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Revisiting Dietary Approaches in the Management of Chronic Pancreatitis
AbstractPurposeChronic pancreatitis is a progressive, fibroinflammatory disease association with multiple nutrition-related comorbidities such as metabolic bone disease, sarcopenia, micronutrient deficiency, and malnutrition. There is a paucity of research focused on optimal management to prevent the occurrence of these consequences.Recent findingsPrevalence of nutrition-related complications are high, and each complication significantly impacts the quality of life of those suffering from this condition. There is a need to develop nutrition-based research protocols that are consistent in terminology and apply appropriate m...
Source: Current Treatment Options in Gastroenterology - October 1, 2022 Category: Gastroenterology Source Type: research

Evaluation of Diarrhea in Older Adults
AbstractPurpose of ReviewTo selectively review the evidence that there are or are not unique features of diarrhea in older individuals that should alter the differential diagnosis or evaluation of diarrhea in older adults.Recent FindingsA recent population-based study indicates a prevalence rate of diarrhea of 6.6% in the entire adult population and 9.6% in the oldest subjects. Several specific diarrheal disorders may have a prevalence pattern skewing to older individuals or to their circumstances, and these should be ranked higher in the differential diagnosis of older people with acute and chronic diarrhea.SummaryAcute, ...
Source: Current Treatment Options in Gastroenterology - September 27, 2022 Category: Gastroenterology Source Type: research

Constipation and Fecal Incontinence in the Elderly
Abstract  Purpose of ReviewTo describe the epidemiology, classification, pathogenesis, clinical features, diagnostic modalities, and treatment options for primary constipation and fecal incontinence (FI) in older adults.Recent FindingsBoth constipation and FI are classified using the Rome IV criteria and require exclusion of secondary causes before a primary diagnosis can be made. Initial evaluation should include a thorough clinical history, review of medications, triaging need for colonoscopy, and a digital rectal examination. When initial evaluation of constipation is unrevealing, conservative management with dietary m...
Source: Current Treatment Options in Gastroenterology - September 27, 2022 Category: Gastroenterology Source Type: research

Management of AKI in Patients with Cirrhosis
AbstractPurpose of ReviewThe development of acute failure of the kidneys in the context of decompensated cirrhosis represents one of the most challenging scenarios in clinical medicine due to the severity and complexity of the coexistence of those 2 illnesses. Thus, managing those cases can be cumbersome.Recent FindingsWhile the state of advanced cirrhosis and portal hypertension can lead to a unique type of acute kidney injury (AKI) —hepatorenal syndrome type 1 (HRS-1)—a number of other etiologies can cause AKI, such as prerenal or cardiorenal insults, acute tubular injury, and other parenchymal entities. As a result,...
Source: Current Treatment Options in Gastroenterology - September 15, 2022 Category: Gastroenterology Source Type: research

Evidence-Based Endoscopic Management of Benign Biliary Strictures
AbstractPurpose of ReviewWe aimed to review the current evidence-based strategies for endoscopic management of benign biliary strictures.Recent FindingsPercutaneous transhepatic biliary drainage (PTBD) as a rescue procedure for patients with an unsuccessful biliary access through ERCP is being replaced by endoscopic ultrasonography-guided biliary access and drainage (EUS-BD) due to its feasibility, safety, and convenience.SummaryEndoscopic management of benign biliary strictures (BBS) initially emerged as an alternative to surgery but has evolved significantly over the past few decades. Currently, endoscopic retrograde cho...
Source: Current Treatment Options in Gastroenterology - August 17, 2022 Category: Gastroenterology Source Type: research

Celiac Disease in the Elderly
AbstractPurpose of ReviewThis review highlights literature from the past several years and explores the impact on current understanding of celiac disease diagnosis, complications, and management in older adults.Recent FindingsCeliac disease in the elderly is becoming increasingly prevalent but remains underdiagnosed, with a high potential burden of downstream morbidity and modestly increased risk of mortality. Clinical presentations are often related to extraintestinal symptoms and can be subtle. Duodenal biopsy remains the gold standard for diagnosis in older adults, along with supporting serologies. Refractory celiac dis...
Source: Current Treatment Options in Gastroenterology - August 5, 2022 Category: Gastroenterology Source Type: research

Eosinophilic Gastritis and Eosinophilic Duodenitis
AbstractPurpose of reviewThis review provides an overview of recent developments in the field of eosinophilic gastritis (EG) and eosinophilic duodenitis (EoD) with emphasis on diagnostic criteria, the clinical manifestation and available or emerging treatments.Recent findingsEosinophilic gastrointestinal diseases such as EG and EoD are chronic inflammatory conditions with gastrointestinal symptoms and increased density of mucosal eosinophilic cells. Recent data suggest an association between increases of duodenal eosinophils and symptoms in patients with functional dyspepsia. Eosinophil infiltrates are patchy, and counts f...
Source: Current Treatment Options in Gastroenterology - July 27, 2022 Category: Gastroenterology Source Type: research

