Complementary Health Approaches for Irritable Bowel Syndrome
AbstractPurpose of reviewIrritable bowel syndrome (IBS) is a common functional disorder with a prevalence of up to 15% in the USA. Patients with IBS are more inclined to seek complementary treatment options for management of their conditions due to a lack of sufficient relief from conventional treatments and preference towards a more natural approach. We reviewed the most up-to-date medical literature regarding complementary health modalities for the treatment of IBS.Recent findingsProposed mechanisms for IBS range from alterations in gut motility, intestinal permeability, intestinal microbiome, visceral hypersensitivity, ...
Source: Current Treatment Options in Gastroenterology - November 24, 2020 Category: Gastroenterology Source Type: research

Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects
AbstractPurpose of reviewTo review recent clinical evidence surrounding the use of cannabinoids and cannabis in gastrointestinal diseases, particularly inflammatory bowel disease (IBD) and functional gut disorders. A second aim is to evaluate the current status of gastrointestinal related adverse effects which have been linked to cannabis use, specifically cannabis hyperemesis syndrome (CHS) and acute pancreatitis.Recent findingsObservational and prospective studies suggest that cannabinoids improve IBD symptoms. Small prospective clinical trials have not shown any effects on objective inflammatory findings, other than one...
Source: Current Treatment Options in Gastroenterology - November 21, 2020 Category: Gastroenterology Source Type: research

Management of Severe Acute Pancreatitis
AbstractPurpose of reviewThere have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications.Recent findingsRecent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be ...
Source: Current Treatment Options in Gastroenterology - November 19, 2020 Category: Gastroenterology Source Type: research

Managing Gastrointestinal Complications in Patients With Systemic Sclerosis
ConclusionsAdvances in the management of gastrointestinal disease in SSc continue to evolve. The application of novel therapies and the repurposing of existing therapies for the management of gastrointestinal involvement are shaping the therapeutic arsenal so that we can more effectively manage these complex patients. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - November 13, 2020 Category: Gastroenterology Source Type: research

Who Needs Gastroprotection in 2020?
AbstractPurpose of reviewPeptic ulcer disease (PUD) is a recognized complication of non-steroidal anti-inflammatory drugs (NSAIDs). Stress ulcers are a concern for intensive care unit (ICU) patients; PUD is also an issue for patients taking anticoagulation.Helicobacter pylori test and treat is an option for patients starting NSAID therapy, and proton pump inhibitors (PPIs) may reduce PUD in NSAID patients and other high-risk groups.Recent findingsThere are a large number of trials that demonstrate thatHelicobacter pylori eradication reduces PUD in NSAID patients. PPI is also effective at reducing PUD in this group and is a...
Source: Current Treatment Options in Gastroenterology - November 11, 2020 Category: Gastroenterology Source Type: research

Management of Pancreatic Cystic Lesions: Making Sense of All the Guidelines
AbstractPurpose of reviewPancreatic cystic lesions are now being identified in increasing frequency, providing an opportunity for early detection of advanced neoplasia. Multiple guidelines have been developed to help risk-stratify pancreatic cystic lesions. However, differences between guidelines provide a source of confusion for most practitioners. In this review, we attempt to highlight the similarities and differences between the guidelines, specifically evaluating their target populations and variations in surveillance/management strategies for pancreatic cystic lesions.Recent findingsThe most commonly used guidelines ...
Source: Current Treatment Options in Gastroenterology - November 10, 2020 Category: Gastroenterology Source Type: research

Nutritional Therapies for Irritable Bowel Syndrome: a Focus on Prebiotics and Probiotics
AbstractPurpose of reviewThe pathophysiology of irritable bowel syndrome (IBS) is incompletely understood, but in at least some patients, alterations in the gut microbiome are likely to be etiologically relevant. The purpose of this review is to evaluate the available evidence to date for the use of prebiotics and probiotics in the treatment of IBS, with particular attention to broad themes in therapeutic rationale as well as critical gaps in the literature.Recent findingsA number of individual studies and meta-analyses have demonstrated efficacy in the use of prebiotics and probiotics for IBS. Even so, variability in stud...
Source: Current Treatment Options in Gastroenterology - November 10, 2020 Category: Gastroenterology Source Type: research

