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...
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

Mucosal defense: gastroduodenal injury and repair mechanisms
Purpose of review The mucosal barrier serves as a primary interface between the environment and host. In daily life, superficial injury to the gastric or duodenal mucosa occurs regularly but heals rapidly by a process called ‘restitution’. Persistent injury to the gastroduodenal mucosa also occurs but initiates a regenerative lesion with specific wound healing mechanisms that attempt to repair barrier function. If not healed, these lesions can be the site of neoplasia development in a chronic inflammatory setting. This review summarizes the past year of advances in understanding mucosal repair in the gastro...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Gastric intestinal metaplasia: when to treat? How to treat?
Purpose of review Gastric intestinal metaplasia (GIM) is an attractive target for surveillance and treatment as it can progress to gastric adenocarcinoma (GAC). Yet, GIM remains a challenging area for clinicians as most patients do not progress to cancer, and there are conflicting data regarding the benefits of surveillance and therapy. This review aims to summarize recently published GIM surveillance guidelines, to discuss, which patients with GIM may benefit from treatment, and to review pivotal and recent literature on GIM therapy. Recent findings Guidelines published by American, British, and European gastro...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Gastroparesis
Purpose of review This review highlights recent research advances regarding the pathophysiology and treatment of gastroparesis. Recent findings Differences in brain activity have been identified on functional MRI imaging in gastroparesis patients with nausea. Abdominal pain is common in patients with gastroparesis and does not correlate with the severity of gastric emptying delay, though may be associated with depression and anxiety. Autonomic dysfunction may play an important role in the pathophysiology of gastroparesis. There is increasing sentiment that gastroparesis should be considered a part of the same sp...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Endoscopic simulators: training the next generation
Purpose of review To provide a review of current evidence evaluating endoscopic simulators as teaching platforms in gastroenterology training, with emphasis on upper gastrointestinal anatomy. Recent findings Endoscopic simulators have leveraged mechanical, virtual reality and ex-vivo or live animal platforms to deliver training in both general and therapeutic endoscopy. Simulators have demonstrated their greatest utility in training novice endoscopists. Intermediate and expert endoscopists may additionally benefit from simulator exposure when learning advanced therapeutic techniques including large tissue resect...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Editorial: Stomach and duodenum: what's current in 2021
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

Gut microbiota and sepsis: from pathogenesis to novel treatments
Purpose of review This review summarizes recent progress in our understanding of the role of the gut microbiota in sepsis pathogenesis and outlines the potential role of microbiota-targeted therapies. Recent findings The composition of the gut microbiome is profoundly distorted during sepsis, with a loss of commensal bacteria and an overgrowth of potential pathogenic micro-organisms. These alterations also extend to nonbacterial intestinal inhabitants. Disruptions of these intestinal communities are associated with both an increased susceptibility to develop sepsis, as well as a higher risk of adverse outcomes. ...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Jocelyn A. Silvester Source Type: research

The bi-directional role of the gut–brain axis in inflammatory and other gastrointestinal diseases
Purpose of review There is a growing body of evidence implicating the role of the gut–brain axis in a multitude of inflammatory and non-inflammatory gastrointestinal disorders. The interaction between the gut and the brain is bidirectional and its therapeutic manipulation is gaining traction as the new frontier in the management of gastrointestinal disorders. This review summarizes the recent literature on this subject and serves as a reference for future research directions. Recent findings Recent studies have shown that the gut–brain axis, through its main communicator – the vagal nerve &ndas...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Jocelyn A. Silvester Source Type: research

Role of gut–kidney axis in renal diseases and IgA nephropathy
Purpose of review Growing evidence show the importance of gut/kidney axis in renal diseases. Advances in gut microbiome sequencing, associated metabolites, detection of gut permeability and inflammation provide new therapeutic strategies targeting gut for kidney diseases and particularly for Immunoglobulin A (IgA) nephropathy (IgAN). Recent findings The diversity and composition of gut flora have been recently deeply explored in kidney diseases. Modulation and depletion of microbiota in animal models allowed the understanding of molecular mechanisms involved in the crosstalk between gut, immune system and kidney...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Jocelyn A. Silvester Source Type: research

Role of the gut–skin axis in IgE-mediated food allergy and atopic diseases
Purpose of review In recent years, landmark clinical trials investigating the role of early oral exposure to food antigens for food allergy (FA) prevention have highlighted the importance of immunoregulatory pathways in the ‘gut–skin axis’. This review highlights recent literature on the mechanisms of the immune system and microbiome involved in the gut–skin axis, contributing to the development of atopic dermatitis (AD), FA, allergic rhinitis (AR) and asthma. Therapeutic interventions harnessing the gut–skin axis are also discussed. Recent findings Epicutaneous sensitization in the...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Jocelyn A. Silvester Source Type: research