Enteral Nutrition Therapy: Which Formula Do You Use?
AbstractPurpose of ReviewOptimal nutritional status is crucial for the well-being and quality of life of patients who suffer with gastrointestinal disorders due to the significant impairments that can occur through oral tolerance and acceptance, digestive absorption and motility, and weight management. For patients who demonstrate an inability to sustain their nutrition and weight orally, enteral nutrition is an appropriate intervention to help meet nutrient needs. Despite established consensus on indications for the initiation of enteral nutrition, there has been a lack of clear guidelines on proper formulary in respect t...
Source: Current Treatment Options in Gastroenterology - July 26, 2022 Category: Gastroenterology Source Type: research

Post-ERCP Pancreatitis — What Is the Best Approach for Prevention?
AbstractPurpose of ReviewPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common adverse event following ERCP. The purpose of this review is to highlight prevention strategies and recent developments in this area and summarize current recommendations to reduce PEP rates.Recent FindingsPEP prevention continues to rely heavily on use of peri-procedural rectal non-steroidal anti-inflammatory drugs (NSAIDs) and intravenous aggressive hydration (AH) while shying away from more invasive maneuvers such as pancreatic stents except in high-risk cases. Comparative studies of medical therapy, ...
Source: Current Treatment Options in Gastroenterology - July 19, 2022 Category: Gastroenterology Source Type: research

The Impact of Racial Disparities on Liver Disease Access and Outcomes
We describe increasing rates of high-risk drinking and a need for culturally tailored treatment. We discuss rising rates of non-alcohol associated fatty liver disease and the need for improved education of patients and providers. Data on disparities in mortality in cholestatic liver diseases are emerging; qualitative data on barriers to care are needed.SummaryUnderstanding racial disparities in liver disease is only the first step. Achieving health equity will take innovative initiatives. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - July 12, 2022 Category: Gastroenterology Source Type: research

The Role of Statins in Cirrhosis
AbstractPurpose of reviewTo critically analyze current evidence regarding the role of statins in cirrhosis with particular emphasis on the source of the evidence.Recent findings.Most evidence is from observational studies; the few data of clinical trials does not support using statins to prevent rebleeding, but suggests that properly designed trials should be conducted to assess a potential disease-modifying effect. Current evidence is not enough to support their use in prevention of decompensation, acute-on-chronic liver failure, hepatocellular carcinoma, infection, or mortality. Regarding safety, outside of clinical tria...
Source: Current Treatment Options in Gastroenterology - July 7, 2022 Category: Gastroenterology Source Type: research

Genetic Testing in Acute and Chronic Pancreatitis
AbstractPurpose of reviewPremature intracellular activation of pancreatic zymogens leads to the initiation of pancreatitis, which in up to 25% leads to chronic tissue destruction, exocrine and endocrine organ failure, and a moderate increased risk of pancreatic cancer development. Whereas in many cases, the trigger of organ damage is identified, diagnostic workup in a significant number of patients does not reveal the underlying etiology of pancreatic inflammation. In these cases, alterations in different pancreatic susceptibility genes have been described to be directly or indirectly involved in disease development. In th...
Source: Current Treatment Options in Gastroenterology - July 4, 2022 Category: Gastroenterology Source Type: research

Exercise Interventions for Cirrhosis
Abstract Purpose of ReviewPoor physical fitness is a common finding in patients with cirrhosis and is associated with increased morbidity and mortality. This review aims to summarize the existing literature on the impact of exercise interventions in cirrhosis and guiding the healthcare providers in determining the optimal exercise program in this population.Recent FindingsExercise interventions including aerobic and resistance training have benefits on markers of sarcopenia, cardiorespiratory fitness and quality of life, and are safe, even in the decompensated stage.SummaryPoor physical fitness in cirrhosis is multifact...
Source: Current Treatment Options in Gastroenterology - July 1, 2022 Category: Gastroenterology Source Type: research

Precision Approaches to Pancreatic Cancer Therapy: What Now and What Next?
AbstractPurpose of ReviewWith recent advances in the understanding of the molecular landscape of pancreas ductal adenocarcinoma (PDAC), genomic-driven treatment approaches are gaining traction. The aim of this review is to summarize and evaluate recent developments in this area and to provide perspectives on the future of precision medicine in PDAC.Recent FindingsIn a subset of patients with PDAC, a biomarker-driven approach to treatment is increasing therapeutic options and improving outcomes for patients. Investigational approaches to areas such as DNA damage repair (DDR), targeting the stroma, tumor metabolism and immun...
Source: Current Treatment Options in Gastroenterology - June 25, 2022 Category: Gastroenterology Source Type: research

Behavioral Interventions After Bariatric Surgery
AbstractPurpose of ReviewBariatric surgery is the most effective and durable treatment for severe obesity. Postoperative behavioral weight management approaches are available for optimizing weight change for both short- and long-term outcomes.Recent FindingsVarying settings such as groups and telemedicine along with techniques such as cognitive behavioral therapy have been assessed in the post-bariatric surgery population. The assessment and application of these programs have been limited due to methodological, financial, and attrition-related constraints.SummaryThis review aims to summarize the current evidence for differ...
Source: Current Treatment Options in Gastroenterology - June 24, 2022 Category: Gastroenterology Source Type: research