Precision Medicine: Predicting Disease Course in Patients with Inflammatory Bowel Disease
AbstractPurpose of reviewThere is increasing demand for a personalized approach to management of patients with inflammatory bowel disease (IBD). Early prognostication and stratification of patients into distinct disease trajectories would enable treatment algorithms to be made which are less generalized and more patient-specific. We have summarized the recent medical literature and highlight the current status of precision medicine and its potential application to patients with IBD.Recent findingsClinical characteristics, aided by serologic studies, fecal and genetic markers are commonly employed to approximate an IBD pati...
Source: Current Treatment Options in Gastroenterology - November 9, 2020 Category: Gastroenterology Source Type: research

Genetic Testing Use and Expectations in Early Onset Colorectal Cancer
AbstractPurpose of reviewA substantial proportion of colorectal cancer (CRC) diagnosed under age 50, or early-onset colorectal cancer (EOCRC), is associated with a hereditary cancer syndrome. It is of utmost importance to identify these patients to customize cancer treatment options, decrease the risk of metachronous cancers, and facilitate testing within the family to identify carriers. The purpose of this paper is to review the evolution of genetic evaluation in patients with EOCRC, review current best practices, and describe areas ripe for future work and research.Recent findingsFourteen to 25% of all EOCRCs are associa...
Source: Current Treatment Options in Gastroenterology - November 6, 2020 Category: Gastroenterology Source Type: research

The Mediterranean Diet in Gastrointestinal and Liver Diseases
AbstractPurpose of reviewThe Mediterranean diet (MD) initially gained notoriety because of its link to reduced cardiovascular disease but over time has been associated with lower metabolic disease (diabetes, hyperlipidemia, hypertension), cancer, and all-cause mortality. Here, we review the existing literature examining the MD in common gastrointestinal and liver diseases.Recent findingsThe composition of the MD is rich in anti-inflammatory micronutrients (omega-9/omega-3 fatty acids, resveratrol) and fiber which are thought to confer its positive effects. The MD can help reduce non-alcoholic fatty liver disease (NAFLD) in...
Source: Current Treatment Options in Gastroenterology - November 3, 2020 Category: Gastroenterology Source Type: research

Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease
AbstractPurpose of reviewThe goal of this paper is to review the utilization of frailty as a predictor of poor outcomes in gastrointestinal disease, hepatology, and gastrointestinal surgery.Recent findingsThe frailty syndrome has been extensively described in the geriatric population as a predictor of poor clinical outcomes and its application has proven valuable in a variety of chronic and inflammatory disease states independent of age. In hepatology and gastroenterology, frailty has been associated with worsening pre- and post-liver transplant outcomes, post-operative complications, periprocedural adverse events during c...
Source: Current Treatment Options in Gastroenterology - October 31, 2020 Category: Gastroenterology Source Type: research

Drug-Induced Pancreatic Injury (DIPI): Redefining Drug-Induced Pancreatitis in Adult and Pediatric Populations
AbstractPurpose of reviewDrug-induced pancreatitis is the second most common cause of acute pancreatitis (AP) in children and ranks as the third in adults. The aims of this targeted review are to provide a basis for conceptualizing drug-induced pancreatic injury (DIPI), to highlight specific drugs that are common or emerging risk factors, and to suggest a framework for future studies of DIPI.Recent findingsWe challenge the traditional notion of diagnosing a drug exposure as the etiology of pancreatitis only after other etiologies could not be identified. Instead, we propose rethinking the disease process as a continuum of ...
Source: Current Treatment Options in Gastroenterology - October 29, 2020 Category: Gastroenterology Source Type: research

