Enteric Hyperoxaluria and Kidney Stone Management in Inflammatory Bowel Disease
AbstractPurpose of reviewEnteric hyperoxaluria is frequently seen in patients with inflammatory bowel disease (IBD). IBD patients are therefore at higher risk of nephrolithiasis, particularly calcium oxalate stones. We reviewed the recent medical literature to elucidate the mechanisms and risk factors behind nephrolithiasis in IBD patients, as well as therapies to treat and prevent the formation of kidney stones.Recent findingsAt present, there are no specific guidelines for screening and monitoring the progression of nephrolithiasis in the IBD population. Yet, recent epidemiologic data suggests that the prevalence of neph...
Source: Current Treatment Options in Gastroenterology - July 6, 2020 Category: Gastroenterology Source Type: research

What Is the Optimal Surveillance Strategy for Non-dysplastic Barrett ’s Esophagus?
AbstractPurpose of reviewThere is conflicting data on the effectiveness of the currently recommended endoscopic surveillance strategy in non-dysplastic Barrett ’s esophagus (BE) patients. We reviewed the literature to evaluate the (cost) effectiveness of the current surveillance strategy. We also reviewed critical strategies and new technologies that could improve dysplasia detection.Recent findingsAdherence to the current EGD surveillance guidelines is suboptimal with high rates of missed dysplasia/esophageal adenocarcinoma (EAC). The influence of surveillance on EAC mortality appears modest. Careful cleansing, insp...
Source: Current Treatment Options in Gastroenterology - June 25, 2020 Category: Gastroenterology Source Type: research

Bloating and Abdominal Distension: Exploring Hidden Depths and Insights
AbstractPurpose of reviewThe goal of this paper is to review categorically treatment options for the diverse mechanisms to which studies have shown underlie bloating and abdominal distension.Recent findingsWhile previous studies typically associate bloating and distension with a functional gastrointestinal disorder, in appropriate clinical settings, workup to look at diseases such as postural orthostatic hypotension, chronic intestinal pseudoobstruction, Ehlers-Danlos syndrome, and mast cell activation syndrome can further provide insight into to these patients.SummaryBloating and distension are commonly presented to the g...
Source: Current Treatment Options in Gastroenterology - May 15, 2020 Category: Gastroenterology Source Type: research

Latest Treatment of Acute Kidney Injury in Cirrhosis
AbstractPurpose of reviewTo discuss the latest on the definition of acute kidney injury (AKI), its pathophysiology and treatment of the condition.Recent findingsAKI in cirrhosis includes both functional and structural causes. Type 1 hepatorenal syndrome is a special form of functional AKI (HRS-AKI) associated with a very poor prognosis. The pathophysiology of AKI involves hemodynamic changes as well as inflammation. The treatment for AKI is mostly designed for HRS-AKI using albumin and vasoconstrictors to improve systemic hemodynamics, hence renal perfusion and function, resulting in a response rate of up to 44%. Otherwise...
Source: Current Treatment Options in Gastroenterology - May 15, 2020 Category: Gastroenterology Source Type: research

Advances in Endoscopic Resection in the Management of Esophageal Neoplasia
AbstractPurpose of reviewThere has been a paradigm shift in the management of early-stage cancer and benign submucosal lesions in the esophagus over the last 30  years. Previous conditions that required either full or partial esophagectomy can now be managed with endoscopic resection techniques, with superior adverse event and comorbidity profiles compared with surgery.Recent findingsThough cap-assisted endoscopic mucosal resection heralded the development of non-surgical therapies, this technique is limited by the size of the lesion, with larger lesions requiring piecemeal resection leading to lack of clear margins. ...
Source: Current Treatment Options in Gastroenterology - May 15, 2020 Category: Gastroenterology Source Type: research