Breastfeeding and the developmental origins of mucosal immunity: how human milk shapes the innate and adaptive mucosal immune systems
Purpose of review Breastfeeding provides passive immunity while the neonatal immune system matures, and may also protect against chronic immune-mediated conditions long after weaning. This review summarizes current knowledge and new discoveries about human milk and mucosal immunity. Recent findings New data suggest that certain microbes in maternal milk may seed and shape the infant gut microbiota, which play a key role in regulating gut barrier integrity and training the developing immune system. Human milk oligosaccharides, best known for their prebiotic functions, have now been shown to directly modulate gene...
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Jocelyn A. Silvester Source Type: research

Editorial: No organ is an island: the role of gut–organ axes in human health and disease
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Jocelyn A. Silvester Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - October 19, 2021 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Diabetes and pancreatic cancer: recent insights with implications for early diagnosis, treatment and prevention
Purpose of review Recent insights into the complex relationship between diabetes and pancreatic cancer have the potential to help direct future approaches to early detection, treatment and prevention. Recent findings Insulin resistance and hyperinsulinemia have been identified as factors that relate to risk of pancreatic cancer among patients with long-standing diabetes. In contrast, weight loss in the setting of new-onset diabetes can help identify patients at an increased risk for harbouring pancreatic-cancer related disturbances in glucose metabolism. Insights into the implications of poor glycaemic control i...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Early detection of pancreatic cancer: current state and future opportunities
Purpose of review Pancreatic ductal adenocarcinoma (PDAC) is third leading cause of cancer death in the United States, a lethal disease with no screening strategy. Although diagnosis at an early stage is associated with improved survival, clinical detection of PDAC is typically at an advanced symptomatic stage when best in class therapies have limited impact on survival. Recent findings In recent years this status quo has been challenged by the identification of novel risk factors, molecular markers of early-stage disease and innovations in pancreatic imaging. There is now expert consensus that screening may be ...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Diabetes in chronic pancreatitis: risk factors and natural history
Purpose of review The purpose of this review is to delineate risk factors for the development of diabetes in patients with chronic pancreatitis. The natural history including progression to diabetes and complications that develop once diabetes occurs in chronic pancreatitis is also reviewed. Recent findings Studies have found that predictors of diabetes in chronic pancreatitis include both risk factors for type 2 diabetes (e.g., obesity, genetic variants) as well as pancreas-specific factors (e.g., pancreatic calcification, exocrine insufficiency). Rates of diabetes in chronic pancreatitis are strongly related t...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Distinguishing diabetes secondary to pancreatic diseases from type 2 diabetes mellitus
Purpose of review Diabetes secondary to pancreatic diseases (i.e., acute pancreatitis, chronic pancreatitis, and pancreatic cancer) is increasingly studied, but remains challenging to distinguish from type 2 diabetes (T2DM). We review the clinical significance and potential biomarkers that may help differentiate these types of diabetes. Recent findings Recent studies have identified several complications (including nonvascular) that occur more frequently in patients with diabetes secondary to acute and chronic pancreatitis than T2DM, and biomarkers to differentiate these types of diabetes. There have been advanc...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Role of standardized reporting and novel imaging markers in chronic pancreatitis
This article reviews recent efforts about standardized imaging features and reporting of chronic pancreatitis and recently published or ongoing imaging studies, which aim to establish novel imaging biomarkers for detection of parenchymal changes seen in chronic pancreatitis. Recent findings New novel MRI techniques are being developed to increase the diagnostic yield of chronic pancreatitis specifically in the early stage. T1 relaxation time, T1 signal intensity ratio and extracellular volume fraction offer potential advantages over conventional cross-sectional imaging, including simplicity of analysis and more obje...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Painful chronic pancreatitis - new approaches for evaluation and management
Purpose of review Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis. Recent findings Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patients frequently changes and is not related to traditional patient and disease-related factors. Psychologic comorbidities, i.e. anxiety and depression, are frequent in patients with chronic pancreatitis, and are associated with more severe pain and pain interference. Adjuncti...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Complications of chronic pancreatitis in children
Purpose of review In children, chronic pancreatitis is infrequent but may be associated with serious complications, including severe pain that limits activities, exocrine and endocrine pancreatic insufficiency and malnutrition. Investigation into pediatric chronic pancreatitis has transitioned from single center reports to multicenter, protocol-driven studies. As a result, we now have information on much larger numbers of children with chronic pancreatitis, allowing a more reliable understanding of the complications of chronic pancreatitis. Recent findings A high percentage of children with chronic pancreatitis ...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Demographics and risk factors for pediatric recurrent acute pancreatitis
Purpose of review Approximately 20–30% of children who experience one episode of acute pancreatitis will have at least one additional episode. For some children, pancreatitis recurs multiple times and in a few years is followed by the diagnosis of chronic pancreatitis. Identifying risk factors for recurrent episodes and disease progression is critical to developing therapeutic interventions. Recent findings Obesity is driving an increase in biliary stone disease and severe acute pancreatitis. Recurrent acute pancreatitis (RAP) may lead to the development of diabetes through autoimmune mechanisms. Cystic fi...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer: achievements and future directions
Purpose of review To answer several important clinical questions, the Consortium for the study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) research consortium has established several ongoing clinical cohort studies focused on pancreatitis in adults and children, pancreatic cancer, and diabetes associated with pancreatic disease. These will provide a unique resource for clinical and basic science research into these hard-to-treat diseases. Recent findings The cause, natural history, and prognosis of acute relapsing and chronic pancreatitis in adults and children are being delineated. The mech...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

