Continued advances for hepatology in 2015
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - April 9, 2016 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 9, 2016 Category: Gastroenterology Tags: Editorial Introductions Source Type: research

Nutritional consequences of long-term acid suppression; are they clinically important?
Purpose of review: As acid suppression therapies with proton pump inhibitors are an extremely common practice for common acid-related diseases, there has been increased scrutiny on the safety of this class of therapy. Recent findings: There have been increasing reports of allegation of harm with the sustained use of proton pump inhibitors, in particular with potential adverse effects on vitamin and mineral absorption. This has prompted a number of product label changes directed by the US Food and Drug Administration, raising concerns for ongoing continued use among clinicians and patients. Summary: This review highlights...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Iron replacement therapy: do we need new guidelines?
Purpose of review: Approximately, one-third of the world's population suffers from anemia, and at least half of these cases are because of iron deficiency. With the introduction of new intravenous iron preparations over the last decade, uncertainty has arisen when these compounds should be administered and under which circumstances oral therapy is still an appropriate and effective treatment. Recent findings: Numerous guidelines are available, but none go into detail about therapeutic start and end points or how iron-deficiency anemia should be best treated depending on the underlying cause of iron deficiency or in regard...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

From coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten free?
Purpose of review: Gluten-free diets (GFDs) have seen a disproportional rise in use and popularity relative to the prevalence of established gluten-related disorders such as coeliac disease or immunoglobulin E wheat allergy. This entity has been termed noncoeliac gluten sensitivity (NCGS). This review aims to provide a current perspective on the emerging evidence for and against NCGS, along with the associated need for a GFD. Recent findings: NCGS and the benefits of a GFD are reported amongst patients with irritable bowel syndrome, inflammatory bowel disease, and nonintestinal disorders such as neuropsychiatric diseases ...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Prebiotics and synbiotics: dietary strategies for improving gut health
Purpose of review: A wide range of dietary carbohydrates, including prebiotic food ingredients, fermentable fibers, and milk oligosaccharides, are able to produce significant changes in the intestinal microbiota. These shifts in the microbial community are often characterized by increased levels of bifidobacteria and lactobacilli. More recent studies have revealed that species of Faecalibacterium, Akkermansia, and other less well studied members may also be enriched. We review the implications of these recent studies on future design of prebiotics and synbiotics to promote gastrointestinal health. Recent findings: Investi...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

Emerging issues in the medical management of Crohn's disease
This article describes why this review is timely and relevant. The medical management of Crohn's disease is complex, and is changing rapidly with the introduction of novel therapeutic agents and management strategies. Recent findings: We have summarized and synthesized up-to-date evidence and opinion on the proper role and composition of combined immunosuppressive therapy in the management of Crohn's disease, the optimal time for introduction of immunomodulator and/or biologic therapies, and the benefits of therapeutic drug monitoring for biologic therapies. We also discuss the evidence supporting the benefits of the nove...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

A gut (microbiome) feeling about the brain
Purpose of review: There is an increasing realization that the microorganisms which reside within our gut form part of a complex multidirectional communication network with the brain known as the microbiome-gut-brain axis. In this review, we focus on recent findings which support a role for this axis in modulating neurodevelopment and behavior. Recent findings: A growing body of research is uncovering that under homeostatic conditions and in response to internal and external stressors, the bacterial commensals of our gut can signal to the brain through a variety of mechanisms to influence processes such neurotransmission,...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

Sensing of nutrients and microbes in the gut
Purpose of review: Sensing of nutrients and microbes in the gut are fundamental processes necessary for life. This review aims to provide an overview of the basic background and new data on cellular nutrient, energy, and microbe sensors. Recent findings: The nutrient sensors 5’ adenosine monophosphate-activated protein kinase, activating transcription factor 4 and mechanistic target of rapamycin (mTOR) are critical in control of the cell cycle. Recent data demonstrate their role in metabolic syndrome, in cell growth, and as therapeutic targets. Regulation of mTOR by the amino acids is the subject of intense investig...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

