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Peptic Ulcer Bleeding: Update on Standards from International Guidelines
AbstractPurpose of reviewWe review the latest advances in management of peptic ulcer bleeding and the updates from international guidelines.Recent findingsA low Glasgow Blatchford score of ≤ 1 can safely identify low-risk patients to manage in out-patient settings. Except patients with persistent haemodynamic instability, early endoscopy within 24 h appears safe when compared with earlier intervention. Over-the-scope-clips (OTSC) show promising result as first-line and second-lin e endoscopic haemostaic therapy, while haemostatic spray can be considered as a stop-gap treatment. After endoscopic intervention, high-dose...
Source: Current Treatment Options in Gastroenterology - January 6, 2021 Category: Gastroenterology Source Type: research

Colorectal Cancer Screening and Surveillance for Non-Hereditary High-Risk Groups —Is It Time for a Re-Think?
AbstractPurpose of reviewColorectal cancer (CRC) is the second most common cause of cancer death worldwide, killing approximately 900,000 people each year. An individual ’s risk of developing CRC is multi-factorial with known risk factors including increasing age, male sex, family history of CRC and raised body mass index. Population-based screening programmes for CRC exist in many countries, and in the United Kingdom (UK), screening is performed through the NHS B owel Cancer Screening Programme (BCSP). Screening programmes offer a population-based approach for those at “average risk”, and do not typically offer enha...
Source: Current Treatment Options in Gastroenterology - January 5, 2021 Category: Gastroenterology Source Type: research

Management of Diverticulosis
AbstractPurpose of reviewThe paradigm in the management of diverticular disease is continuously changing. This review serves as an overview of the management of diverticular disease including modifiable risk factors and medical and surgical therapies.Recent findingsThe treatment of acute uncomplicated diverticulitis has changed over time to a more conservative approach with the most recent trials showing that antibiotics neither accelerated recovery nor prevented complications of diverticulitis. Another paradigm shift has been in the surgical management of patients with acute diverticulitis with a more individualized appro...
Source: Current Treatment Options in Gastroenterology - January 2, 2021 Category: Gastroenterology Source Type: research

Evaluation and Management of Patients with PPI-Refractory Heartburn
AbstractPurpose of reviewTo use recent insights on the causes and treatment of PPI-refractory heartburn to formulate an effective approach to patient management.Recent findingsPPI-refractory heartburn results from 5 major potential mechanisms: (1) PPIs have not normalized esophageal acid exposure; (2) PPIs have normalized esophageal acid exposure, but there is reflux hypersensitivity in which persistent “physiologic” reflux events evoke heartburn; (3) the sensation of heartburn is caused by an esophageal disorder other than GERD (e.g., eosinophilic esophagitis, achalasia); (4) the sensation of heartburn is caused by an...
Source: Current Treatment Options in Gastroenterology - January 2, 2021 Category: Gastroenterology Source Type: research

Updates in Chemoprevention Research for Hereditary Gastrointestinal and Polyposis Syndromes
AbstractPurpose of reviewTo critically examine recently published research in the area of chemoprevention in hereditary polyposis and gastrointestinal cancers, and to briefly review several ongoing chemoprevention trials testing novel agents in this population.Recent findingsFour recent chemoprevention trials in patients with familial adenomatous polyposis (FAP) were identified and reviewed. In the FAPEST trial, the combination of erlotinib + sulindac (compared to placebo) met its primary outcome of decreased duodenal polyp burden. A secondary analysis of lower gastrointestinal tract outcomes also demonstrated significant ...
Source: Current Treatment Options in Gastroenterology - December 28, 2020 Category: Gastroenterology Source Type: research

Maintaining a Balanced Diet While Gluten-Free: Treatment Options
AbstractPurpose of reviewThe goal of this review is to address the different reasons individuals adopt a gluten-free diet (GFD), including, but not limited to, celiac disease (CD), gluten ataxia (GA), and dermatitis herpetiformis (DH) and non-celiac gluten sensitivity (NCGS). The perceived health benefits and confusion surrounding gluten and gluten-free (GF) options will be addressed. The benefits and challenges of the diet will be discussed. There will be a specific emphasis on how to avoid and correct potential nutritional deficiencies which are commonly seen in patients on a GFD.Recent findingsSeveral studies have addre...
Source: Current Treatment Options in Gastroenterology - December 1, 2020 Category: Gastroenterology Source Type: research

Complementary Health Approaches for Irritable Bowel Syndrome
AbstractPurpose of reviewIrritable bowel syndrome (IBS) is a common functional disorder with a prevalence of up to 15% in the USA. Patients with IBS are more inclined to seek complementary treatment options for management of their conditions due to a lack of sufficient relief from conventional treatments and preference towards a more natural approach. We reviewed the most up-to-date medical literature regarding complementary health modalities for the treatment of IBS.Recent findingsProposed mechanisms for IBS range from alterations in gut motility, intestinal permeability, intestinal microbiome, visceral hypersensitivity, ...
Source: Current Treatment Options in Gastroenterology - November 24, 2020 Category: Gastroenterology Source Type: research

Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects
AbstractPurpose of reviewTo review recent clinical evidence surrounding the use of cannabinoids and cannabis in gastrointestinal diseases, particularly inflammatory bowel disease (IBD) and functional gut disorders. A second aim is to evaluate the current status of gastrointestinal related adverse effects which have been linked to cannabis use, specifically cannabis hyperemesis syndrome (CHS) and acute pancreatitis.Recent findingsObservational and prospective studies suggest that cannabinoids improve IBD symptoms. Small prospective clinical trials have not shown any effects on objective inflammatory findings, other than one...
Source: Current Treatment Options in Gastroenterology - November 21, 2020 Category: Gastroenterology Source Type: research

Management of Severe Acute Pancreatitis
AbstractPurpose of reviewThere have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications.Recent findingsRecent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems. In patients with established SAP and vascular leak syndrome, intravenous fluids should be ...
Source: Current Treatment Options in Gastroenterology - November 19, 2020 Category: Gastroenterology Source Type: research

Managing Gastrointestinal Complications in Patients With Systemic Sclerosis
ConclusionsAdvances in the management of gastrointestinal disease in SSc continue to evolve. The application of novel therapies and the repurposing of existing therapies for the management of gastrointestinal involvement are shaping the therapeutic arsenal so that we can more effectively manage these complex patients. (Source: Current Treatment Options in Gastroenterology)
Source: Current Treatment Options in Gastroenterology - November 13, 2020 Category: Gastroenterology Source Type: research

Who Needs Gastroprotection in 2020?
AbstractPurpose of reviewPeptic ulcer disease (PUD) is a recognized complication of non-steroidal anti-inflammatory drugs (NSAIDs). Stress ulcers are a concern for intensive care unit (ICU) patients; PUD is also an issue for patients taking anticoagulation.Helicobacter pylori test and treat is an option for patients starting NSAID therapy, and proton pump inhibitors (PPIs) may reduce PUD in NSAID patients and other high-risk groups.Recent findingsThere are a large number of trials that demonstrate thatHelicobacter pylori eradication reduces PUD in NSAID patients. PPI is also effective at reducing PUD in this group and is a...
Source: Current Treatment Options in Gastroenterology - November 11, 2020 Category: Gastroenterology Source Type: research

Management of Pancreatic Cystic Lesions: Making Sense of All the Guidelines
AbstractPurpose of reviewPancreatic cystic lesions are now being identified in increasing frequency, providing an opportunity for early detection of advanced neoplasia. Multiple guidelines have been developed to help risk-stratify pancreatic cystic lesions. However, differences between guidelines provide a source of confusion for most practitioners. In this review, we attempt to highlight the similarities and differences between the guidelines, specifically evaluating their target populations and variations in surveillance/management strategies for pancreatic cystic lesions.Recent findingsThe most commonly used guidelines ...
Source: Current Treatment Options in Gastroenterology - November 10, 2020 Category: Gastroenterology Source Type: research

Nutritional Therapies for Irritable Bowel Syndrome: a Focus on Prebiotics and Probiotics
AbstractPurpose of reviewThe pathophysiology of irritable bowel syndrome (IBS) is incompletely understood, but in at least some patients, alterations in the gut microbiome are likely to be etiologically relevant. The purpose of this review is to evaluate the available evidence to date for the use of prebiotics and probiotics in the treatment of IBS, with particular attention to broad themes in therapeutic rationale as well as critical gaps in the literature.Recent findingsA number of individual studies and meta-analyses have demonstrated efficacy in the use of prebiotics and probiotics for IBS. Even so, variability in stud...
Source: Current Treatment Options in Gastroenterology - November 10, 2020 Category: Gastroenterology Source Type: research

Precision Medicine: Predicting Disease Course in Patients with Inflammatory Bowel Disease
AbstractPurpose of reviewThere is increasing demand for a personalized approach to management of patients with inflammatory bowel disease (IBD). Early prognostication and stratification of patients into distinct disease trajectories would enable treatment algorithms to be made which are less generalized and more patient-specific. We have summarized the recent medical literature and highlight the current status of precision medicine and its potential application to patients with IBD.Recent findingsClinical characteristics, aided by serologic studies, fecal and genetic markers are commonly employed to approximate an IBD pati...
Source: Current Treatment Options in Gastroenterology - November 9, 2020 Category: Gastroenterology Source Type: research

Genetic Testing Use and Expectations in Early Onset Colorectal Cancer
AbstractPurpose of reviewA substantial proportion of colorectal cancer (CRC) diagnosed under age 50, or early-onset colorectal cancer (EOCRC), is associated with a hereditary cancer syndrome. It is of utmost importance to identify these patients to customize cancer treatment options, decrease the risk of metachronous cancers, and facilitate testing within the family to identify carriers. The purpose of this paper is to review the evolution of genetic evaluation in patients with EOCRC, review current best practices, and describe areas ripe for future work and research.Recent findingsFourteen to 25% of all EOCRCs are associa...
Source: Current Treatment Options in Gastroenterology - November 6, 2020 Category: Gastroenterology Source Type: research