The national institutes of health's approach to address research gaps in pancreatitis, diabetes and early detection of pancreatic cancer
Purpose of review Diseases of the pancreas are a broad spectrum of conditions resulting from metabolic, inflammatory, and neoplastic processes (pancreatitis, pancreatogenic diabetes, and pancreatic cancers). Pancreatic diseases cause significant morbidity, mortality, and cost. Recent findings Research progress in diseases of the exocrine pancreas (chronic pancreatitis [CP], pancreatogenic diabetes mellitus, and pancreatic cancer) has been hampered by the disorders’ heterogeneity, the limitations of previous small cross-sectional studies, the inability to safely obtain pancreatic tissue for study, and the l...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Editorial: Introduction to the issue: chronic pancreatitis, diabetes and pancreatic cancer consortium (CPDPC)
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: PANCREAS: Edited by Dhiraj Yadav Source Type: research

Advancing flexible endoscopy to natural orifice transluminal endoscopic surgery
Purpose of review This review is an update on the recent advancements and clinical applications of flexible endoscopy in the context of natural orifice translumenal endoscopic surgery (NOTES). We focus on recent developments in gastrointestinal luminal and transluminal NOTES. Recent findings NOTES has evolved from a hybrid approach utilizing a laparoscopic assistant to pure NOTES without laparoscopic assistance. Current experimental and clinical studies focus on the implementation of new minimally invasive approaches as well as on the training in the use of these procedures. In recent years, flexible endoscopic-...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Third space endoscopy: the future of treating gastrointestinal dysmotility
Purpose of review Third space endoscopy (TSE) or submucosal endoscopy provides with the opportunity for minimally invasive management of various gastrointestinal disorders. TSE is a relatively new field and the knowledge on its utility continues to advance. The purpose of this review is to provide with updated evidence on the efficacy and utility of TSE in gastrointestinal motility disorders including achalasia and refractory gastroparesis. Recent findings Peroral endoscopic myotomy (POEM) is a safe procedure with emerging evidence on its durability as well. Major technical variations do not appear to impact the...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Interventional endoscopic ultrasound
Purpose of review To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques. Recent findings The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreat...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Endoscopic approaches to gastroesophageal reflux disease
Purpose of review Gastroesophageal reflux disease (GERD) is one of the most common chronic conditions affecting adults. A substantial proportion of patients continue to have symptoms despite medical therapy, and there has been increased demand for minimally invasive GERD therapy. We will examine currently available techniques and outcomes data on endoscopic approaches to the treatment of GERD. Recent findings In the last 2 years, research has given rise to more robust understanding of not only the pathophysiology of GERD but also how to better manage the various phenotypes. We are learning the ideal patient to b...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Tips for successful deep enteroscopy
Purpose of review The aim of this study was to provide practical tips to readers on how to perform deep enteroscopy efficiently. Recent findings Deep enteroscopy has revolutionized the diagnosis and management of small intestinal conditions in recent years. They are extremely valuable, but may be technically challenging to perform, regardless if it is double balloon enteroscopy, single balloon enteroscopy or spiral enteroscopy. The common issues to these procedures are repetitive motion, extended procedure duration and physical exertion during scope advancement. These situations may in turn lead to a variety of ...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Updates in artificial intelligence in gastroenterology endoscopy in 2020
Purpose of review Artificial intelligence is becoming rapidly integrated into modern technology including medicine. Artificial intelligence has a wide range of potential in gastroenterology, particularly with endoscopy, given the required analysis of large datasets of images. The aim of this review is to summarize the advances of artificial intelligence in gastroenterology (GI) endoscopy over the past year. Recent findings Computer-aided detection (CADe) systems during real-time colonoscopy have resulted in increased adenoma detection rate with no significant increase in procedure times. Deep learning techniques...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Incorporating image enhanced endoscopy in your everyday practice
Purpose of review The purpose of this review is to analyze newly available image enhanced endoscopic techniques and to evaluate how these techniques can be integrated into daily routine. Recent findings Recent guidelines have clearly stated how competency can be achieved. Endoscopist should have achieved general competence in endoscopy (more than 300 examinations) before commencing training in optical diagnosis. Summary A validated optical diagnosis training course should be attended and meeting competence thresholds by assessing a minimum number of lesions prospectively during real-time endoscopy should ...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Single-use duodenoscopes: where are we and where are we going?
Purpose of review Given the growing concerns about infection transmission from use of contaminated reusable duodenoscopes, technological advancements have been made that vary from modifications of existing designs to development of single-use devices. Recent findings To circumvent mechanical limitations that preclude access to critical areas of a duodenoscope to perform thorough cleaning and disinfection, single-use disposable duodenoscopes have been developed. A thorough assessment of this technology is limited by the minimal published data that is currently available. This opinion assesses the current technica...
Source: Current Opinion in Gastroenterology - August 7, 2021 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research

