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Diagnosis and Management of Opioid-Induced Esophageal Dysfunction
AbstractPurpose of ReviewThe purpose of this review is to discuss the pathophysiology, clinical presentation, and diagnosis of opioid-induced esophageal dysfunction (OIED) and describe the limited data available on its management.Recent FindingsOIED is defined by chronic opioid use, esophageal symptoms, and specific manometric abnormalities. Larger retrospective studies show that patients with OIED present with significant esophageal symptoms particularly dysphagia. High-resolution esophageal manometry findings in OIED include distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, and hy...
Source: Current Treatment Options in Gastroenterology - April 10, 2023 Category: Gastroenterology Source Type: research

Treatment Options for Eosinophilic Esophagitis: Elimination Diets and Beyond
AbstractPurpose of ReviewEosinophilic Esophagitis (EoE) is a chronic immune-mediated disease triggered by a complex interplay of allergens with the esophageal epithelium. Elimination diets are a well-established effective treatment option. This review provides details on both the established and novel evidence supporting dietary therapy. We also explore barriers to dietary implementation and long-term maintenance.Recent FindingsOptions for elimination diets in EoE include allergen-directed elimination, six-food elimination diet (SFED), four-food elimination diet (4FED), two-food elimination diet (2FED), step-up diet (2 –...
Source: Current Treatment Options in Gastroenterology - April 10, 2023 Category: Gastroenterology Source Type: research

Current Screening and Management Strategies for Dysplasia in IBD
AbstractPurpose of reviewAn association between development of colorectal cancer (CRC) and inflammatory bowel disease (IBD) has long been established. Significant advances in the detection and management of dysplastic lesions have occurred in recent years. The purpose of our review is to summarize available literature and recommendations on screening and management of dysplasia in IBD.Recent findingsThe major advancement of endoscopic techniques and the almost standard use of high definition (HD) colonoscopes allows for better identification of small and subtle dysplastic lesions. In addition to dye chromoendoscopy (DCE) a...
Source: Current Treatment Options in Gastroenterology - March 16, 2023 Category: Gastroenterology Source Type: research

The Importance of Nutrition and Obesity Education in GI Fellowship: How to Train the Next-Generation of Gastroenterologists
AbstractPurpose of ReviewIt is widely recognized that nutrition plays an important role in disease prevention and management; however, formal physician education in nutrition still lags behind recommended national guidelines. As experts of digestion and metabolism, gastroenterologists are uniquely positioned to incorporate nutrition into clinical care. Gastroenterology fellowship presents itself as a unique time to capture trainees for more formalized education in nutrition and obesity which can then be implemented in practice.Recent FindingsRecent literature suggests a large knowledge gap regarding foundational nutritiona...
Source: Current Treatment Options in Gastroenterology - March 14, 2023 Category: Gastroenterology Source Type: research

Management of Post Ablative Barrett ’s Esophagus: a Review of Current Practices and Look at Emerging Technologies
AbstractPurpose of reviewEndoscopic eradication therapy is an effective and durable treatment for Barrett ’s esophagus (BE) related neoplasia, but even after achieving successful eradication, these patients remain at risk for recurrence and require ongoing routine examinations. The optimal surveillance protocol including endoscopic technique, sampling strategy, and timing are still being refined. The aim of this review is to discuss current management principles for the post ablation patient and emerging technologies to guide clinical practice.Recent findingsThere is increasing evidence to support less frequent surveilla...
Source: Current Treatment Options in Gastroenterology - March 10, 2023 Category: Gastroenterology Source Type: research

Autoimmune Gastritis: Update and New Perspectives in Therapeutic Management
AbstractPurpose of ReviewDiagnosis of autoimmune gastritis (AIG) is often delayed because of the absence of typical symptoms. Clinical guidelines are lacking which results in inadequate treatment and poor cancer screening. This review presents an overview of current management options and aims at raising awareness for this often-neglected disease.Recent FindingsAutoimmune gastritis is mostly thought of as a disease of the elderly with vitamin B12 deficiency and pernicious anemia. Today it is recognized that AIG is found with a similar prevalence among all age-groups, with iron deficiency being a frequent feature. Conventio...
Source: Current Treatment Options in Gastroenterology - March 2, 2023 Category: Gastroenterology Source Type: research

The Role of the Gastroenterologist in Modern Nutrition Support Services
AbstractPurpose of ReviewNutrition support teams were popularized at the end of the twetieth century because of the prevalence of malnutrition in hospitalized patients and innovation in parenteral nutrition. This is a review of the history of nutrition support services (NSS) and the role played by the gastroenterologist as its lead physician.Recent FindingsNSS have evolved from a team that was responsible for parenteral nutrition (PN) orders and prescription to a multidisciplinary effort that is able to optimize nutrition and additionally promote and provider enteral nutrition (EN) support. Base on their training, gastroen...
Source: Current Treatment Options in Gastroenterology - February 23, 2023 Category: Gastroenterology Source Type: research

Management of Non-achalasia Esophageal Hypercontractility: EGJ Outflow Obstruction and Hypercontractile Esophagus
AbstractPurpose of reviewWe review and summarize current evidence-based management strategies for non-achalasia esophageal hypercontractility disorders: esophagogastric junction outflow obstruction (EGJOO) and hypercontractile esophagus.Recent findingsEGJOO. Per Chicago Classifications version 4.0 (CCv4.0), current diagnostic criteria for EGJOO require conclusive manometric findings, clinically relevant symptoms plus at least one supportive test confirming obstruction (either timed barium esophagram (TBE) or functional lumen imaging probe (FLIP)).Hypercontractile esophagus. Per CCv4.0, current diagnostic criteria for hyper...
Source: Current Treatment Options in Gastroenterology - February 22, 2023 Category: Gastroenterology Source Type: research

