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 important th...
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