Contemporary celiac disease diagnosis: is a biopsy avoidable?
Purpose of review: The duodenal biopsy is the gold standard for the diagnosis of celiac disease. However, given improvements in the performance of serological testing, the possibility of accurately diagnosing celiac disease without the need of a biopsy has attracted interest. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition has revised its recommendations to include a diagnostic algorithm that includes sequential serological testing and human leukocyte antigen genotyping for symptomatic children which would enable a diagnosis of celiac disease to be made in the absence of a confirmatory intest...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

Leaky gut – concept or clinical entity?
This article evaluates the current status of the gut barrier in gastrointestinal disorders. Recent findings: The gut barrier is a complex, multicomponent, interactive, and bidirectional entity that includes, but is not restricted to, the epithelial cell layer. Intestinal permeability, the phenomenon most readily and commonly studied, reflects just one (albeit an important one) function of the barrier that is intimately related to and interacts with luminal contents, including the microbiota. The mucosal immune response also influences barrier integrity; effects of inflammation per se must be accounted for in the interpret...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

Exercise, fitness, and the gut
Purpose of review: Exercise and gut symptomatology have long been connected. The possibility that regular exercise fosters intestinal health and function has been somewhat overlooked in the scientific literature. In this review, we summarize current knowledge and discuss a selection of recent, relevant, and innovative studies, hypotheses and reviews that elucidate a complex topic. Recent findings: The multiorgan benefits of regular exercise are extensive. When taken in moderation, these benefits transcend improved cardio-respiratory fitness and likely reach the gut in a metabolic, immunological, neural, and microbial mann...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

Reconfiguration of the small intestine and diabetes remitting effects of Roux-en-Y gastric bypass surgery
Purpose of review: Alterations in small intestinal physiology are proposed to play a causative role in the beneficial impact of Roux-en-Y gastric bypass on type 2 diabetes mellitus. The present article describes the key proposed mechanisms implicated with an emphasis on some of the newer findings in the field. Recent findings: Augmented incretin and diminished anti-incretin effects postsurgery are explored and a model proposed that reconciles the hindgut and foregut hypotheses of improved glycaemic control as being complementary rather than mutually exclusive. Synthesis of recent findings on postbypass changes in intestin...
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Fergus Shanahan Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - February 5, 2016 Category: Gastroenterology Tags: Editorial Introductions Source Type: research

Chronic unexplained diarrhea: a logical and cost-effective approach to assessment
Purpose of review: The workup of chronic unexplained diarrhea can be equally frustrating for care providers and patients. It carries a physical, financial, and social toll. In this review we provide a sensible approach to evaluating and managing chronic diarrhea. Recent findings: Bile acid diarrhea is becoming increasingly recognized as a potential cause behind some cases of chronic diarrhea. Summary: A detailed history and physical examination can provide clues that guide a logical approach to the evaluation. We suggest a cost-effective approach to the workup and management of chronic diarrhea based on individual patient ...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Problems after restorative proctocolectomy: assessment and therapy
Purpose of review: Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Although the surgical procedure significantly improves the patients’ quality of life, complications are common. Mechanical or structural complications related to surgical techniques as well as chronic pouchitis are common after the procedure. Recent findings: Recent literature has suggested some of those mechanical complications, along with chronic pouchitis, may share similar risk factors, particularly betwee...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Colonic and anorectal motility testing in the high-resolution era
Purpose of review: The past few years have seen an increase in the number of research and clinical groups around the world using high-resolution manometry (HRM) to record contractile activity in the anorectum and colon. Yet despite the uptake and growing number of publications, the clinical utility and potential advantages over traditional manometry remain undetermined. Recent findings: Nearly all of the publications in the field of anorectal and colonic HRM have been published within the last 3 years. These studies have included some data on normal ranges in healthy adults, and abnormalities in patient groups with constip...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