An Update on the Role of the Microbiome in Non-alcoholic Fatty Liver Disease Pathogenesis, Diagnosis, and Treatment
AbstractThe microbiome was originally postulated to contribute to the pathogenesis of NAFLD when the first studies of dysbiosis in NAFLD were reported. Since then, a number of studies have investigated this finding further, in order to discern whether the dysbiosis is the result of the metabolic dysregulation seen with NAFLD or a contributor to the pathogenesis of this condition.Purpose of reviewThis review is aimed at highlighting the most important discoveries from the years 2017 –2019 that linked the microbiome to the pathogenesis, diagnosis, and treatment of NAFLD.Recent findingsRecent data have revealed further ...
Source: Current Treatment Options in Gastroenterology - May 2, 2020 Category: Gastroenterology Source Type: research

Endoscopic Diagnosis and Therapy in Primary Sclerosing Cholangitis
AbstractPurpose of reviewPrimary sclerosing cholangitis (PSC) is a progressive idiopathic fibrosing liver disease which leads to multiple biliary complications often best managed with endoscopic retrograde cholangiopancreatography (ERCP).Recent findingsPSC biliary complications include dominant biliary strictures, bile duct stones, cholangitis, and cholangiocarcinoma (CCA). Balloon dilation is the preferred treatment for management of dominant strictures as biliary stenting has been associated with higher rates of adverse events (AEs). Biliary stenting is reserved for patients with benign refractory strictures or CCA. Mult...
Source: Current Treatment Options in Gastroenterology - May 1, 2020 Category: Gastroenterology Source Type: research

EUS-Guided Versus ERCP-Guided Biliary Drainage for Primary Treatment of Distal Malignant Biliary Obstruction
(Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - April 28, 2020 Category: Gastroenterology Source Type: research

Diagnosis and Treatment of Diminutive Polyps in the Colon
AbstractPurpose of reviewColonoscopy and polypectomy reduce the incidence and mortality of colorectal cancer (CRC) by detecting and removing colorectal adenomas. Diminutive polyps (1 –5 mm) account for 75% of all polyps found but rarely contain or progress to CRC. Although a high adenoma detection rate (ADR) is associated with improved cancer prevention, the increase in detection of diminutive polyps also increases costs associated with CRC prevention programs. This review pr ovides an update on endoscopic management and considerations related to diminutive colorectal polyps.Recent findingsRecent studies show th...
Source: Current Treatment Options in Gastroenterology - April 15, 2020 Category: Gastroenterology Source Type: research

A Comprehensive Review of Dietary Management of Eosinophilic Esophagitis
This article will highlight major developments and evolution of dietary treatment for EoE in adults and review the advantages and limitations to the various approaches described.Recent findingsDietary therapy is effective for treating adults and children with EoE, and various dietary approaches have been found to be effective. Effectiveness does vary among these approaches with higher effectiveness seen as more antigens are avoided initially. Minimally invasive ways to assess the esophagus during diet reintroduction are being developed and may make this approach more feasible in the future. Choosing the right diet plan nee...
Source: Current Treatment Options in Gastroenterology - April 13, 2020 Category: Gastroenterology Source Type: research

Advances in POEM for Achalasia: Optimal Technique, Post-POEM GERD
AbstractPurpose of reviewPeroral endoscopic myotomy (POEM) is a novel procedure introduced into clinical practice by Inoue in 2010 for the treatment of achalasia. It is a safe and efficient procedure but with unknown long-term consequences of post-treatment gastroesophageal reflux (GER). Compared with surgical Heller myotomy with fundoplication, endoscopic myotomy has no standardized complementary procedure to prevent reflux.Recent findingsSeveral techniques aiming at diminishing the risk of post-procedural reflux have been described in the literature with promising outcomes. The double-scope technique (DST) is recommended...
Source: Current Treatment Options in Gastroenterology - April 11, 2020 Category: Gastroenterology Source Type: research

Palliative Care in Cirrhosis: Beyond Misconceptions
AbstractPurpose of reviewIntegrating palliative care in the management of patients with advanced liver disease is a growing area of interest in hepatology. This review will provide practical updates based on recent literature, rectify common misunderstandings, and help clinicians learn facts they can apply in their routine practice to offer their patients the benefits of palliative care.Recent findingsCompelling data proves the need and benefits of using palliative care for patients with cirrhosis and/or liver cancer, including those waiting for liver transplantation. This additional layer of supportive care for patients a...
Source: Current Treatment Options in Gastroenterology - April 6, 2020 Category: Gastroenterology Source Type: research

