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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 guidelines also ...
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 ove...
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 supporting the ...
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 have had surg...
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