 mutations cause kidney cysts often accompanied by liver cysts. Glucosidase II Alpha Subunit (GANAB) has been report...
Source: Current Opinion in Gastroenterology - February 1, 2019 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research