Endoscopic Retrograde Cholangiopancreatography in Patients With Surgically Altered Anatomy
AbstractPurpose of reviewThis review describes the recent advances and evolving techniques in endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) and highlights the novel alternative approaches for pancreato-biliary interventions in this group of patients.Recent findingsThe limitations of ERCP in patients with SAA have led to the development of improved endoscopic devices and accessories, and alternative approaches for pancreato-biliary interventions. Dedicated short-type single and double balloon enteroscopes (BE) have been developed with increased maneuverability and la...
Source: Current Treatment Options in Gastroenterology - April 1, 2020 Category: Gastroenterology Source Type: research

Non-invasive Assessment of Liver Fibrosis
AbstractPurpose of reviewIn the USA, there is a growing prevalence of liver disease, particularly from alcohol and fatty liver, as well as improvements in hepatitis C therapy that should be adjusted for level of fibrosis. There is accordingly a great need for rapid non-invasive fibrosis testing (NIT) to determine who should be referred for specialty care, started on specific therapies, screened for varices and malignancy, and selected for clinical trials.Recent findingsIt is not only the accuracy of NIT that matters, but the order in which they are applied and the population selected for screening. All NIT to date have hig...
Source: Current Treatment Options in Gastroenterology - March 31, 2020 Category: Gastroenterology Source Type: research

How to Develop a Training Program for Third-Space Endoscopic Procedures in Western Countries
AbstractPurpose of reviewWe reviewed the literature in order to determine the best system to develop a training program for third space endoscopic procedures in the West.Recent findingsThere has been a steady growth in the number and type of advanced endoscopic procedures over the past several decades, including the expansion of “third-space” or submucosal endoscopy. Most of our knowledge on training in third-space endoscopy stems from the East, with a lack of consensus regarding the optimal training model for Western endoscopists. We review the current literature and provide insight into a potential training a...
Source: Current Treatment Options in Gastroenterology - March 30, 2020 Category: Gastroenterology Source Type: research

Artificial Intelligence for Colorectal Polyp Detection and Characterization
AbstractPurpose of reviewTo elucidate the advantages and limitations of existing artificial intelligence technologies for colonoscopy by evaluating the currently available eight prospective studies (two for automated polyp detection and six for automated polyp characterization).Recent findingsAI is expected to mitigate the inherent risk of human error causing a polyp to be missed or mischaracterized by assisting polyp detection and characterization (i.e., pathological prediction). Some of the prospective studies clearly demonstrate the potential for AI to improve adenoma detection rates, which is considered one of the most...
Source: Current Treatment Options in Gastroenterology - March 26, 2020 Category: Gastroenterology Source Type: research

Lactose Intolerance and Milk Protein Allergy
AbstractPurpose of reviewReal or perceived lactose intolerance (LI) and true cow ’s milk allergy (CMA) are common reasons for dairy avoidance but are underdiagnosed and under-treated. Dairy avoidance is associated with nutrient deficiencies and unintended health consequences that disproportionately affect minorities.Recent findingsSurveyed GI physicians report that at least 30% of their patients had LI and 16% had food allergies including CMA. In a 2019 survey, approximately 10.8% of adults have symptoms consistent with a food allergy and CMA was the second most common allergy reported. LI and CMA are more common in ...
Source: Current Treatment Options in Gastroenterology - February 20, 2020 Category: Gastroenterology Source Type: research

New Developments in the Diagnosis and Management of Gastroesophageal Reflux
AbstractPurpose of reviewTo examine recent key developments in the pathophysiology, diagnosis, and treatment of gastroesophageal reflux disease (GERD).Recent findingsNewer research has suggested cytokine-mediated inflammation may play a role in the physiology of GERD, implying that the underlying mechanism may not be entirely related to chemical damage due to acid. Aided by novel technologies, diagnostic testing is also moving toward elucidating individual mechanisms and better defining specific GERD phenotypes with the goal of providing directed therapy. This is especially important in current times given the increase in ...
Source: Current Treatment Options in Gastroenterology - February 19, 2020 Category: Gastroenterology Source Type: research