Familial Barrett ’s Esophagus and Esophageal Adenocarcinoma
AbstractPurpose of reviewTo examine the evidence for Familial Barrett ’s Esophagus and Esophageal Adenocarcinoma and putative causative genes.Recent findingsRecent large population studies continue to provide evidence for Familial Barrett ’s Esophagus and Esophageal Adenocarcinoma. Also, based on sequencing of two multigenerational families with Barrett’s esophagus and/or esophageal adenocarcinoma, two new possible causative gene variants have been identified includingVSIG10L andMSX1.SummaryFamilial Barrett ’s esophagus and esophageal adenocarcinoma is increasingly becoming more recognized. Current ...
Source: Current Treatment Options in Gastroenterology - October 24, 2020 Category: Gastroenterology Source Type: research

Biologic Therapy in Elderly Patients with IBD: Current Trends and Special Management Considerations
AbstractPurpose of reviewWith the aging IBD population and increasing incidence of elderly-onset IBD, the overall prevalence of IBD in the elderly is rising. The elderly have unique medical, psychosocial, and other age-related comorbidities and disabilities that need to be taken into account when assessing the impact of IBD on the patient ’s overall health and quality of life, and choosing an effective therapy.Recent findingsThere is a general reluctance among physicians to prescribe biologic therapies out of concerns of their potential side effects, in favor of mesalamine, steroids, and surgery. Although there is an...
Source: Current Treatment Options in Gastroenterology - October 23, 2020 Category: Gastroenterology Source Type: research

Genetic Gastric Cancer Risk Syndromes
AbstractPurpose of reviewGastric cancer is a leading cause of cancer death in the world. Between 1 and 3% of cases are associated with specific genetic cancer risk syndromes. The purpose of this article is to review the latest insights, as well as gaps in knowledge, regarding some of the most common hereditary gastric cancer syndromes: hereditary diffuse gastric cancer (HDGC), gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), Lynch syndrome, the adenomatous polyposis syndromes, and the hamartomatous polyposis syndromes.Recent findingsPatients carrying pathogenic variants inCDH1, but not meeting clinical...
Source: Current Treatment Options in Gastroenterology - October 19, 2020 Category: Gastroenterology Source Type: research

Gastritis: An Update in 2020
AbstractPurpose of reviewThe gastritis constellation includes heterogeneous clinicopathological entities, among which long-standing, non-self-limiting gastritis, mainly due toHelicobacter pylori infection, has been epidemiologically, biologically, and clinically linked to gastric cancer development (i.e. “inflammation-associated cancer”). This review illustrates the updated criteria applied in the taxonomy of gastritis (Kyoto classification), elucidates the biological rationale for endoscopy biopsy sampling (heterogeneity of gastric mucosa), and finally reports the results of long-term follow-up studies support...
Source: Current Treatment Options in Gastroenterology - August 25, 2020 Category: Gastroenterology Source Type: research

Update on Pregnancy in Patients with IBD
AbstractPurpose of reviewThis review summarizes the most current clinical research and latest clinical guidelines in managing inflammatory bowel disease (IBD) before, during, and after pregnancy.Recent findingsRecent guidelines emphasize the safety of thiopurines and biologics during pregnancy and nursing. Patients should be in remission for 3 –6 months prior to conceiving and remain in remission to decrease the risk of poor pregnancy outcomes. Fertility is decreased in women with active IBD and in women who have had anal or rectal resection. Women with IBD, especially those with Crohn’s disease (CD) who h...
Source: Current Treatment Options in Gastroenterology - August 12, 2020 Category: Gastroenterology Source Type: research

Inflammatory Bowel Disease Therapy and Venous Thromboembolism
AbstractPurpose of reviewTo explore the relationship between IBD (inflammatory bowel diseases) therapy and VTE (venous thromboembolism) risk, as well as the safety, barriers, and utility of VTE prophylaxis.Recent findingsIn 2019, the Food and Drug Administration (FDA) issued a black box warning concerning the use of tofacitinib among ulcerative colitis (UC) patients with a post hoc analysis revealing that all patients had additional risk factors for VTE. Additionally, although IBD patients experiencing a disease flare often present with hematochezia, these patients are less likely to receive VTE prophylaxis, despite data s...
Source: Current Treatment Options in Gastroenterology - August 3, 2020 Category: Gastroenterology Source Type: research