The diminutive colon polyp: biopsy, snare, leave alone?
Purpose of review: Diminutive polyps, measuring between 1 and 5 mm, represent the vast majority of colorectal polyps encountered during screening colonoscopy. Although the chance of harboring advanced adenoma or neoplastic cells is low, ensuring a complete polyp resection with clear margins is crucial to reduce the risk of interval colorectal cancer. The purpose of this review was to evaluate the different methods applied for polypectomy of diminutive polyps and clarify whether a diminutive polyp should be retrieved or left in place. Recent findings: Cold biopsy polypectomy is indicated for resection of polyps measuring ...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Cancer surveillance in ulcerative colitis and Crohn's disease: new strategies
Purpose of review: Inflammatory bowel disease (IBD) patients have a higher incidence of colon cancer than the general population. Colon cancer surveillance has traditionally involved taking numerous random biopsies to provide sufficient yield to detect dysplasia. Recently, consensus guidelines have been published which promote the use of chromoendoscopy for IBD colon cancer surveillance. This presents a new set of opportunities and challenges in the evaluation and management of dysplasia in IBD. Recent findings: Dysplasia, previously thought to be ‘invisible’ to the endoscopist, is now considered to be ‘v...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

How to deal with large colorectal polyps: snare, endoscopic mucosal resection, and endoscopic submucosal dissection; resect or refer?
Purpose of review: The importance of accurate polyp detection and removal is paramount to preventing colon cancer. Resection of large polyps can be challenging to the endoscopist based on their size, shape, or location. Large polyps have the potential of harboring malignancy and a higher risk of complications with resection. Careful assessment of each lesion and meticulous resection using the appropriate tools and techniques is essential. Recent findings: Over the last 15 years, the development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) techniques has presented the endoscopist with the...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Advances in colonic disease: some light at the end of the tunnel at the end of the light!
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: LARGE INTESTINE: Edited by Eamonn M.M. Quigley Source Type: research

Global challenges in acute diarrhea
Purpose of review: Childhood diarrhea is the most common cause of morbidity and mortality, especially in the low and middle-income countries. The burden of child mortality because of diarrhea has declined, but still a lot is desired not only to reduce diarrhea-specific mortality but reduce the overall incidence, and hence the morbidity associated with childhood diarrhea. Recent findings: A recent Lancet series on diarrhea suggests that amplification of the current interventions can eliminate virtually all preventable diarrhea deaths. A refocused attention and strategy and collective effort from the multilateral entities to...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mitchell B. Cohen Source Type: research

Environmental enteropathy
Purpose of review: Environmental enteropathy has long been recognized as an important intermediary condition leading to chronic malnutrition in children in developing countries. Interest has lately renewed in this topic because of increased focus on improving the quality of lives as opposed to just saving them. Here, we provide an overview of recent scientific literature and our perspective about this disorder. Recent findings: Current understanding of the disorder of environmental enteropathy is based on studies conducted decades ago. Results of some new studies on histopathologic characterization of environmental enterop...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mitchell B. Cohen Source Type: research

Rhythm and bugs: circadian clocks, gut microbiota, and enteric infections
Purpose of review: To highlight recent developments in understanding the dynamic relationship between circadian rhythms, the gut microbiome, and gastrointestinal infections. Recent findings: In humans and mice, the composition and functions of the intestinal microbiome display diurnal rhythms orchestrated by feeding behaviors and host circadian gene expression. Jet lag, or circadian disruption, perturbs these rhythms to produce gut dysbiosis. When mice are orally infected with Salmonella typhimurium in the morning (the beginning of their rest period) they show higher levels of colonization and gut inflammation vs. infectio...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mitchell B. Cohen Source Type: research

The long-term functional consequences of acute infectious diarrhea
Purpose of review: The study reviews recent publications that build on previous studies showing that acute enteric infection can produce persistent dysfunction in the lower gut (postinfectious irritable bowel syndrome) and proximal gut (postinfectious functional dyspepsia). The review addresses risk factors, the pathophysiological basis of persistent gut dysfunction, and the factors that initiate and maintain it. Recent findings: Recent work has identified several loci of host genetic predisposition to these syndromes that focus attention on host immune responses that may lead to gut dysfunction, including changes in intes...
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: GASTROINTESTINAL INFECTIONS: Edited by Mitchell B. Cohen Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - December 16, 2015 Category: Gastroenterology Tags: Editorial introductions Source Type: research