Burden of Gastroduodenal Diseases from the Global Perspective
AbstractPurpose of reviewWe reviewed the recent medical literature to show global burden of gastroduodenal disease, potential strategies, and further perspectives.Recent findingsGastrointestinal and liver diseases are growing health problems, and cause more than 8 million deaths per year worldwide; encompass a range of long-term health conditions, such as digestive cancers, gastroesophageal reflux disease, Helicobacter pylori infection, peptic ulcer disease, liver diseases, inflammatory bowel disease, coeliac disease, and functional gastrointestinal disorders. Scientific knowledge demonstrates that the noncommunicable dise...
Source: Current Treatment Options in Gastroenterology - January 28, 2020 Category: Gastroenterology Source Type: research

The Use of Attachment Devices to Aid in Adenoma Detection
AbstractPurpose of reviewWith the intent of maximizing adenoma detection rate (ADR), different devices and colonoscopic innovations have been introduced over the past few years. There are a variety of attachment devices available for use in colonoscopy, all intended to improve ADR. In this review, we evaluate the evidence surrounding the available attachment devices and their impact on ADR.Recent findingsEndocuff, Endoring, Transparent cap, G-EYE balloon, and Third Eye Retroscope were all included in this review. Three of the devices, Endocuff, Endoring, and transparent hood or cap, have been shown to increase ADR without ...
Source: Current Treatment Options in Gastroenterology - January 27, 2020 Category: Gastroenterology Source Type: research

Molecular Diagnostics and Testing for Pancreatic Cysts
AbstractPurpose of reviewIn current clinical practice, the diagnosis and management of pancreatic cystic lesions (PCLs) are based on guidelines that combine clinical and imaging findings. These guidelines usefully identify a large category of low-risk PCLs that do not require treatment. However, they have limited accuracy for diagnosis of advanced neoplasia in worrisome and high-risk PCLs. Novel molecular markers that can accurately detect advanced neoplasia in PCLs can transform the care of patients with PCLs. We reviewed the recent medical literature on molecular diagnostics of PCLs and summarized molecular biomarkers as...
Source: Current Treatment Options in Gastroenterology - January 27, 2020 Category: Gastroenterology Source Type: research

Chronic Burping and Belching
AbstractAbstractBelching is a physiological event that allows venting of swallowed gastric air. Excessive belching is a common presentation to gastroenterology clinics and could be isolated complains or associated with other gastrointestinal problems.Purpose of this ReviewIt is to describe the presentation, diagnosis, and treatment of belching disordersRecent FindingsThese demonstrate that learned abnormal behaviors in response to unpleasant feeling in the abdomen are the driving causes for excessive belching and addressing these behaviors by speech pathology and cognitive behavior therapy considered as the keystone in its...
Source: Current Treatment Options in Gastroenterology - January 23, 2020 Category: Gastroenterology Source Type: research

Chronic Hiccups
AbstractPurpose of reviewNearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD.Recent findingsBased on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If...
Source: Current Treatment Options in Gastroenterology - January 23, 2020 Category: Gastroenterology Source Type: research

Artificial Intelligence and Polyp Detection
AbstractPurpose of reviewThis review highlights the history, recent advances, and ongoing challenges of artificial intelligence (AI) technology in colonic polyp detection.Recent findingsHand-crafted AI algorithms have recently given way to convolutional neural networks with the ability to detect polyps in real-time. The first randomized controlled trial comparing an AI system to standard colonoscopy found a 9% increase in adenoma detection rate, but the improvement was restricted to polyps smaller than 10  mm and the results need validation. As this field rapidly evolves, important issues to consider include standardi...
Source: Current Treatment Options in Gastroenterology - January 21, 2020 Category: Gastroenterology Source Type: research

