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

Refeeding syndrome: update and clinical advice for prevention, diagnosis and treatment
Purpose of review The aim of this review is to provide a brief overview of the refeeding syndrome, to discuss more recent advice on diagnosis and treatment, and to raise awareness of this still poorly understood metabolic condition. Recent findings To date, evidence regarding the refeeding syndrome has been very limited. A number of reviews and case reports exist, but only a few are randomized trials. Recently, it has been shown that the vast majority of physicians are unaware of this metabolic condition. Precise guidelines for diagnosis and treatment of this syndrome were lacking for a long time. Now, a consensus sta...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

When is parenteral nutrition indicated in the hospitalized, acutely ill patient?
Purpose of review The current review discusses current practices regarding appropriate indications for parenteral nutrition in acutely ill hospitalized patients. We address-specific indications for parenteral nutrition in the perioperative period, and in inflammatory bowel disease, oncology, hepatobiliary, critical care and end-stage renal disease patients. Recent findings Acutely ill hospitalized patients can develop intestinal failure requiring parenteral nutrition. Recent studies have provided insight into the main indications. The most common indications for inpatient parenteral nutrition include postsurgical comp...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Clinical nutrition for the gastroenterologist: bedside strategies for feeding the hospitalized patient
This article reviews management strategies in delivering the optimal nutrition regimen capable of improving outcomes in the hospitalized patient. Recent findings Enteral nutrition should be initiated in the first 24–36 h after admission. Determination of nutritional risk helps guide the urgency with which nutritional therapy is provided and predicts the likelihood for difficulties in delivering the prescribed regimen. Feeds should be advanced slowly over 3–4 days to meet 70–80% of goal for calories (20 kcal/kg/day) and 100% for protein (2.0 gm/kg/day). Reaching protein goals early on may be more ...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Clinical nutrition for the gastroenterologist: the physiologic rationale for providing early nutritional therapy to the hospitalized patient
This article describes the physiologic response to enteral feeding, which accounts for the outcome benefits, and illustrates how use of the gut alters immune responses and the intestinal microbiota. Recent findings The provision of early enteral nutrition has been shown to reduce infection and mortality in high-risk hospitalized patients (compared with not providing such therapy). Early feeding maintains gut integrity, reduces permeability, promotes tolerance and appropriate immune responses, and supports commensalism of the intestinal microbiota. Early enteral nutrition influences cross-talk signaling between luminal b...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Recent insights into trace element deficiencies: causes, recognition and correction
Purpose of review Trace elements are vital components involved in major body functions. Cases of trace elements deficiencies are increasingly encountered in clinical practice, although often underrecognized. This review gives a thorough insight into the newest findings on clinical situations associated with trace elements deficiencies in children and adults, their recognition and management. Recent findings Trace elements deficiencies are frequently found in various conditions, most commonly in burns, bariatric surgery, intestinal failure, renal replacement therapy, oncology, critical illness and cardiac surgery. The ...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Routine disaccharidase testing: are we there yet?
