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Is fecal microbiota transplantation a temporary patch for treatment of Clostridium difficile infection or a new frontier of therapeutics?
Authors: Khoruts A PMID: 29667436 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - April 20, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions.
Authors: Dietrich CF, Tana C, Caraiani C, Dong Y Abstract INTRODUCTION: Ultrasound is well accepted worldwide for imaging of the liver. Absences of radiation exposure, low cost and large diffusion are some of the advantages that make this technique the first to be used in the assessment of focal liver lesions (FLL). Areas covered: Contrast enhanced ultrasound (CEUS) has been introduced more than twenty years ago, and its detection rate is comparable to that of contrast enhanced magnetic resonance imaging (CEMRI) and contrast enhanced computed tomography (CECT). In this narrative review, we discuss the main CEUS fea...
Source: Expert Review of Gastroenterology and Hepatology - April 17, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Pediatric Irritable Bowel Syndrome and Other Functional Abdominal Pain Disorders: An Update of Non-Pharmacological Treatments.
Authors: Gupta S, Schaffer G, Saps M Abstract INTRODUCTION: Functional abdominal pain disorders, including irritable bowel syndrome, are common in children and treatment can often be difficult. Pharmacological therapies and complementary treatments are widely used, despite the limited data in pediatrics. Areas covered: This review provides an overview of the available data for the use of diet, probiotics, percutaneous electrical nerve stimulation and psychosocial interventions, including hypnotherapy, yoga, cognitive and behavioral therapy and mind-body interventions for the treatment of functional abdominal pain d...
Source: Expert Review of Gastroenterology and Hepatology - April 12, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The role of neutrophil to lymphocyte ratio for the assessment of liver fibrosis and cirrhosis: a systematic review.
Authors: Peng Y, Li Y, He Y, Wei Q, Xie Q, Zhang L, Xia Y, Zhou X, Zhang L, Feng X, Chen K, Chen S, Chen W, Long Q, Chai J Abstract INTRODUCTION: Neutrophil to lymphocyte ratio (NLR) is widely used to assess inflammatory diseases. We performed a systematic review to explore the prognostic role of NLR for the assessment of liver fibrosis and cirrhosis. Areas covered: We searched the PubMed and EMBASE databases for the eligible papers which explored the association between NLR and liver fibrosis/cirrhosis or investigated the prognostic value of NLR in cirrhotic patients. Expert commentary: In accordance with assessme...
Source: Expert Review of Gastroenterology and Hepatology - April 10, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Molecular profiling of pancreatic neuroendocrine tumors (pNETS) and the clinical potential.
Authors: Camilli M, Papadimitrio K, Nogueira A, Incorvaia L, Galvano A, D'Antonio F, Ferri J, Santini D, Silvestris N, Russo A, Peeters M, Rolfo C Abstract INTRODUCTION: Pancreatic neuroendocrine tumors (pNETs) represent a small part of pancreatic neoplasms, and the knowledge about their indolent clinical course remains a subject of investigation. They occur sporadically or as part of familial cancer syndromes and are classified by WHO in 3 categories. There is ongoing research to understand their molecular profiling and leading mutations. Areas covered: The aim of this review is to clarify the overall aspects of t...
Source: Expert Review of Gastroenterology and Hepatology - April 10, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The relationship between obesity and the severity of non-alcoholic fatty liver disease: systematic review and meta-analysis.
Authors: Lu FB, Hu ED, Xu LM, Chen L, Wu JL, Li H, Chen DZ, Chen YP Abstract INTRODUCTION: A number of researches have explored the association between obesity and nonalcoholic fatty liver disease (NAFLD) liver function, histopathology, complications, genetic factors and prognosis, but the results were conflicting and inconclusive. Areas covered: In this meta-analysis, the liver function, histopathology, metabolic complications, patatin-like phospholipase domain-containing protein 3 (PNPLA3) genetic polymorphism and prognosis were compared between non-obese and obese NAFLD. Pubmed, EMBASE, Cochrane databases were s...
Source: Expert Review of Gastroenterology and Hepatology - April 5, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The use of human albumin in patients with cirrhosis: a European survey.