Multi-Target Stool DNA Testing for Colorectal Cancer Screening: Emerging Learning on Real-world Performance
AbstractPurpose of ReviewMulti-target stool DNA (MT-sDNA) was approved in 2014 for use in screening average-risk patients for colorectal cancer (CRC). Here, we highlight recent literature from post-market studies to provide an update on clinical use and utility not possible from pre-approval studies.Recent FindingsMT-sDNA has been included in major society guidelines as an option for colorectal cancer screening, and has seen exponentially increasing use in clinical practice. MT-sDNA appears to be attracting new patients to CRC screening, and patient adherence to diagnostic colonoscopy after a positive MT-sDNA test is high....
Source: Current Treatment Options in Gastroenterology - January 21, 2020 Category: Gastroenterology Source Type: research

The Effects of Bariatric Surgery and Endoscopic Bariatric Therapies on GERD: An Update
AbstractPurpose of reviewBariatric surgery and endoluminal bariatric therapies (EBTs) form an increasingly utilized therapeutic approach to treat obese patients but may worsen gastroesophageal reflux disease (GERD). In this updated article, we review the evidence on the effects of bariatric procedures on GERD.FindingsRecent evidence implicates sleeve gastrectomy with the highest rates of de novo GERD and Barrett ’s esophagus (BE), whereas malabsorptive-restrictive procedures such as Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) were shown to have significantly lower reported rates. The int...
Source: Current Treatment Options in Gastroenterology - January 20, 2020 Category: Gastroenterology Source Type: research

Rumination Syndrome: Recognition and Treatment
AbstractPurpose of reviewThe purpose of this paper is to discuss current diagnostic and treatments of rumination.Rumination is often underdiagnosed or misdiagnosed in adults, especially when symptoms suggest regurgitation rather than vomiting accompanied by re-chewing and re-swallowing and should be included in the differential diagnosis. It is primarily diagnosed clinically by ROME-IV or DSM-5.Recent findingsThat rumination can be re-affirmed by characteristic patterns on objective testing such as high-resolution esophageal manometry and 24-h pH impedance testing. However, although gastroduodenal manometry and EMG are hel...
Source: Current Treatment Options in Gastroenterology - January 20, 2020 Category: Gastroenterology Source Type: research

Minor esophageal functional disorders: are they relevant?
AbstractPurpose of reviewHigh resolution esophageal manometry (HRM) has expanded understanding of esophageal motor function. The Chicago Classification scheme has allowed systematic categorization of the myriad of manometric parameters identified during HRM. Multichannel intraluminal impedance pH has enhanced ambulatory reflux monitoring through complete assessment of esophageal content transit. However, the clinical implications of identified minor esophageal functional disorders remain unclear.Recent findingsEsophagogastric junction outlet obstruction is defined by esophagogastric junction obstruction with preserved peri...
Source: Current Treatment Options in Gastroenterology - January 17, 2020 Category: Gastroenterology Source Type: research

Correction to: An Approach to Obesity Management for Gastroenterologists and Hepatologists
The original article unfortunately contained a mistake. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - January 7, 2020 Category: Gastroenterology Source Type: research

Current Endpoints of Clinical Trials in Ulcerative Colitis: Are They Valid?
AbstractNote: This statement is mandatory. Please provide. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - January 4, 2020 Category: Gastroenterology Source Type: research

Correction to: Incorporating Colorectal Cancer Genetic Risk Assessment into Gastroenterology Practice
The original article unfortunately contained a mistake. On page 8, Table 2, the row with “POLE POLD1” has been shifted right so all the columns are not correct. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - December 23, 2019 Category: Gastroenterology Source Type: research

Beyond the Calories —Is the Problem in the Processing?
AbstractPurpose of reviewThe purpose of this review is to describe the trends in dietary patterns and food quality over time along with the possible role of ultra-processed foods in obesity, chronic diseases, and all-cause mortality in the US population.Recent findingsThere is a rising obesity epidemic, corresponding chronic diseases, and increases in ultra-processed food consumption. In mice and in vitro trials, emulsifiers, found in processed foods, have been found to alter microbiome compositions, elevate fasting blood glucose, cause hyperphagia, increase weight gain and adiposity, and induce hepatic steatosis. Recent h...
Source: Current Treatment Options in Gastroenterology - November 30, 2019 Category: Gastroenterology Source Type: research