Purpose of review Disaccharidase testing, as applied to the evaluation of gastrointestinal disturbances is available but it is not routinely considered in the diagnostic work-up. The purpose of this review was to determine if disaccharidase testing is clinically useful and to consider how the results could alter patient management. Recent findings Indicate that carbohydrate maldigestion could contribute functional bowel disorders and negatively impact the fecal microbiome. Diagnostic techniques include enzyme activity assays performed on random endoscopically obtained small intestinal biopsies, immunohistochemistry, s...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Editorial: Nutrition in gastroenterology: more relevant than ever yet largely ignored in our education and training
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Genetically engineered animal models of biliary tract cancers
Purpose of review Biliary tract cancers which include intrahepatic and extrahepatic cholangiocarcinomas and gallbladder cancer, are characterized by poor outcome. Therefore, identifying the molecular mechanisms of the disease has become a priority. However, such identification has to cope with extreme heterogeneity of the disease, which results from the variable anatomical location, the numerous cell types of origin and the high number of known genetic alterations. Recent findings Animal models can develop invasive and metastatic tumours that recapitulate as faithfully as possible the molecular features of the human t...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Advances in the treatment of biliary tract cancers
Purpose of review To review new treatment and advances in biliary tract cancer (BTC). Recent findings In the prespecified per-protocol analysis of the randomized phase III trial BILCAP, adjuvant capecitabine offers overall survival (OS) benefit when compared with observation with statistical significance. In the first-line setting in metastatic BTC, gemcitabine and S-1 had noninferior OS compared with gemcitabine and cisplatin. In a separate phase III study, the triplet of gemcitabine, cisplatin and S-1 (GCS) had superior OS compared with standard gemcitabine and cisplatin. The regimen of modified FOLFOX (fluorouracil...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Cholangiocarcinoma in patients with primary sclerosing cholangitis
Purpose of review Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intrahepatic and/or extrahepatic bile ducts. It is associated with a significantly increased risk of malignancy, particularly cholangiocarcinoma (CCA). In this review, we discuss what is currently known about the epidemiology of and risk factors for CCA in PSC as well as recent advances in its prevention, diagnosis, and surveillance. Recent findings An area of major focus has been finding novel biomarkers (in serum, bile, and urine) for CCA. With the advancement o...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Immune contexture of cholangiocarcinoma
Purpose of review Considering the failure of standard treatments (i.e. surgery, radiotherapy, chemotherapy) in treating cholangiocarcinoma (CCA), introduction of alternative interventions is urgently needed. During the past 2 decades, discoveries of the mechanisms of cancer immunosurveillance and tumor immune evasion have precipitated the emergence and clinical approval of immunotherapies in multiple malignant indications. Interest in their introduction for the care of CCA is recent and several immunotherapeutic approaches are undergoing a clinical evaluation. Undoubtedly, their efficient application, as monotherapy or i...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Cancer-associated fibroblasts in cholangiocarcinoma
Purpose of review To give a state-of-art knowledge regarding cancer-associated fibroblasts (CAF) in cholangiocarcinoma (CCA) based both on direct evidence and studies on other desmoplastic cancers. High contingency of CAF characterizes CCA, a tumor with a biliary epithelial phenotype that can emerge anywhere in the biliary tree. Current treatments are very limited, the surgical resection being the only effective treatment but restricted to a minority of patients, whereas the remaining patients undergo palliative chemotherapy regimens. In cancer, CAF shape the tumor microenvironment, drive cancer growth and progression, a...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Molecular classification of cholangiocarcinoma
Purpose of review Cholangiocarcinoma (CCA) are heterogeneous tumors that arise from the malignant transformation of cholangiocytes along the biliary tree. CCA heterogeneity occurs at multiple levels and results in resistance to therapy and poor prognosis. Here, we review the molecular classification of CCA by focusing on the latest progresses based on genetic, epigenetic, transcriptomic and proteomic profiles. In addition, we introduce the emerging field of radiogenomics. Recent findings Genome-wide integrative omics approaches have been widely reported by using large cohorts of CCA patients. Morphomolecular correlati...
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Editorial: Cholangiocarcinoma - a rare and devastating, but no longer forsaken tumor
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: BILIARY TRACT: Edited by Chantal Housset Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - January 31, 2020 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Appendiceal neuroendrocrine neoplasms: incidentaloma or something we should worry about?
Purpose of review To synthesize the current knowledge and guidelines on the management of appendiceal neuroendocrine neoplasms (ANENs). Recent findings Most recent guidelines are essentially based on heterogeneous retrospective series. With the advent of a more precise classification of neuroendocrine neoplasms, this heterogeneity is rightly criticized and many ‘grey areas’ are now debated in expert literature. The only way to solve these issues is through the conduct of large prospective multicentre studies, but this seems somewhat utopian, given the rarity of this disease. Summary ANENs are rare tumou...