Editorial: Recent advances in diagnostic and therapeutic endoscopy: moving towards the frontier
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 7, 2021 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 7, 2021 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Long-term outcomes of treatments for achalasia
Purpose of review Idiopathic achalasia is a primary motility disorder of the esophagus that results in dysphagia, weight loss, and impaired quality of life. Several treatment options are available to gastroenterologists, and insights on the long-term outcome of these modalities are discussed. Recent findings Peroral endoscopic myotomy (POEM) represents a novel endoscopic technique in the treatment of achalasia. Studies on long-term outcomes and comparison to other well-known treatment modalities such as laparoscopic Heller myotomy (LHM) and pneumodilation have recently been published. POEM and LHM both have exce...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Management of the patient with esophagogastric junction outflow obstruction
Purpose of review Esophagogastric junction outflow obstruction (EGJOO), defined as elevated integrated residual pressure (IRP) with preservation of esophageal peristalsis, is a common finding on high-resolution esophageal manometry. Recent findings The recent Chicago classification version 4.0 proposes changes to the criteria for diagnosing EGJOO, making this diagnosis more restrictive to now include elevated IRP in both supine and upright positions (with preservation of esophageal peristalsis), presence of obstructive symptoms, and confirmatory tests for EGJOO, such as timed barium esophagram with barium tablet...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

The role of the allergist in the management of eosinophilic esophagitis
Purpose of review The purpose of this review is to provide the current understanding of the role of allergens/antigens, the use of allergy testing, and to elucidate the role of the allergist in the management of eosinophilic esophagitis (EoE). Recent findings EoE is a T2 immune disorder that is part of the atopic march. EoE patients commonly have multiple concurrent allergic disorders. Recent studies demonstrate that, like other allergic diseases, epithelial barrier dysfunction plays a key role in EoE pathogenesis. Aero- and food allergens have been identified as EoE triggers. EoE management includes the assessm...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

The role of magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease
Purpose of review Magnetic sphincter augmentation (MSA) has been designed as a less disruptive and more standardized laparoscopic surgical procedure than fundoplication for patients with early stage gastroesophageal reflux disease (GERD). We analyzed the more recent literature in search of updates regarding indications, technique, perioperative management, and long-term outcomes. Recent findings Over the years, the procedure of MSA has evolved to including full hiatus repair rather than relying on the preservation of the phreno-esophageal ligament. Restoring the mechanical synergy between the lower esophageal sp...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

How extent of Barrett's metaplasia influences the risk of esophageal adenocarcinoma
Purpose of review This review will focus on how the extent of Barrett's metaplasia influences the risk of esophageal adenocarcinoma (EAC). More specifically, this review will discuss the concepts of long and short-segment Barrett's metaplasia and irregular Z line as they relate to EAC risk. Recent findings The Prague classification can standardize reporting of Barrett's metaplasia. Recent literature has found significant associations between the length of Barrett's metaplasia and increased progression risk to EAC in multiple geographically distinct populations. Length of Barrett's metaplasia has been incorporate...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Esophageal afferent innervation and its role in gastro-esophageal reflux disease symptoms
Purpose of review Despite the wide prevalence of gastro-esophageal reflux disease (GERD), the neurophysiological mechanisms underlying heartburn perception in the esophagus of patients with GERD remains incompletely understood. Recent studies have highlighted the potential influence sensory afferent nerves innervating the oesophageal epithelium may have on heartburn pathogenesis. The purpose of this review is to consider the current understanding of esophageal afferent neuronal innervation, including the nociceptive role of acid-sensing receptors expressed on these sensory nerves, in relation to pain perception in the ...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