Sleep Disturbances in the Elderly Patient with Inflammatory Bowel Disease
AbstractPurpose of reviewStudies have suggested that sleep and inflammatory bowel disease (IBD) appear to have an important bi-directional relationship, where active disease promotes sleep disruption and poor sleep promotes ongoing and worsening inflammation. In the geriatric population, poor sleep has been linked to increasing morbidity and mortality. The etiologies of poor sleep in the elderly are multifactorial and are understood to be a part of the geriatric syndromes, conditions in the elderly associated with poorer mortality and morbidity. We review the current literature regarding the common sources of sleep disturb...
Source: Current Treatment Options in Gastroenterology - November 27, 2019 Category: Gastroenterology Source Type: research

Initiatives for a Healthy Stomach
AbstractPurpose of reviewThe stomach is not only a major digestive organ, but also a sophisticated endocrine organ and an essential microbial defense organ. Stomach diseases, such as peptic ulcer diseases, stomach cancer, and functional dyspepsia, are important health burden worldwide. However, the public awareness about the stomach health and diseases are relatively low.Recent findingsTo promote the awareness of medical professionals and also the general population on stomach health and diseases, the healthy stomach initiatives (HSI) was established in 2012. The HSI is very active in promoting international collaboration ...
Source: Current Treatment Options in Gastroenterology - November 27, 2019 Category: Gastroenterology Source Type: research

Genetic testing for hereditary gastrointestinal cancer syndromes: Interpreting results in today's practice
AbstractPurpose of reviewAdvances in genomics have led to the discovery of multiple predisposition genes linked to increased risk for gastrointestinal (GI) cancer. The goal of this review is to assist physicians and allied health care professionals in understanding the current paradigm shift in clinical genetic testing for hereditary GI cancer predisposition syndromes; with a focus on multigene panel testing (MGPT) and test results interpretation. Additionally, this review introduces direct-to-consumer and at-home genetic testing. Both delivery models are increasing in popularity and clinicians will be expected to address ...
Source: Current Treatment Options in Gastroenterology - November 25, 2019 Category: Gastroenterology Source Type: research

Pancreatic Cancer Surveillance: Who, When, and How
AbstractPurpose of ReviewIndividuals who have an increased risk for pancreatic cancer (PC) due to personal or family history may benefit from surveillance of the pancreas to increase the likelihood of early detection. This review explores current indications for PC surveillance, as well as options for surveillance modality and timing, and data regarding surveillance outcomes.Recent FindingsRecently published data suggests that individuals undergoing surveillance who develop PC are more likely to be diagnosed with resectable disease, which improves survival. Several professional organizations have published guidelines for s...
Source: Current Treatment Options in Gastroenterology - November 24, 2019 Category: Gastroenterology Source Type: research

An Approach to Obesity Management for Gastroenterologists and Hepatologists
AbstractPurpose of ReviewObesity is associated with multiple gastrointestinal and liver diseases such as gastroesophageal reflux disease, Barrett ’s esophagus, esophageal adenocarcinoma, cholelithiasis, colon polyps, and fatty liver disease. To effectively manage obesity, it is imperative to understand current and emerging therapies and procedures.FindingsObesity is becoming increasingly prevalent and is associated with a growing monetary health care burden. Cardiac disease, cerebrovascular disease, and diabetes are among the leading causes of preventable and premature death of Americans related to obesity. In additi...
Source: Current Treatment Options in Gastroenterology - November 21, 2019 Category: Gastroenterology Source Type: research

Special Considerations for Colorectal Surgery in the Elderly IBD Patient
AbstractPurpose of reviewWe sought to understand the key aspects to optimize in the perioperative period when treating an elderly surgical patient with inflammatory bowel disease.Recent findingsAddressing preoperative polypharmacy, frailty, and nutrition is important in the elderly population. Understanding intraoperative principles of oncologic risk and pouch formation and the advantages of laparoscopy are key. Postoperative-enhanced recovery pathways and VTE prophylaxis are essential for high-quality care.SummaryPreoperative, perioperative, and postoperative factors can greatly impact elderly patients ’ surgical ou...
Source: Current Treatment Options in Gastroenterology - November 21, 2019 Category: Gastroenterology Source Type: research

