Bad blood: ischemic conditions of the large bowel
Purpose of review Colon ischemia is the most common form of intestinal ischemic injury and is seen frequently in an elderly population. This disease is usually self-limited, and many causes have been identified. The recent literature has focused on estimates of prognosis, triaging appropriate level of care, and identification of optimal treatments. In this review, we will address our current understanding of colon ischemia including epidemiology, pathophysiology, segmental distribution, presentation, diagnosis, and management. Recent findings Research has recently been focused on factors associated with poor out...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Russell D. Cohen Source Type: research

Colour me blue: chromoendoscopy and advanced detection methods in ulcerative colitis
Introduction Surveillance colonoscopy is recommended in patients with long standing ulcerative colitis or Crohn's colitis. Chromoendoscopy is the main technique for increased detection of colitis-associated dysplasia. However, the recommendation was made on the basis of studies using standard definition colonoscopes. Purpose of review This review highlights randomized controlled trials and meta-analysis, which were published between 2018 and 2021 with the focus of conventional chromoendoscopy, virtual chromoendoscopy and high-definition imaging. In addition, studies investigating the value of random biopsies wer...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Russell D. Cohen Source Type: research

‘Bumps down under:’ hemorrhoids, skin tags and all things perianal
Purpose of review There continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula. The emphasis remains on therapies that definitively address the underlying pathology yet minimize pain and risk of incontinence, have a short recovery period, and are cost-effective. In this analysis, recent developments in the literature are reviewed. Recent findings Treatment of early stage hemorrhoidal disease remains the same. For grades II–IV disease, hemorrhoidal vessel ligation/obliteration with laser or bi...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Russell D. Cohen Source Type: research

A brave new world: the gastrointestinal lab during and after a pandemic
Purpose of review The COVID-19 global pandemic resulted in a radical change in the provision and delivery of endoscopy services worldwide. As we emerge from this pandemic, various strategies were advocated to resume endoscopy whilst prioritizing the safety and wellbeing of patients and staff. Recent findings This review summarizes the main changes including infection control and prevention measures in endoscopy and explores the overarching impact of the pandemic on the gastrointestinal lab. Various solutions are outlined to enable the well tolerated resumption of endoscopy services including retention of certain...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Russell D. Cohen Source Type: research

Updates in the understanding and management of diverticular disease
Purpose of review Diverticulosis leads to significant morbidity and mortality and is increasing in prevalence worldwide. In this paper, we review the clinical features, diagnosis, and management of diverticular disorders, followed by a discussion of recent updates and changes in the clinical approach to diverticular disease. Recent findings Recent literature suggests that antibiotics are likely not necessary for low-risk patients with acute uncomplicated diverticulitis, and not all patients with recurrent diverticulitis require colectomy. Dietary restrictions do not prevent recurrent diverticulitis. Visceral hyp...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Russell D. Cohen Source Type: research

How many is too many? Polyposis syndromes and what to do next
Purpose of review The goal of this review is to help providers recognize, diagnose and manage gastrointestinal (GI) polyposis syndromes. Recent findings Intestinal polyps include a number of histological sub-types such as adenomas, serrated, hamartomas among others. Over a quarter of individuals undergoing screening colonoscopy are expected to have colonic adenomas. Although it is not uncommon for adults to have a few GI polyps in their lifetime, some individuals are found to have multiple polyps of varying histology throughout the GI tract. In these individuals, depending on polyp histology, number, location an...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Russell D. Cohen Source Type: research

Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections
Purpose of review There has been much debate about treating Shiga toxin-producing Escherichia coli (STEC) infections with antibiotics. No data convincingly demonstrate that antibiotics are better than no antibiotic treatment at all, and many studies suggest antibiotics increase the risk of developing the hemolytic uremic syndrome (HUS). This topic is timely, because emerging technology enables rapid identification of STEC-infected patients, and we anticipate questions about management will increase. This review is designed to familiarize readers with the series of observations that underlie our recommendations. Rece...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

