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Colorectal Cancer in Young Adults
AbstractPurpose of reviewRoutine screening for colorectal cancer (CRC) in adults>  50 years of age has led to overall reductions in CRC incidence and CRC-related mortality. Yet CRC incidence among young adults age<  50 continues to increase without a clear explanation. This review examines the changing epidemiology of CRC and emerging evidence regarding the influence of genetic and lifestyle factors on risk for colorectal neoplasia.Recent findingsYoung-onset CRC (yCRC), defined as CRC diagnosed in individuals younger than age 50, is a heterogeneous disease. Approximately, one in every five individuals affected w...
Source: Current Treatment Options in Gastroenterology - February 2, 2019 Category: Gastroenterology Source Type: research

New Developments in Esophageal Motility Testing
AbstractPurpose of reviewThe purpose of this review is to present the latest developments in esophageal motility testing and summarize the current paradigm of esophageal motility disorders.Recent findingsWhile high-resolution esophageal pressure topography interpreted according to the Chicago Classification represents the gold standard to evaluate esophageal motility, recent studies highlight the additional value of novel manometric applications. Novel applications include provocative measures to assess for obstructive physiology at the esophagogastric junction (EGJ), esophageal peristaltic reserve, and rumination and supr...
Source: Current Treatment Options in Gastroenterology - February 2, 2019 Category: Gastroenterology Source Type: research

New Developments in the Diagnosis and Treatment of Eosinophilic Esophagitis
AbstractPurpose of reviewEosinophilic esophagitis (EoE) is a chronic, allergen-driven, immune-mediated disease of the esophagus that progresses to esophageal fibrostenosis if left untreated. The aim of this review is to provide a concise update on recent clinically relevant advances in the development of diagnostic and therapeutic approaches for EoE.Recent findingsCurrent diagnostic and disease monitoring protocols for EoE rely on repetitive endoscopic evaluations and esophageal tissue acquisition for histopathologic analysis. Recent advancements in EoE diagnosis include endoscopic functional lumen imaging probe (FLIP), tr...
Source: Current Treatment Options in Gastroenterology - February 1, 2019 Category: Gastroenterology Source Type: research

New Advances in the Treatment of Acute Pancreatitis
AbstractPurpose of reviewDespite the increasing incidence of acute pancreatitis, the overall mortality of AP has decreased.Recent findingsThe findings of recent studies on fluid therapy, analgesics, antibiotics, and enteral nutrition as well as the management of AP complications have led to improvements in clinical care. However, there are still no pharmacologic treatment(s) for AP.SummaryExperimental studies have revealed many potential therapeutic targets, but these will need to be further developed and tested before they can be assessed in randomized controlled trials with important clinical endpoints. (Source: Current ...
Source: Current Treatment Options in Gastroenterology - January 30, 2019 Category: Gastroenterology Source Type: research

Esophageal Third Space Endoscopy: Recent Advances
AbstractPurpose of the reviewThe novel concept of third space endoscopy was first applied to humans in 2008 for the management of achalasia through peroral endoscopic myotomy (POEM) procedure. Over the ensuing 10  years, this revolutionary procedure, which started in Japan, has been adopted and mastered by surgeons and gastroenterologists across the globe. In this article, we review the recent innovations and applications of third space endoscopy in the management of esophageal disorders.Recent findingsWith experience and innovation, the application of third-space endoscopy has extended beyond achalasia, and currently, it...
Source: Current Treatment Options in Gastroenterology - January 26, 2019 Category: Gastroenterology Source Type: research

Advances in the Diagnosis and Treatment of GERD: New Tricks for an Old Disease
AbstractPurpose of reviewGastroesophageal reflux disease (GERD) is a common diagnosis encountered by both primary care providers and specialists, but despite its prevalence, there are limitations in the current diagnostic tests for GERD. Once an accurate diagnosis is made, treatment options can be offered, and this field continues to burgeon with options. In this review, we seek to review the recent advances in GERD diagnostics and subsequent treatment options.Recent findingsNovel impedance markers and novel techniques (mucosal impedance testing, salivary pepsin, high-resolution manometry, and narrow-band imaging) have sho...
Source: Current Treatment Options in Gastroenterology - January 25, 2019 Category: Gastroenterology Source Type: research

Advances in Therapeutic Drug Monitoring for Small-Molecule and Biologic Therapies in Inflammatory Bowel Disease
AbstractPurpose of reviewTherapeutic drug monitoring (TDM) is increasingly utilized as a strategy to optimize inflammatory bowel disease (IBD) therapeutics. As management paradigms have evolved towards treat-to-target strategies, there has been growing interest in expanding the role of TDM to guide drug optimization for achieving objective endpoints. This review summarizes the evidence for using TDM with biologic and oral small-molecule therapies, evaluates the role of reactive versus proactive TDM in treatment algorithms, and identifies potential future applications for TDM.Recent findingsAchieving therapeutic drug concen...
Source: Current Treatment Options in Gastroenterology - January 25, 2019 Category: Gastroenterology Source Type: research