Bariatric and metabolic surgery: current trends and what's to follow
Purpose of review: Obesity is a global epidemic and bariatric surgery remains an underperformed modality for its treatment. Even though the dangers of obesity are well understood, surgical intervention is underestimated. The purpose of this review is to discuss emerging trends in bariatric surgery. Recent findings: Studies suggest that different operations have different effects on both obesity and its comorbidities. Combining the concepts of malabsorption and restriction, we are looking toward more advanced and efficient treatment options. Less-invasive techniques such as endoscopic devices are under investigation and the...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Portal hypertensive gastropathy and gastric antral vascular ectasia
This article reviews the pathogenesis and guidelines in management of both of these conditions with emphasis on recent advances in the field. Recent findings: Off-label use of Hemospray has been shown in several case series to be useful in managing acute bleeding from PHG. Balloon-occluded retrograde transvenous obliteration presents an alternative approach for this condition. Radiofrequency ablation may be an alternative therapy to argon plasma coagulation in the endoscopic treatment of GAVE, as it consists of fewer sessions and has been shown to decrease gastrointestinal blood loss. Summary: The treatment options for PHG...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Gastroparesis
Purpose of review: This review summarizes recent progress in the epidemiology, pathophysiology, and treatment of gastroparesis. Recent findings: The relationship between delayed gastric emptying and symptom pattern in gastroparesis and, related to it, its separation from functional dyspepsia remains an area of controversy and uncertainty. Pathophysiological studies have focused on the role of pyloric resistance and duodenal motility in generation of symptoms. In diabetic patients, glycemic control did not determine short-term changes in gastric emptying rate in type 2 diabetes, but poor glycemic control was a major risk fa...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Functional dyspepsia
Purpose of review: Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge holds the prospect that targeted therapy may more optimally manage subsets of these patients with functional dyspepsia. Recent findings: An understanding of gut-to-brain and brain-to-gut pathways in functional dyspepsia is expanding. Minimal mucosal inflammation with eosinophils (and in some cases mast cells) characterized by ultrastructural changes in the duodenum appears to be present in a substantial subgroup of functional dyspepsia pati...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Gastroduodenal mucosal defense mechanisms
Purpose of review: To highlight recent developments in the field of gastroduodenal mucosal defense with emphasis on lumen–gut interactions. Recent findings: There has been a growing interest in the physiological functions of luminal chemosensors present from tongue to colon that detect organic molecules in the luminal content associated with nutrient ingestion, usually associated with specialized cells, in particular the enteroendocrine cells. These receptors transduce the release of peptide hormones, in particular proglucagon-derived products such as the glucagon-like peptides (GLPs), which have profound effects on ...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Functional anatomy and physiology of gastric secretion
Purpose of review: This review summarizes the past year's literature regarding the neuroendocrine and intracellular regulation of gastric acid secretion, discussing both basic and clinical aspects. Recent findings: Gastric acid facilitates the digestion of protein as well as the absorption of iron, calcium, vitamin B12, and certain medications. High acidity kills ingested microorganisms and limits bacterial overgrowth, enteric infection, and possibly spontaneous bacterial peritonitis. The main stimulants of acid secretion are gastrin, released from antral gastrin cells; histamine, released from oxyntic enterochromaffin-lik...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Stomach and duodenum
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Mitchell L. Schubert Source Type: research

Role of type 2 immunity in intestinal inflammation
Purpose of review: Type 2 (Th2) immune responses play important roles in intestinal immunity by contributing to the maintenance of mucosal homeostasis, not only conferring protection against helminthic infection but also participating in pro-inflammatory pathways in chronic intestinal inflammatory disorders, including inflammatory bowel disease. The current review focuses on recent developments regarding the role of Th2 responses in intestinal inflammation. Recent findings: Th2 gut mucosal responses are promoted by mediators that are released following injury to the epithelium, and act as alarmin-type danger signals. Inter...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Fabio Cominelli Source Type: research

Reciprocal interaction of diet and microbiome in inflammatory bowel diseases
Purpose of review: Diet is an emerging but poorly defined disease modulator in inflammatory bowel diseases (IBDs). Dietary factors exert direct effects on epithelial and immune cells and indirectly modulate immune homeostasis by shaping the intestinal microbiota. Recent findings: The increase in IBD prevalence in industrialized countries is associated with lifestyle changes including diets rich in energy, saturated fats, meat and sugar. Despite the fact that the intestinal ecosystem shows high stability and resilience to short-term perturbations, long-term dietary habits have profound effects on composition and function ev...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Fabio Cominelli Source Type: research

