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

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

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

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

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

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

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

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

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

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

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

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

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

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

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