Correction to: RECENT Advances in Endoscopic Treatments for Gastroesophageal Reflux Disease
In the article, “7RECENT Advances in Endoscopic Treatments for Gastroesophageal Reflux Disease,” published in the September issue of Current Treatment Options in Gastroenterology, the title is printed in correctly. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - July 29, 2020 Category: Gastroenterology Source Type: research

Update on the Management of Helicobacter pylori Infection
AbstractPurpose of reviewOur purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities.Recent findingsIncreasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The pot...
Source: Current Treatment Options in Gastroenterology - July 16, 2020 Category: Gastroenterology Source Type: research

Evidence Supporting High-Dose Use of Biologics in Clinical Practice
AbstractPurpose of reviewBiologic therapies have transformed the management of inflammatory bowel disease (IBD). However, a significant proportion of patients demonstrate primary non-response (PNR) or develop a secondary loss of response (LOR) to these agents. Studies using therapeutic drug monitoring (TDM) have demonstrated a correlation between drug concentration and improved outcomes and that inadequate drug concentrations may be accountable for a significant proportion of PNR and LOR. This review aims to evaluate the role for high-dose biologic therapy in the treatment of IBD.Recent findingsSeveral studies have demonst...
Source: Current Treatment Options in Gastroenterology - July 16, 2020 Category: Gastroenterology Source Type: research

Novel Therapeutics for the Treatment of IBD: Current Status and Future Directions
This article reviews novel and emerging therapeutic agents for the treatment of inflammatory bowel disease (IBD), including biologic and small molecule drugs.Recent findingsBeyond TNF antagonist therapy, there are several newer classes of biologics targeting alternative pathways with lower immunogenicity rates and favorable safety profiles. Furthermore, the inherent limitations of biologics, mainly immunogenicity and parenteral administration, have led to renewed interest in the development of small molecule drugs.SummaryOver the last two decades, the pharmacological management of inflammatory bowel disease has transitione...
Source: Current Treatment Options in Gastroenterology - July 14, 2020 Category: Gastroenterology Source Type: research

Obscure Gastrointestinal Bleeding Due to Colonic Source
AbstractPurpose of reviewAcute GI bleeding is a prevalent condition responsible for significant morbidity, mortality, and overall health care burden in the United States and globally. Obscure GIB is defined as recurrent or persistent evidence of blood loss after negative endoscopic assessment. The purpose of this review is to further examine colonic sources of obscure GI bleeding with regard to epidemiology, diagnosis, therapy, rebleeding rate, and areas in need of further study.Recent findingsNewer diagnostic modalities like video capsule endoscopy have shown the importance of continued investigation of colonic bleeding a...
Source: Current Treatment Options in Gastroenterology - July 11, 2020 Category: Gastroenterology Source Type: research

7RECENT Advances in Endoscopic Treatments for Gastroesophageal Reflux Disease
AbstractPurpose of reviewThere is a growing interest in minimally invasive approaches to the management of gastroesophageal reflux disease (GERD), including endoscopic GERD therapy. This review evaluates available endoscopic therapeutic options utilized in GERD management.Recent findingsApplication of radiofrequency energy at the esophagogastric junction (EGJ) reduces reflux symptoms, but esophageal acid exposure does not necessarily normalize, and esophageal sensation is compromised. Two approaches to the creation of a valve at the EGJ, the Medigus ultrasonic surgical stapler (ultrasound guided stapling of the gastric fun...
Source: Current Treatment Options in Gastroenterology - July 8, 2020 Category: Gastroenterology Source Type: research

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 5, 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 24, 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 14, 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 14, 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 14, 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 1, 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 - April 30, 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 27, 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 14, 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 12, 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 10, 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 5, 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 - March 31, 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 30, 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 29, 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 25, 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 19, 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 18, 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 27, 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 26, 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 26, 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 22, 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 22, 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 20, 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 20, 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 19, 2020 Category: Gastroenterology Source Type: research