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Opioid-Induced Esophageal Dysfunction: An Emerging Entity with Sweeping Consequences
AbstractAdverse effects of opioids on the gastrointestinal tract are well known. However, with the rising epidemic of opioids, its detrimental effects on esophageal physiology are now being increasingly recognized. In this commentary, we briefly review the current evidence behind opioid-induced esophageal dysfunction with potential pathophysiology and treatment options. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - October 31, 2018 Category: Gastroenterology Source Type: research

Timing of Endoscopic Necrosectomy Following Transmural Stent Placement for Pancreatic Necrosis
AbstractPurpose of the reviewPancreatic walled-off necrosis (WON) may require adjunctive direct endoscopic necrosectomy (DEN) following transmural stent placement. DEN is performed immediately or delayed in relation to index endoscopy. There is currently no consensus on the optimal timing of DEN. We review the most recent literature addressing each practice.Recent findingsSome expert opinion prefer delayed DEN; however, recent data reveal immediate DEN may reduce the number of endoscopic sessions required for successful clinical resolution of WON.SummaryFuture studies are needed to determine the optimal timing for DEN foll...
Source: Current Treatment Options in Gastroenterology - October 27, 2018 Category: Gastroenterology Source Type: research

Potent Acid Suppression with PPIs and P-CABs: What ’s New?
AbstractPurpose of the reviewAcid suppression treatment has revolutionized the management of the acid-related disorders since the introduction of the H2-receptor antagonists (H2-RAs) and the proton pump inhibitors (PPIs). However, there has been increasing identification of needs for improvement in antisecretory therapy, especially in gastroesophageal reflux disease (GERD), the eradication ofHelicobacter pylori (H. pylori), protection from aspirin (ASA) and non-steroidal inflammatory drug (NSAID) injury and the management of upper gastrointestinal (UGI) bleeding. There have also been increasing publications addressing safe...
Source: Current Treatment Options in Gastroenterology - October 25, 2018 Category: Gastroenterology Source Type: research

Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders
AbstractPurpose of reviewCyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder characterized by episodic nausea and vomiting and is diagnosed using Rome IV criteria. CVS is being recognized more frequently in adults with a prevalence of 2%. It is associated with several functional disorders like autonomic dysfunction, anxiety, and depression, but the strongest association is with migraine.Purpose of reviewTo elucidate the close relationship between migraine and CVS and briefly discuss its association with other gastrointestinal disorders.Recent findingsWe highlight similarities in pathophysiology...
Source: Current Treatment Options in Gastroenterology - October 25, 2018 Category: Gastroenterology Source Type: research

Parkinson ’s Disease and Current Treatments for Its Gastrointestinal Neurogastromotility Effects
AbstractPurpose of ReviewGastrointestinal disturbances are seen in nearly all patients with Parkinson ’s disease and lead to impaired quality of life, affect drug pharmacodynamics, and potentially worsen patient’s existing motor fluctuations, leading to further disability. Recent evidence links abnormal accumulations of α-synuclein aggregates in the periphery (gut) as seen in the cortex which c auses dysfunctions impacting every level of the gastrointestinal tract from the esophagus, to the stomach, small bowel, colon, and rectum and can even predate the onset of the central neurologic disorder itself. Many treatments...
Source: Current Treatment Options in Gastroenterology - October 25, 2018 Category: Gastroenterology Source Type: research

Gastric Cancer: an Evolving Disease
AbstractPurpose of ReviewPrevalence ofHelicobacter pylori, the primary risk factor for gastric cancer, is declining globally. Paralleling this trend, gastric cancer incidence is also decreasing. Historically, the populations most affected by this neoplasia have been males, Asians, and groups with low socioeconomic status. This review provides an update on recently published literature regarding changes in gastric cancer epidemiology.Recent FindingsGastric cancer incidence trends vary by age, sex, race/ethnicity, and tumor anatomical location. Overall incidence appears to be leveling off among young birth cohorts in Western...
Source: Current Treatment Options in Gastroenterology - October 25, 2018 Category: Gastroenterology Source Type: research