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Pouchitis: diagnosis and management
Purpose of review Pouchitis is the most common complication in patients who undergo ileal pouch-anal anastomosis (IPAA), occurring more frequently in patients with ulcerative colitis. Pouchitis – the inflammation of the pouch – can be due to idiopathic or secondary causes. Chronic antibiotic-dependent pouchitis (CADP) and chronic antibiotic-resistant pouchitis (CARP) are the most difficult forms of chronic idiopathic pouchitis to treat. Crohn's disease of the pouch may develop de novo in ulcerative colitis patients following colectomy with IPAA. It carries a high risk for pouch failure, and its diagnosis and ...
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Endoscopic management of inflammatory bowel disease-associated complications
Purpose of review The main complications of inflammatory bowel disease (IBD) are strictures, fistulas, abscesses, and colitis-associated neoplasia. In addition to diagnosis, disease monitoring, and surveillance, endoscopy plays an important role in the management of those complications. This review is to provide up-to-date information in endoscopic treatment modalities for those complications. Recent findings The endoscopic therapy of IBD complication has evolved from balloon dilation of strictures to endoscopic stricturotomy, strictureplasty, stenting, fistulotomy, sinusotomy, and neoplasia ablation. These endoscopic...
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Immune-checkpoint inhibitors induced diarrhea and colitis: a review of incidence, pathogenesis and management
Purpose of review Diarrhea and colitis are among the most commonly encountered immune-mediated adverse events among patients receiving antiprogrammed cell death protein/ligand-1 (PD-1/L1) as well as anticytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibodies. With growing indications and widespread use of immune checkpoint inhibitors, it is imperative to summarize the current body of evidence concerning the incidence, pathogenesis, risk factors, diagnostic challenges, and treatment options currently available for the management of immune-mediated diarrhea and colitis. Additionally, with emerging evidence analyzin...
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Anal fissure management by the gastroenterologist
This article should help in preventing unnecessary surgery and its complications, mainly incontinence in a small but significant number. The search for more effective drugs and options for managing this disorder continues. (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Editorial: Colon updates 2020 – some old, some new but novel insights throughout
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Carbapenemase-producing Enterobacteriaceae – once positive always positive?
Purpose of review This review provides an overview of gastrointestinal tract colonization with carbapenemase-producing Enterobacteriaceae (CPE), including risk factors for colonization, determinants for duration of colonization, and whether patients can decolonize, either spontaneously or via targeted interventions. Recent findings CPE colonization is disseminating globally with increasing numbers of carbapenemases being identified in increasing patient cohorts. Numerous risk factors including repeated healthcare contact, patient co-morbidities and international travel have all been linked to increased rates of coloni...
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

Foodborne transmission of Clostridioides difficile: a review
Purpose of review The epidemiology of Clostridioides difficile infection (CDI) is changing, with increasing rates of community-acquired infections. In light of recent advances in understanding C. difficile transmission networks with whole-genome sequencing, new routes of spread outside the hospital need to be considered. This review examines the evidence behind food as a driver of C. difficile dissemination. Recent findings Recently published studies adding to the existing body of literature supporting C. difficile as a foodborne pathogen are discussed. Specifically, new evidence on the presence of C. difficile in roo...
Source: Current Opinion in Gastroenterology - November 29, 2019 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mark H. Wilcox Source Type: research

Measuring outcomes in complicated intra-abdominal infections
Purpose of review Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. Clinical trials should help guide and improve the management of cIAIs. However, inappropriate selection or measurement of outcomes in cIAIs clinical trials can lead to misleading results on the effectiveness of interventions. This review aims to describe how outcomes are reported in randomized controlled trials evaluating antibiotic treatment for cIAIs and discuss how outcome reporting may be improved. Recent findings Commonly used primary outcomes are treatment success or failure, and these outcom...