The Evolving Role of Thiopurines in Inflammatory Bowel Disease
AbstractPurpose of reviewWith the advent of biologic therapies for the treatment of IBD, the roles of thiopurines have continued to evolve. This review will focus on recent advances in pharmacology and the safety and efficacy of thiopurines as maintenance therapies for steroid-induced remissions, post-surgical maintenance of remission, and as combination therapies to reduce immunogenicities of biologic agents.Recent findingsDue to pharmacogenetics of TPMT, thiopurine dosing is more effectively based on monitoring of thiopurine metabolites rather than weight-based dosing. Thiopurines continue to have a role as maintenance t...
Source: Current Treatment Options in Gastroenterology - November 21, 2019 Category: Gastroenterology Source Type: research

Treatment of Severe and Fulminnant Clostridioides difficile Infection
This article will review current management strategies for severe and fulminantClostridioides difficile infection (CDI).Recent findingsClostridioides difficile is the most common nosocomial cause of infectious diarrhea. With the rise of hypervirulent strains of CDI, almost 8% of patients hospitalized with CDI are afflicted with severe CDI (SCDI) or fulminant CDI (FCDI). A significant proportion of these patients do not respond to recommended anti-CDI antibiotic therapy such as oral vancomycin and fidaxomicin. Current recommendations suggest that patients with refractory CDI should proceed to colectomy or diverting loop ile...
Source: Current Treatment Options in Gastroenterology - November 19, 2019 Category: Gastroenterology Source Type: research

Immune-Mediated Colitis
AbstractPurpose of reviewThis review addresses our current knowledge of immune-mediated colitis (IMC) and offers a practical guide to its management.Recent findingsDue to the similarity in clinical, endoscopic, and histologic findings between IMC and inflammatory bowel disease (IBD), gastroenterologists have tailored their approach to IMC management to that of IBD.SummaryImmune checkpoint inhibitors (ICIs) are monoclonal antibodies that augment the T-cell anti-tumor response of the immune system and have demonstrated their importance in the treatment of a wide range of malignancies. With the growing benefits of ICIs, there...
Source: Current Treatment Options in Gastroenterology - November 18, 2019 Category: Gastroenterology Source Type: research

Incorporating Colorectal Cancer Genetic Risk Assessment into Gastroenterology Practice
AbstractPurpose of reviewDecades have passed since the underlying molecular etiologies of the most common hereditary forms of colorectal cancer (CRC), Lynch syndrome, and familial adenomatous polyposis (FAP) were first described. With the advent of next-generation sequencing (NGS) panels, the landscape of hereditary CRC testing has changed dramatically. We review available screening strategies, novel CRC predisposition genes, and challenges and opportunities in this field.Recent findingsImproved sensitivity and availability of NGS panel testing have greatly expanded our understanding regarding the number of CRC syndromes a...
Source: Current Treatment Options in Gastroenterology - November 18, 2019 Category: Gastroenterology Source Type: research

Esophageal Dysphagia in the Elderly
AbstractPurpose of reviewWith a globally aging population, dysphagia is a growing health concern among elderly. Increasing reflux disease has contributed to an increased prevalence of dysphagia from peptic strictures and esophageal cancer. Dysphagia can lead to malnutrition and aspiration pneumonia, causing considerable morbidity and mortality. This review article focuses on recent advances in the approach and management of esophageal dysphagia.Recent findingsEndoscopic functional luminal imaging probe is a novel test that complements upper endoscopy, esophagram, and esophageal manometry for evaluation of esophageal dyspha...
Source: Current Treatment Options in Gastroenterology - November 18, 2019 Category: Gastroenterology Source Type: research

What is the Relevance of Gastric Microbiota Beyond H. pylori ?
ConclusionOther bacteria beyondH. pylori enter the focus in research on gastric carcinogenesis. However, we are still far from a thorough understanding of the pathophysiology of host-microbiota interaction and its impact on the development of malignant and precancerous changes. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - November 15, 2019 Category: Gastroenterology Source Type: research