The genetic architecture of inflammatory bowel disease: past, present and future
We describe the potential clinical applications of genetics, and provide important challenges in the field and the future steps to be taken. Recent findings: GWAS and meta-analyses have identified 163 loci associated with IBD, and have implicated key pathways in IBD pathogenesis. Only few of the association signals correspond to nonsynonymous coding variation with a clear effect on protein function. The majority of signals involve noncoding genetic variation, of which a large part is related to gene expression changes. More recently, expression and epigenetic studies in IBD are increasingly being reported, and have shown t...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Fabio Cominelli Source Type: research

Cross-talk between type 3 innate lymphoid cells and the gut microbiota in inflammatory bowel disease
Purpose of review: Innate lymphoid cells (ILCs) are a newly-identified population of immune cells prevalent in, but not limited to, mucosal tissues that not only play a significant role in immune homeostasis and host defense, but also in disease pathogenesis. This review highlights the importance of type 3 ILCs (ILC3s) and their interactions with the intestinal microflora, both in maintaining gut health and in the development of inflammatory bowel disease (IBD). Recent findings: Distinct lineages of ILCs are defined based on the presence of cell surface proteins, secretion of effector cytokines and expression of master tra...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Fabio Cominelli Source Type: research

Strategies that target leukocyte traffic in inflammatory bowel diseases: recent developments
Purpose of review: We review the most recent developments regarding the targeting of molecules involved in the traffic of leukocytes for the treatment of inflammatory bowel diseases (IBD). Recent findings: We discuss the most important findings of one published phase II trial that targeted the β7 integrin (etrolizumab), two phase II trials that targeted the α4β7 integrin ligand: mucosal addressin cell adhesion molecule 1 (MAdCAM-1, PF-00547659), a phase II trial targeting the chemokine IP-10 (CXCL10) in Crohn's, and a phase II trial that targeted the sphingosine-1-phosphate receptor-1: ozanimod in patients ...
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: IMMUNOLOGY: Edited by Fabio Cominelli Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - October 9, 2015 Category: Gastroenterology Tags: Editorial Introductions Source Type: research

Per oral endoscopic myotomy for the treatment of achalasia
Per oral endoscopic myotomy (POEM) represents the culmination of natural orifice transluminal endoscopic surgery (NOTES) research, and its most successful application to date. Over a thousand POEMs have been performed globally with remarkable results in terms of clinical efficacy and safety. (Source: Current Opinion in Gastroenterology)
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: Special Commentary Source Type: research

