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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 disease, ...
Source: Current Treatment Options in Gastroenterology - November 8, 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 pote...
Source: Current Treatment Options in Gastroenterology - November 7, 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 7, 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 3, 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 - October 31, 2019 Category: Gastroenterology Source Type: research

Hereditary or Not? Understanding Serrated Polyposis Syndrome
AbstractPurpose of reviewTo present the current understanding of the diagnosis, management, and potential genetic causes of serrated polyposis syndrome.Recent findingsThe clinical criteria for serrated polyposis syndrome was recently updated and now includes individuals with five or more serrated polyps proximal to the rectum that are 5 mm in size or greater and at least two that are 10 mm in size of greater as well as individuals with 20 or more serrated polyps throughout the colon with at least five proximal to the rectum. There is a significant risk for colon cancer in first-degree relatives of individuals with serrated...
Source: Current Treatment Options in Gastroenterology - October 30, 2019 Category: Gastroenterology Source Type: research

Nutrition in Chronic Liver Disease
AbstractPurpose of reviewMalnutrition is a common finding in patients with chronic advanced liver disease (CLD) and is an important prognostic predictor for morbidity and mortality. This review aims to summarize the latest evidence-based guidelines and expert opinion regarding diagnosing malnutrition in patients with CLD and providing optimal solutions.Recent findingsIn addition to diet, evidence demonstrates sarcopenia and frailty are emerging concepts critical to outcomes in those with CLD. Thus, adequate assessment of nutritional status incorporates the interplay of nutrient intake, sarcopenia, and frailty.SummaryAddres...
Source: Current Treatment Options in Gastroenterology - October 30, 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 inflammatory bowel disease, 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 and post-surgical maintenance of remission and as combination therapies to reduce immunogenicities of biologic agents.Recent findingsDue to pharmacogenetics of thiopurine S-methyltransferase, thiopurine dosing is more effectively based on monitoring of thiopurine metabolites rather than weight-based dosing. T...
Source: Current Treatment Options in Gastroenterology - July 26, 2019 Category: Gastroenterology Source Type: research

Current Status and Future Perspective in Cholangiopancreatoscopy
AbstractPurpose of reviewWith the rapid growth of cholangiopancreatoscopy, several platforms of cholangiopancreatoscopy have been currently available. Since the introduction of digital single-operator cholangiopancreatoscopy, there have been several reports describing its efficacy for long-standing and novel applications. The purpose of this review is to show the current status and future perspective of cholangiopancreatoscopy.Recent findingsMeta-analysis of cholangiopancreatoscopy have demonstrated good diagnostic yield for visual impression; however, it should be noted that there is no standardized classification system ...
Source: Current Treatment Options in Gastroenterology - July 23, 2019 Category: Gastroenterology Source Type: research

The Role of Behind Folds Visualizing Techniques and Technologies in Improving Adenoma Detection Rate
AbstractPurpose of reviewColorectal cancer is one of the most common malignancies in the Western world and is thought to develop from premalignant polyps. Over the past decade, several behind folds visualizing techniques (BFTs) have become available to improve polyp detection. This systematic review and meta-analysis aims to compare BFTs with conventional colonoscopy (CC).Recent findingsIn the past five  years, 14 randomized controlled trials (RCTs) including 8384 patients comparing different BFTs with CC were published. The overall relative risks for adenoma detection rate, polyp detection rate, and adenoma miss rate com...
Source: Current Treatment Options in Gastroenterology - July 21, 2019 Category: Gastroenterology Source Type: research

Interplay of Liver Disease and Gut Microbiota in the Development of Colorectal Neoplasia
AbstractPurpose of the reviewLiver disease, colon cancer, and the gut microbiome are intimately interrelated; however, the connections linking liver disease and colorectal neoplasia via the gut microbiota remain poorly understood and rarely addressed in a single space. The goal of this review is to take a broad perspective on the clinical problem of colorectal neoplasia in the liver disease population, recognize the significance of the clinical study findings, and delve into the evidence supporting putative molecular mechanisms connecting dysbiosis in the progression of liver disease to the development of colorectal neopla...
Source: Current Treatment Options in Gastroenterology - July 19, 2019 Category: Gastroenterology Source Type: research

Hepatitis C elimination: a Public Health Perspective
AbstractPurpose of reviewHepatitis C virus (HCV) infection is a principal cause of morbidity, mortality, and economic burden, and the global elimination of HCV is now considered a public health objective. Globally, an estimated 71 million have chronic HCV infection with an estimated annual mortality of 3,99,000.Recent findingsThe 69th World health Assembly has endorsed the global HCV elimination strategy by 2030, which is made possible because of all oral, cost-effective, efficacious, generic direct-acting antivirals. The public health strategy targets not only diagnosed chronic hepatitis C patients but also asymptomatic u...
Source: Current Treatment Options in Gastroenterology - July 17, 2019 Category: Gastroenterology Source Type: research

Endoscopic Methods for Gallbladder Drainage
AbstractPurpose of reviewAcute cholecystitis is conventionally managed with cholecystectomy; however, when this occurs in the non-operative patient, it requires consideration for alternative means of gallbladder drainage (GBD).Recent findingsSuitable endoscopic methods for GBD include transpapillary cystic duct stent or endoscopic ultrasound (EUS)-guided transmural stent placement. Importantly, patients who undergo endoscopic GBD have comparable outcomes to those who undergo placement of percutaneous transhepatic catheters by interventional radiology (IR).SummaryThere is evolving evidence to support endoscopic gallbladder ...
Source: Current Treatment Options in Gastroenterology - July 16, 2019 Category: Gastroenterology Source Type: research

Epigenetic Mechanisms of Pancreatobiliary Fibrosis
AbstractPurpose of reviewThe goal of this manuscript is to review the current literature related to fibrogenesis in the pancreatobiliary system and how this process contributes to pancreatic and biliary diseases. In particular, we seek to define the current state of knowledge regarding the epigenetic mechanisms that govern and regulate tissue fibrosis in these organs. A better understanding of these underlying molecular events will set the stage for future epigenetic therapeutics.Recent findingsWe highlight the significant advances that have been made in defining the pathogenesis of pancreatobiliary fibrosis as it relates ...
Source: Current Treatment Options in Gastroenterology - July 11, 2019 Category: Gastroenterology Source Type: research

Indications for Single-Operator Cholangioscopy and Pancreatoscopy: an Expert Review
AbstractPurpose of reviewDirect endoscopic visualization of the biliary and pancreatic ducts by single-operator cholangioscopy (SOC) and pancreatoscopy (SOP) is an expanding technique with an increasing number of indications. This review provides technical tips and tricks and a literature update on the usefulness of SOC and SOP in clinical practice.Recent findingsSOC has shown a 91.3% and 87.3% diagnostic procedural success in indeterminate strictures and difficult stones respectively, with a 9.4% –16.4% complication rate. Although the interpretation of the images suspected for malignancy can be challenging, new classifi...
Source: Current Treatment Options in Gastroenterology - June 3, 2019 Category: Gastroenterology Source Type: research