Update on the Prevention of Post-ERCP Pancreatitis
AbstractPurpose of reviewEndoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure to manage pancreaticobiliary disease. Post-ERCP pancreatitis (PEP) is the most common adverse event of ERCP with a significant burden of morbidity and cost.Recent findingsAppropriate indication and counseling is mandatory especially for patients at increased risk for PEP such as those with suspected sphincter of Oddi dysfunction, pancreatic indications, and a prior history of PEP. Guidewire-facilitated deep cannulation is favored over contrast injection. High-quality trials support the use of rectal administered...
Source: Current Treatment Options in Gastroenterology - October 18, 2018 Category: Gastroenterology Source Type: research

Update on Vaccinating the Patient With Inflammatory Bowel Disease
AbstractPurpose of reviewPatients with inflammatory bowel disease (IBD) are at increased risk of infectious diseases independent of their immunosuppression status, and yet, studies suggest that this population is not receiving standard vaccinations at the same rate as the general population. This review seeks to understand why IBD patients may not be receiving recommended immunizations and to provide guidelines on vaccinating this vulnerable population.Recent findingsInactive vaccines are recommended for patients with IBD regardless of immunosuppression status due to the increased risk for many vaccine-preventable illnesse...
Source: Current Treatment Options in Gastroenterology - October 6, 2018 Category: Gastroenterology Source Type: research

Botulinum Toxin as a Treatment for Refractory Gastroparesis: a Literature Review
AbstractPurpose of reviewGastroparesis (GP) is a disorder of gastrointestinal motility which leads to delayed gastric emptying in the absence of mechanical obstruction. Treatment is limited as many patients are refractory to dietary modification and the use prokinetic medications carry significant adverse risks. These limitations necessitate more research into experimental therapies. The purpose of this article is to summarize the known information and guidelines on the diagnosis and management of GP and to review the latest literature on experimental treatments.Recent findingsBased on the current available literature, the...
Source: Current Treatment Options in Gastroenterology - September 26, 2018 Category: Gastroenterology Source Type: research

Selection of EMR and ESD for Laterally Spreading Lesions of the Colon
AbstractIntroductionColonic laterally spreading lesions (LSL) are increasingly managed using endoscopic methods that comprise two main techniques: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).Purpose of ReviewIn this review, we aimed to review the most recent literature on selection of the best endoscopic technique in the management of colonic LSL.Recent FindingsEMR and ESD are complimentary techniques in the management of patients with colonic LSL.SummaryEMR is safe and effective in most patients with LSL, except for cancers with submucosal invasion in whom R0 resection is favored. (Source...
Source: Current Treatment Options in Gastroenterology - September 21, 2018 Category: Gastroenterology Source Type: research

Recurrent Acute Pancreatitis: Current Concepts in the Diagnosis and Management
ConclusionWith a focused approach and appropriate investigations, the etiology of RAP can be identified in a significant proportion of patients. Therapeutic options are limited and future research is needed to improve understanding of the disease. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - September 19, 2018 Category: Gastroenterology Source Type: research

What Is the Best Endoscopic Strategy in Acute Non-variceal Gastrointestinal Bleeding?
Opinion statementPurpose of reviewUpper non-variceal gastrointestinal bleeding (UNVGIB) remains an important clinical challenge for endoscopists, requiring skill and expertise for correct management. In this paper, we suggest the best strategy for an effective treatment of this complex category of patients.Recent findingsEarly endoscopic examination, the increasingly widespread use of endoscopic hemostasis methods, and the most powerful antisecretory agents that induce clot stabilization have radically modified the clinical scenario for treating this pathology. While hospitalization for digestive hemorrhage is decreasing, ...
Source: Current Treatment Options in Gastroenterology - September 18, 2018 Category: Gastroenterology Source Type: research