Source: Current Opinion in Gastroenterology - November 29, 2019 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 - November 29, 2019 Category: Gastroenterology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Gastrointestinal stromal tumor: epidemiology, diagnosis, and treatment
Purpose of review The purpose of this review is to review the past year's literature to provide comprehensive information to researchers, physicians, and the general public regarding the epidemiology, diagnosis, and treatment of gastrointestinal stromal tumors (GISTs). Common ground as well as divergent viewpoints will be highlighted and discussed. Recent findings The diagnosis of GISTs may involve imaging tests such as computed tomorgraphy scan and MRI, endoscopy with or without endoscopic ultrasound, and biopsy. Only biopsy, however, can yield a positive diagnosis. As most GISTs express KIT protein, immunostaining f...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Advances in the treatment of gastric cancer: 2019
Purpose of review The aim of this study was to review studies published within the past year regarding management of gastric cancer. Recent findings Laparoscopic gastrectomy achieves equivalent survival compared with open gastrectomy in early stage and locally advanced gastric cancer. Adjuvant chemotherapy with 6 months of S-1 and oxaliplatin was superior to 12 months of S-1, and the addition of postoperative radiation therapy did not improve survival. The FLOT regimen is the new standard for preoperative chemotherapy. In metastatic gastric cancer, the addition of docetaxel to S-1 and cisplatin failed to improve overa...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Treatment of Helicobacter pylori
Purpose of review Helicobacter pylori eradication has become more challenging over the past decade due to increasing antimicrobial resistance, especially to clarithromycin and levofloxacin. We identified 508 recent publications on H. pylori treatment (published between January 2018 and June 2019), focusing on the most highly clinically relevant for this review. Recent findings Declining H. pylori eradication rates with clarithromycin triple therapy have led to most guidelines recommending 14 days bismuth-based quadruple therapy or concomitant therapy as the best initial empiric regimen. Substituting amoxicillin for te...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Diagnosis: gastric intestinal metaplasia – what to do next?
Purpose of review One of the most vexing problems for gastroenterologists is what actions to take after receiving a histological diagnosis of gastric intestinal metaplasia. We approach the problem by starting with suggesting a biopsy protocol that ensures obtaining the biopsies required for diagnosis, assessing the status of the gastric mucosa, and effective communication with the pathologist and patient. Recent findings The rediscovery and integration of the long history of gastric damage and repair resulting in pseudopyloric metaplasia (called SPEM) into the thinking of investigators working with animal models of ga...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Gastric variceal bleeding
Discussion of treatment is further subdivided into primary and secondary prophylaxis and the management of acute gastric variceal bleeding with a focus on emerging endoscopic interventions. Summary Cyanoacrylate injection may have a role in the primary and secondary prophylaxis of gastric variceal. Endoscopic band ligation should be considered for GOV1. EUS-guided injection of synthetic glues like cyanoacrylate is superior to direct injection. However, EUS-guided coil injections with or without cyanoacrylate should be considered first-line endoscopic treatment in all bleeding gastric variceal except for GOV1. Balloon re...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Updates on management of nonvariceal upper gastrointestinal bleeding
Purpose of review Upper gastrointestinal bleeding (UGIB) is a common and life-threatening condition in the United States and worldwide. Recent findings There have been several exciting recent advances in the endoscopic management of UGIB. One such advance is the recent approval of Hemospray by US Food and Drug Administration in May 2018. Another one is the emerging role of video capsule endoscopy as a triage and localization tool for UGIB patients. Finally, the development of new reversal agents for antithrombotic medications is an important advance in the management of life-threatening upper gastrointestinal bleed. ...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Proton pump inhibitors: placing putative adverse effects in proper perspective
Purpose of review This review summarizes the past year's literature, both clinical and basic science, regarding potential adverse effects of proton pump inhibitors (PPIs). Recent findings PPIs are amongst the most widely prescribed and over-prescribed medications worldwide. Although generally considered well tolerated, epidemiologic studies that mine large databases have reported a panoply of putative adverse effects associated with PPIs. It should be emphasized that the quality of the evidence underlying most of these associations is very low and the studies, by design, cannot ascribe cause and effect. These associat...
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Editorial: Stomach and duodenum
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - October 12, 2019 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research