Pancreatic Cysts in the Elderly
AbstractPurpose of reviewIncidental pancreatic cysts are common, and management strategies continue to evolve. This review summarizes diagnostic and management recommendations in older patients with these lesions based on guidelines and best clinical evidence.Recent findingsDiagnosis of cyst type has been enhanced with improved imaging and cyst fluid analysis and visualization. Recent outcome studies indicate that certain cyst types should be followed independent of patient age as long as certain criteria which are reviewed are met.SummaryDifferentiation of pancreatic cyst type is important as this dictates the need for lo...
Source: Current Treatment Options in Gastroenterology - November 9, 2019 Category: Gastroenterology Source Type: research

The Gluten-Free Diet: Use in Digestive Disease Management
AbstractPurpose of ReviewGluten is a commonly ingested polymeric protein found in wheat, barley, and rye that has gained recent notoriety because of its relationship to disease and health. Avoidance of gluten is appropriate in patients with a diagnosed gluten –related disorder and may have treatment implications in other diseases of the digestive tract. This review highlights current knowledge of gluten related disorders and the use of a gluten-free diet in gastrointestinal disease management.Recent FindingsGluten-free diets should be used in patients with a diagnosed gluten –related disorder including celiac d...
Source: Current Treatment Options in Gastroenterology - November 9, 2019 Category: Gastroenterology Source Type: research

Hereditary Polyposis Syndromes
AbstractPurpose of ReviewColorectal cancer (CRC) is the third most common cancer in the USA and inherited cancer syndromes are responsible for approximately 3 –5% of all CRCs. Genetic testing costs have plummeted in recent years; however, awareness and referral of high-risk patients for testing is still very low. We review the salient clinical features, genetics, and management of well-defined gastrointestinal (GI) hereditary polyposis syndromes includi ng familial adenomatous polyposis, MUTYH-associated polyposis, and the hamartomatous polyposis syndromes.Recent FindingsComprehensive endoscopic surveillance has the ...
Source: Current Treatment Options in Gastroenterology - November 8, 2019 Category: Gastroenterology Source Type: research

Popular Diet Trends for Inflammatory Bowel Diseases: Claims and Evidence
AbstractPurpose of reviewPatients with inflammatory bowel disease (IBD) frequently look to diet to improve symptoms. Although regularly asked for dietary guidance, gastroenterologists are often unprepared to provide evidence-based recommendations. This review will summarize popular diets claiming benefits in IBD, as well as current data evaluating their efficacies.Recent findingsThe Specific Carbohydrate Diet has demonstrated symptom improvement and even mucosal healing; however, large trials and prospective data are lacking. The low FODMAP diet has shown benefit for functional symptoms in IBD, yet efficacy regarding infla...
Source: Current Treatment Options in Gastroenterology - November 8, 2019 Category: Gastroenterology Source Type: research

Vaccination in the Elderly and IBD
AbstractPurpose of reviewSignificant gaps in knowledge and utilization of vaccinations exist among practitioners providing care for patients with IBD. This review is intended to update the reader on best practices for vaccination within the IBD population with a specific focus on the elderly.Recent findingsAdvances in IBD therapeutics have recently increased the number of immunosuppressive therapies available to practitioners. Differences in mechanisms of action of these medications have led to differential implications pertaining to vaccination strategies. Additionally, new vaccines, including the recombinant zoster vacci...
Source: Current Treatment Options in Gastroenterology - November 4, 2019 Category: Gastroenterology Source Type: research

Effective Identification of Lynch Syndrome in Gastroenterology Practice
AbstractPurpose of reviewIdentification of Lynch syndrome is important from an individual patient and public health standpoint. As paradigms for Lynch syndrome diagnosis have shifted in recent years, this review will discuss rationale and limitations for current strategies as well as provide an overview of future directions in the field.Recent findingsIn recent years, the use of clinical criteria and risk scores for identification of Lynch syndrome has been augmented by universal testing of all newly diagnosed colorectal cancers with molecular methods to screen for mismatch repair deficiency with high sensitivity and speci...
Source: Current Treatment Options in Gastroenterology - November 1, 2019 Category: Gastroenterology Source Type: research