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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, inspecti...
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. The ...
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 the ...
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 that only ...
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 algorithm...
Source: Current Treatment Options in Gastroenterology - March 29, 2020 Category: Gastroenterology Source Type: research