Management of Esophageal Diverticula
AbstractPurpose of reviewEsophageal diverticula are outpouchings of the esophageal mucosa that are an uncommon but well-established cause of dysphagia. The purpose of this review is to highlight the endoscopic and surgical management of the various subtypes of esophageal diverticula.Current findingsBoth surgical and endoscopic management options exist for the various esophageal diverticula subtypes, including Zenker ’s diverticulum, Killian–Jamieson diverticulum, mid-esophageal diverticulum, and epiphrenic diverticulum. These treatment options should be considered for patients with symptomatic esophageal diverticula, w...
Source: Current Treatment Options in Gastroenterology - February 21, 2023 Category: Gastroenterology Source Type: research

Obesity Pharmacotherapy: a Review of Current Practices and Future Directions
AbstractPurpose of ReviewThe aim of this article is to review the current pharmacologic treatment options available for the treatment of obesity. The efficacy of each medication and its effect on cardiometabolic profile is highlighted. The use of off-label medications is discussed, along with medications currently under development.Recent FindingsAchieving and maintaining long-term clinically significant weight loss is likely to require the use of two or more anti-obesity medications. While the current evidence for combination therapies is limited, polypharmacotherapy is an area of active research, and emerging therapies a...
Source: Current Treatment Options in Gastroenterology - February 8, 2023 Category: Gastroenterology Source Type: research

A Review of Complications, Outcomes, and Technical Considerations of Endoscopically Placed Feeding Tubes in Obesity
AbstractPurpose of ReviewAs the prevalence of obesity continues to rise, so does the need for enteral access for nutrition in patients who are overweight or obese. While gastrostomy tube placement is considered a safe procedure with a low complication rate in nonobese populations, there is limited literature regarding the outcomes and technical considerations of tube placement and nutritional feed selection in patients who are overweight or obese. In this review, we aim to discuss the outcomes of tube placement, technical considerations to optimize success, and selection of enteral feeds in patients who are overweight or o...
Source: Current Treatment Options in Gastroenterology - February 2, 2023 Category: Gastroenterology Source Type: research

Ileal Pouch-Anal Anastomosis in the Older Adult: a Review of Postoperative Outcomes and Pouchitis Treatment
AbstractPurpose of ReviewIleal pouch-anal anastomosis (IPAA) has become the preferred surgical treatment for patients with medically refractive ulcerative colitis (UC). Previous studies have suggested that outcomes of this procedure may be worse in older patients; however, more recent reports have suggested that IPAA in select patients is safe, feasible, and results in good quality of life. In this review, we discuss the recent literature surrounding clinical considerations and treatment management of IPAA in older adults.Recent FindingsIPAA complication rates and adverse events are similar in the older adult population, a...
Source: Current Treatment Options in Gastroenterology - December 6, 2022 Category: Gastroenterology Source Type: research

The Use of Telemedicine in Older Patients with Gastrointestinal Diseases
AbstractPurpose of Review The COVID-19 pandemic helped us understand that telemedicine provides an alternative way to manage patients remotely, with an added benefit of saving time and travel costs. However, barriers may exist in an older population of patients such as inadequate technology availability and knowledge, and lack of internet connectivity. This systematic review and analysis of data at an academic medical center examines the current literature and investigates the efficacy of telemedicine for older adults requiring gastrointestinal care.Recent FindingsIn the systematic review, we included 22 manuscripts fro...
Source: Current Treatment Options in Gastroenterology - November 30, 2022 Category: Gastroenterology Source Type: research

Special Considerations for the Management of Disorders of Gut-Brain Interaction in Older Adults
AbstractPurpose of ReviewThe world ’s population is aging rapidly, with 40% of patients seen in US gastroenterology (GI) clinics being 60 years or older. Many gastrointestinal problems are more common or unique to the older adult because of progressive damage to the structure and function of the GI tract. Until recently, the epide miology of disorders of gut-brain interaction (such as irritable bowel syndrome and functional dyspepsia) was not well-characterized.Recent FindingsForty percent of persons worldwide have disorders of gut-brain interaction (DGBI), with varying global patterns of incidence in older adults. Ther...
Source: Current Treatment Options in Gastroenterology - November 12, 2022 Category: Gastroenterology Source Type: research

Esophageal Manifestations of Dermatological Diseases, Diagnosis, and Management
AbstractPurpose of ReviewThe purpose of this article is to discuss the diagnosis and treatment of diseases that affect both the skin and the esophagus.Recent FindingsThe diagnosis of dermatological conditions that affect the esophagus often requires endoscopy and biopsy with some conditions requiring further investigation with serology, immunofluorescence, manometry, or genetic testing. Many conditions that affect the skin and esophagus can be treated successfully with systemic steroids and immunosuppressants including pemphigus, pemphigoid, HIV, esophageal lichen planus, and Crohn ’s disease. Many conditions are associa...
Source: Current Treatment Options in Gastroenterology - October 18, 2022 Category: Gastroenterology Source Type: research