Intraductal papillary mucinous neoplasms
Purpose of review: Our understanding of intraductal papillary mucinous neoplasm (IPMN) of the pancreas has remarkably grown within the last decade; nonetheless there is still an ongoing controversy if the majority of these potentially malignant neoplasms need to be resected or if observation in a subset is well tolerated. Recent findings: Novel cyst fluid biomarkers, like Gnas mutations or mab DAS-1, could play a pivotal role in the distinction of IPMN vs. other cystic lesions, in the sub-classification of IPMN and in the detection of IPMN with high-grade dysplasia or invasive cancer. Other recent studies focused on natura...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Pancreatic stellate cell: physiologic role, role in fibrosis and cancer
Purpose of review: Ever since the first descriptions of methods to isolate pancreatic stellate cells (PSCs) from rodent and human pancreas 17 years ago, rapid advances have been made in our understanding of the biology of these cells and their functions in health and disease. This review updates recent literature in the field, which indicates an increasingly complex role for the cells in normal pancreas, pancreatitis and pancreatic cancer. Recent findings: Work reported over the past 12 months includes improved methods of PSC immortalization, a role for PSCs in islet fibrosis, novel factors causing PSC activation as well a...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Pancreatic pain
Purpose of review: Pain is the most common symptom of chronic pancreatitis, with a profound socioeconomic impact. Historical management paradigms failed, as they did not adequately address the fundamental underlying mechanisms. The present article describes the neurobiology of pain and sensitization in this condition, in an effort to explain prior failings and provide future directions for managing pain in chronic pancreatitis. Recent findings: A number of recent advances have been made in understanding the neurobiology of pain for this condition. This has been coupled with clinical advances in assessing sensitization to p...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Diabetes associated with pancreatic diseases
Purpose of review: A relevant number of patients with pancreatic disorders suffer from secondary diabetes. Recent data have shed light on the link between pancreatic damage and subsequent impairments in glucose homeostasis. Furthermore, epidemiological studies provided insights into the relationship between diabetes and the risk of pancreatic carcinoma or pancreatitis. Pancreaticogenic diabetes requires a tailored therapeutic approach taking into account the individual properties of the available glucose-lowering drugs. Recent findings: We review the available literature concerning diabetes in patients with acute or chroni...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Inflammation in acute and chronic pancreatitis
This report reviews recent animal model and human studies associated with inflammatory responses in acute and chronic pancreatitis. Recent findings: Animal model and limited human acute and chronic pancreatitis studies unravel the dynamic nature of the inflammatory processes and the ability of the immune cells to sense danger and environmental signals. In acute pancreatitis, such molecules include pathogen-associated molecular pattern recognition receptors such as toll-like receptors, and the more recently appreciated damage-associated molecular pattern molecules or ‘alarmin’ high mobility group box 1 and IL-33...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Recent developments in steroid-responsive pancreatitides (autoimmune pancreatitis)
Purpose of review: There are two distinct steroid responsive chronic fibro-inflammatory diseases of the pancreas, called type 1 and type 2 autoimmune pancreatitis (AIP). We review recent progress in this field. Recent findings: It has recently been suggested that the term AIP be used to describe type 1 AIP and the term idiopathic duct-centric chronic pancreatitis (IDCP) be used for type 2 AIP. Clinical features and long-term outcomes of AIP and IDCP are well characterized and prognosis of both diseases is excellent. Diagnostic strategies tailored to regional practice patterns have emerged with the application of Internatio...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Paediatric pancreatitis
Purpose of review: The purpose of this review is to describe recent developments in paediatric pancreatitis and to discuss causes and current management. Recent findings: Although recent studies have estimated the annual incidence of paediatric acute pancreatitis approaching that of adults, there are no established guidelines about its diagnosis and treatment in children. Genetic and structural/congenital abnormalities are emerging as the primary risk factors for paediatric acute recurrent and chronic pancreatitis. Specifically, chronic pancreatitis is associated with a significant socioeconomic burden in children. Both me...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Acute pancreatitis
Purpose of review: To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis. Recent findings: Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis. A reliable clinical or laboratory marker or a scoring system to predict severity is lacking. Th...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: PANCREAS: Edited by Fred Gorelick Source Type: research

Endoscopic approaches to gastroparesis
Purpose of review: This review covers the cause, evaluation and treatment options for gastroparesis. Symptoms of delayed gastric emptying are increasingly seen by gastroenterologists and gastrointestinal surgeons. Endoscopy – both laparoscopic and flexible – is increasingly important in treatment algorithms for this problem. Recent findings: Gastroparesis is increasingly being seen in clinical practice. A progressive algorithm needs to be followed in these challenging cases: starting with medical treatment and diet modification, progressing through endoscopic treatments including new ones such as per-oral pylor...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Tony Kalloo Source Type: research

Endoscopic management of bariatric surgical complications
Purpose of review: Bariatric surgery is recognized as the most effective treatment against obesity as it results in significant weight reduction and a high rate of remission of obesity-related comorbidities. However, bariatric surgery is not uncommonly associated with complications and an endoscopic approach to management is preferred over surgical reintervention. This review illustrates the latest developments in the endoscopic management of bariatric surgical complications. Recent findings: For successful management of complications, precipitating and perpetuating factors must be addressed in addition to directing therap...
Source: Current Opinion in Gastroenterology - August 7, 2015 Category: Gastroenterology Tags: ENDOSCOPY: Edited by Tony Kalloo Source Type: research