CONCLUSIONS: The present survey indicates that hepatologists across Europe present adherence to international guidelines and highlights the areas where solid scientific data are awaited to achieve a more appropriate HA prescription in patients with decompensated cirrhosis. PMID: 29611452 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - April 5, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Acid suppression in patients treated with endoscopic therapy for the management of gastroesophageal varices: A systematic review and meta-analysis.
CONCLUSION: Acid suppression might be considered in patients undergoing prophylactic EVL for gastroesophageal varices. PMID: 29564926 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - March 26, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Emerging therapeutic biomarkers of autoimmune hepatitis and their impact on current and future management.
Authors: Czaja AJ Abstract INTRODUCTION: Autoimmune hepatitis lacks a quantifiable biomarker that is close to its pathogenic mechanisms and that accurately reflects inflammatory activity, correlates with treatment response, and ensures inactive disease before treatment withdrawal. Areas covered: Micro-ribonucleic acids, programmed death-1 protein and its ligands, macrophage migration inhibitory factor, soluble CD163, B cell activating factor, and metabolite patterns in blood were considered the leading candidates as therapeutic biomarkers after search of PubMed from August 1981 to August 2017 using the search words...
Source: Expert Review of Gastroenterology and Hepatology - March 17, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Conditional survival of patients with hepatocellular carcinoma: results from the Surveillance, Epidemiology, and End Results registry.
CONCLUSIONS: Conditional survival exhibited an improved prognosis over time. For hepatocellular carcinoma patients who survived for a specific period of time after diagnosis, more dramatic improvements occurred in patients aged 65-74 years, patients with AJCC stage IVB, and patients with a positive/elevated AFP value. PMID: 29543072 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - March 17, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Elucidating the link between collagen and pancreatic cancer: what's next?
Authors: Hamada S, Masamune A PMID: 29495889 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - March 4, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Fecal microbiota transplantation for managing irritable bowel syndrome.
Authors: El-Salhy M, Mazzawi T Abstract INTRODUCTION: Irritable bowel syndrome (IBS) is a widespread gastrointestinal disorder affecting 11.2% of the world adult population. The intestinal microbiome is thought to play a pivotal role in the pathophysiology of IBS. The composition of the fecal microbiome in IBS patients differs from that in healthy individuals, but the exact bacteria species involved in the development of IBS remain to be determined. There is also an imbalance between useful and harmful bacteria (dysbiosis) in the intestinal microbiome in patients with IBS. Consuming prebiotics, probiotics, or synbi...
Source: Expert Review of Gastroenterology and Hepatology - March 3, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The potential of gut microbiota and fecal volatile organic compounds analysis as early diagnostic biomarker for necrotizing enterocolitis and sepsis in preterm infants.
Authors: Berkhout DJC, Niemarkt HJ, de Boer NK, Benninga MA, de Meij TGJ Abstract INTRODUCTION: Although the exact pathophysiological mechanisms of both necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants are yet to be elucidated, evidence is emerging that the gut microbiota plays a key role in their pathophysiology. Areas covered: In this review, initial microbial colonization and factors influencing microbiota composition are discussed. For both NEC and LOS, an overview of studies investigating preclinical alterations in gut microbiota composition and fecal volatile organic compounds (V...
Source: Expert Review of Gastroenterology and Hepatology - March 1, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Esophageal hiatal hernia: Risk, Diagnosis and Management.
Authors: Yu HX, Han CS, Xue JR, Han ZF, Xin H Abstract INTRODUCTION: Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus. Age and increased body mass index are key risk factors, and congenital skeletal aberrations trigger pathogenesis through intestinal malrotations. Familiar manif...
Source: Expert Review of Gastroenterology and Hepatology - February 18, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Clinical management of pediatric achalasia.
Authors: van Lennep M, van Wijk MP, Omari TI, Benninga MA, Singendonk MMJ Abstract INTRODUCTION: Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM). Areas covered: In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia. ...
Source: Expert Review of Gastroenterology and Hepatology - February 15, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The potential role of statins in treating liver disease.