Challenges in Endoscopic Therapy of Dysplastic Barrett ’s Esophagus
AbstractPurpose of reviewBarrett ’s esophagus (BE) is the only known measurable factor associated with esophageal adenocarcinoma. The development of endoscopic eradication therapy (EET) has transformed the way BE is managed. Given the fairly recent development of EET, its role in BE is still evolving.Recent findingsThis paper discusses the challenges that endoscopists face at the preprocedural, intraprocedural, and postprocedural stages of BE management. These include challenges in risk stratification, dysplasia detection, ablation methods and dosimetry, choice of resection technique, and management of refractory disease...
Source: Current Treatment Options in Gastroenterology - January 19, 2019 Category: Gastroenterology Source Type: research

The Gut Microbiome as a Target for IBD Treatment: Are We There Yet?
AbstractPurpose of reviewThis review aims to highlight recent research on the gut microbiome in IBD and the application of microbiome-modulating therapies for the treatment of IBD including the use of the microbiome as an indicator for disease severity and treatment response.Recent findingsDespite the high number of gut microbiome studies and emerging evidence supporting the gut microbiome ’s involvement in disease pathogenesis, no single microorganism has been identified as a pathogenic agent in IBD. Retrospective studies and meta-analyses on antibiotic use in ulcerative colitis and Crohn’s disease and long-term outco...
Source: Current Treatment Options in Gastroenterology - January 19, 2019 Category: Gastroenterology Source Type: research

Gastroduodenal “Dysbiosis”: a New Clinical Entity
AbstractPurpose of reviewLike the rest of the gastrointestinal tract, the small intestine is colonised by microbes, but how this “microbiome” affects the immune system and digestive functions has largely been overlooked, especially in the “omics” era. Here, we present recent findings that show that the diversity, density and interactions of these microbes in the small intestine can play an important role in the pathog enesis of a number of gastrointestinal and extraintestinal disorders.Recent findingsChanges in the small intestinal mucosa-associated microbiota (SI-MAM) have been shown to occur with inflammatory bow...
Source: Current Treatment Options in Gastroenterology - November 12, 2018 Category: Gastroenterology Source Type: research

Helicobacter pylori Infection: New Facts in Clinical Management
ConclusionClinical aspects ofH. pylori infection have evolved over time and the therapeutic management requires continuous adaptation. A vaccine is still a non-fulfilled promise. The future will tell us more about the role ofH. pylori in interactions with the gut microbiome. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - November 10, 2018 Category: Gastroenterology Source Type: research

The Role of Botulinum Toxin Injections for Esophageal Motility Disorders
AbstractPurpose of reviewThe advancement of high-resolution esophageal manometry has led to improvement in the diagnosis of esophageal motility disorders. We reviewed the recent medical literature regarding the use of botulinum toxin (BTx) injections in the esophagus and the indications, current outcomes, and reported complications of this therapy.Recent findingsThe response rates of BTx injection therapy vary depending on the esophageal motility disorder. Studies have shown that response is transient in achalasia patients and given the more effective therapies available, it is only recommended in patients who are not surg...
Source: Current Treatment Options in Gastroenterology - November 8, 2018 Category: Gastroenterology Source Type: research

The Role of Botox in Colorectal Disorders
AbstractPurpose of reviewTo overview the current medical literature on the efficacy of botulism toxin treatment (BTX-A) for lower gastrointestinal disorders (GIT).Recent findingsBTX-A was found to have a short-term efficacy for the treatment of dyssynergic defecation. Surgical treatment was found to be more effective than BTX-A for the healing of chronic anal fissures, and BTX-A can be considered when surgery is undesirable. Data regarding the effects of BTX-A injection for the treatment of chronic anal pain is limited. Beneficial effects were observed only in a minority of patients. BTX-A treatment was found to be effecti...
Source: Current Treatment Options in Gastroenterology - November 5, 2018 Category: Gastroenterology Source Type: research

Which Patient-Related Factors Determine Optimal Bowel Preparation?
AbstractPurpose of reviewAdequate bowel cleansing before colonoscopy is a simple concept but the high rate of inadequate or incomplete bowel cleanliness and its consequences have been the subject of many studies, guidelines, and meta-analysis. The complexity resides in all the factors surrounding preparation intake such as type and regimen of bowel preparation, diets, compliance, and also patient-related factors that all influence quality of the bowel preparation. The purpose of this review is to focus specifically on patient-related factors and their challenges. Patients with lower GI bleeding are excluded from this revie...
Source: Current Treatment Options in Gastroenterology - November 3, 2018 Category: Gastroenterology Source Type: research

Endoscopic Full-Thickness Defects and Closure Techniques
AbstractPurpose of ReviewGastrointestinal transmural defects are defined as total rupture of the gastrointestinal wall and can be divided into three main categories: perforations, leaks, and fistulas. Due to an increase in the number of therapeutic endoscopic procedures including full-thickness resections and the increase incidence of complications related to bariatric surgeries, there has been an increase in the number of transmural defects seen in clinical practice and the number of non-invasive endoscopic treatment procedures used to treat these defects.Recent FindingsThe variety of endoscopic approaches and devices, in...
Source: Current Treatment Options in Gastroenterology - October 31, 2018 Category: Gastroenterology Source Type: research