Can SARS-CoV-2 be transmitted via faeces?
Purpose of review COVID-19 patients can present gastrointestinal symptoms, being diarrhoea one of the most frequent, suggesting intestinal health can be impacted by COVID-19. Here, we will discuss whether there is a correlation between the presence of SARS-CoV-2 RNA in faeces and diarrhoea, the relevance of gastrointestinal symptoms in disease diagnosis and transmission, and how COVID-19 can impact the gut microbial balance. Recent findings SARS-CoV-2 RNA has been reported in faeces or rectal swabs of COVID-19 patients with and without diarrhoea, suggesting faecal shedding can occur independently of gastrointest...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

Faecal microbiota replacement to eradicate antimicrobial resistant bacteria in the intestinal tract – a systematic review
Purpose of review Antimicrobial resistance is a rising threat to global health and is associated with increased mortality. Intestinal colonisation with multidrug-resistant organisms (MDRO) can precede invasive infection and facilitates spread within communities and hospitals. Novel decolonisation strategies, such as faecal microbiota transplantation (FMT), are being explored. The purpose of this review is to provide an update on how the field of FMT for MDRO decolonisation has developed during the past year and to assess the efficacy of FMT for intestinal MDRO decolonisation. Recent findings Since 2020, seven hi...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

Can prediction scores be used to identify patients at risk of Clostridioides difficile infection?
Purpose of review To describe the current state of literature on modeling risk of incident and recurrent Clostridioides difficile infection (iCDI and rCDI), to underscore limitations, and to propose a path forward for future research. Recent findings There are many published risk factors and models for both iCDI and rCDI. The approaches include scores with a limited list of variables designed to be used at the bedside, but more recently have also included automated tools that take advantage of the entire electronic health record. Recent attempts to externally validate scores have met with mixed success. Summa...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

The potential of microbiome replacement therapies for Clostridium difficile infection
Purpose of review There is a paradox when treating Clostridium difficile infection (CDI); treatment antibiotics reduce C. difficile colonization but cause further microbiota disruption and can lead to recurrent disease. The success of faecal microbiota transplants (FMT) in treating CDI has become a new research area in microbiome restorative therapies but are they a viable long-term treatment option? Recent findings C. difficile displays metabolic flexibility to use different nutritional sources during CDI. Using microbiome therapies for the efficient restoration of bile homeostasis and to reduce the bioavailabi...
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - December 10, 2021 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

The prevention of gastric cancer by Helicobacter pylori eradication
Purpose of review Gastric cancer remains one of the most common causes of death globally. Increasing evidence suggests that many gastric cancer cases can be prevented by eradicating its most important etiological agent, Helicobacter pylori. Using the search terms ‘H. pylori’ and ‘gastric cancer’ we reviewed the scientific literature regarding the association between H. pylori and gastric cancer published from 1 January 2020 to 30 May 2021. We review the most important articles relevant to the clinical issues regarding H. pylori eradication for gastric cancer prevention. Recent findings In randomized tria...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Celiac disease: clinical update
Purpose of review This review highlights literature from the past year and explores the impact on current understanding of celiac disease pathogenesis, diagnosis, and management. Recent findings In contrast to earlier clinical trials, recent data suggests that early gluten introduction may protect against the development of celiac disease. Celiac disease is underdiagnosed, associated with high burden of disease and linked to excess mortality risk, yet, there remains considerable uncertainty regarding the utility of mass screening in asymptomatic individuals. The gut microbiome is increasingly implicated in celia...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Advances in the treatment of gastric cancer: 2020–2021
Purpose of review To review studies from 2020 to 2021 in esophagogastric cancer. Recent findings After up front D2 gastrectomy for lymph node-positive gastric cancer, 6 months of adjuvant chemotherapy with S-1 and oxaliplatin achieved superior disease-free survival (DFS) compared with 1 year of S-1. The addition of adjuvant radiotherapy, however, added no benefit. After chemoradiotherapy and surgery in esophageal and gastroesophageal junction cancer, in patients with residual disease found at surgery, 1 year of adjuvant nivolumab substantially improved DFS compared with observation alone, leading to regulatory a...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research