Impact of bariatric surgery on gastroesophageal reflux disease and esophageal motility
Purpose of review Obesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed. Recent findings Laparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: ESOPHAGUS: Edited by Stuart J. Spechler Source Type: research

New targets in inflammatory bowel disease therapy: 2021
Purpose of review In the rapidly progressing world of inflammatory bowel disease, this review discusses and summarizes new drug targets and results from major clinical trials in order to provide an update to physicians treating patients with inflammatory bowel diseases (IBD). Recent findings Multiple new mechanisms in the treatment of IBD are being developed and many are showing promising results in both ulcerative colitis and Crohn's disease patients. In addition to efficacy, some of these treatments may provide safety benefits over existing therapies. Summary The IBD physicians’ therapeutic armame...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research

Positioning biologics in the management of moderate to severe Crohn's disease
Purpose of review Since there is a lack of head-to-head randomized controlled trials, little direction is provided from guidelines on the positioning of biologics for the treatment of Crohn's disease (CD). This review utilizes comparative effectiveness and safety results from real-world data and network meta-analyses to inform clinical practice for positioning of biological therapies in the treatment of moderate-to-severe CD. Recent findings We summarize the results of studies pertaining to the identification of predictors for response to biologics in CD. Recently published studies about the management of modera...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research

Positioning biologics and small molecules in the management of moderate to severe ulcerative colitis
Purpose of review This review addresses the selection of biologic and small molecule therapy for patients with moderate to severe ulcerative colitis (UC). With several new treatment options approved within the past few years, an update in positioning is timely and relevant. Recent findings Updates on the safety and comparative efficacy of approved therapeutic agents for UC are presented. Newly approved therapies including tofacitinib and ustekinumab, as well as where to position these treatments are discussed. Data on the first-ever head-to-head trial of biologic therapy in UC are examined. This review provides ...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research

Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease
Purpose of review Clostridioides difficile infection (CDI) may complicate the course of ulcerative colitis and Crohn's disease. The clinical presentation of CDI in this population is often atypical, and patients may experience exacerbations of their underlying inflammatory bowel disease (IBD) secondary to C. difficile. In this review, we aim to review the risk factors, diagnosis, and management of CDI in the context of IBD. Recent findings Patients with colonic involvement of their IBD are at higher risk for CDI and colonization may be more common than in the general population. Therefore, CDI is confirmed using...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research

Social media in inflammatory bowel disease: the patient and physician perspective
Purpose of review Social media use by patients with inflammatory bowel disease (IBD) and their respective providers continues to increase, promoting disease awareness and scholarship. In this review article, we summarize the current literature regarding social media use and IBD, discuss both the patient and physician perspective, and provide guidance to avoid commonly encountered pitfalls. Recent findings Patients and providers commonly rely on social media to share medical information, advocate for improved IBD care, and to network and collaborate on common research interests. This shift from more traditional f...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research

Practical insights into stomas in inflammatory bowel disease: what every healthcare provider needs to know
Purpose of review Despite advances in medical and surgical therapy in inflammatory bowel disease (IBD) management, intestinal stomas can be needed in a significant proportion of patients. The impact of stomas in patients’ lives is significant, and the topic is still challenging for different specialties involved in IBD care. Recent findings Indications for intestinal ostomies in IBD can occur in elective (malnutrition, anemia, or previous steroids) or emergency (perforation, abdominal abscess, obstruction) settings. Different types of stomas can be used (loop, end, or double loop ostomies) depending on dif...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research

Optimal inflammatory bowel disease management during the global coronavirus disease 2019 pandemic
Purpose of review This review aims to summarize the current evidence regarding the risks and implications of coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD) and discuss optimal management of IBD during this pandemic. Recent findings Patients with IBD are not at increased risk of COVID-19 but several risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection) have been identified, such as active IBD, obesity, and corticosteroid use. COVID-19 outcomes are similar among patients with IBD and the overall population. Although biologics have not been sh...
Source: Current Opinion in Gastroenterology - June 17, 2021 Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel D. Regueiro Source Type: research