Authors: Imprialos KP, Stavropoulos K, Doumas M, Skalkou A, Zografou I, Athyros VG Abstract INTRODUCTION: Statins are commonly use for the management of dyslipidemia, worldwide. Various studies have demonstrated that statins offer significant reduction in the risk of cardiovascular morbidity and mortality. However, this class of drugs has been implicated in potential liver toxicity, thus has been considered as a "forbidden-drug" in patients with increased liver enzymes. Areas covered: Studies have shown that statins might offer clinical benefits in the setting of viral hepatitis, progression of cirrhosis,...
Source: Expert Review of Gastroenterology and Hepatology - February 14, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Understanding gastroschisis and its clinical management: where are we?
Authors: Haddock C, Skarsgard ED Abstract INTRODUCTION: Gastroschisis is the commonest developmental defect of the anterior abdominal wall in both developed and developing countries. The past 30 years have seen transformational improvements in outcome due to advances in neonatal intensive care and enhanced integration between the disciplines of maternal fetal medicine, neonatology and pediatric surgery. A review of gastroschisis, which emphasizes its epidemiology, multidisciplinary care strategies and contemporary outcomes is timely. Areas covered: This review discusses the current state of knowledge related to pre...
Source: Expert Review of Gastroenterology and Hepatology - February 9, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Functional abdominal pain disorders in children.
Authors: Rajindrajith S, Zeevenhooven J, Devanarayana NM, Perera BJC, Benninga MA Abstract INTRODUCTION: Chronic abdominal pain is a common problem in pediatric practice. The majority of cases fulfill the Rome IV criteria for functional abdominal pain disorders (FAPDs). At times, these disorders may lead to rather serious repercussions. Area covered: We have attempted to cover current knowledge on epidemiology, pathophysiology, risk factors related to pathophysiology, clinical evaluation and management of children with FAPDs. Expert commentary: FAPDs are a worldwide problem with a pooled prevalence of 13.5%. There ...
Source: Expert Review of Gastroenterology and Hepatology - February 8, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Acute-on-chronic liver failure in chronic hepatitis B: an update.
Authors: Zhao RH, Shi Y, Zhao H, Wu W, Sheng JF Abstract INTRODUCTION: Acute-on-chronic liver failure is a common pattern of end-stage liver disease in clinical practice and occurs frequently in patients with chronic hepatitis B or HBV-related cirrhosis. New progress in recent years leads to a better understanding of this disease. Areas covered: This review updates the current comprehensive knowledge about HBV-ACLF from epidemiological studies, experimental studies, and clinical studies and provide new insights into the definition, diagnostic criteria, epidemiology, nature history, pathogenesis, treatment and progn...
Source: Expert Review of Gastroenterology and Hepatology - January 18, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Clinical characteristics and outcomes of traditional Chinese medicine-induced liver injury: a systematic review.
CONCLUSIONS: Our work summarises current knowledge regarding clinical presentation, disease course, and prognosis of TCM-ILI. TCM can result in hepatotoxicity, even death or necessitate life-saving liver transplantation. Governmental regulation of TCM products should be strictly established. PMID: 29323538 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - January 13, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Impact of prior malignancy on outcomes of stage IV esophageal carcinoma: SEER based study.
CONCLUSION: Prior malignancy does not adversely impact survival of stage IV esophageal cancer. These results should be taken into consideration when designing clinical trials. PMID: 29316808 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - January 12, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

New therapies target the toxic consequences of cholestatic liver disease.
Authors: Jansen PLM Abstract Introduction In most cholestatic liver diseases the primary cholestasis-causing lesions are located in the biliary tree and may be of (auto)immune origin. Bile salts are responsible for the secondary toxic consequences. Bile salt and nuclear hormone directed therapies primarily aim at improving this secondary toxic injury. In primary biliary cholangitis, trials show statistically significant responses on biochemical endpoints. Preclinical studies suggest that FXR- and PPAR-agonists, inhibitors of the apical sodium-dependent bile salt transporter (ASBT-inhibitors) and the C23 UDCA deriva...
Source: Expert Review of Gastroenterology and Hepatology - January 10, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure.
This study aimed to evaluate the prognostic value of stratified AFP in patients with acute-on-chronic hepatitis B liver failure (ACHBLF). METHODS: A total of 192 patients were included and AFP were categorized into quartiles. The prognostic value was determined for overall survival (OS) and assessed by Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazard regression analyses studied the association of all independent parameters with disease prognosis. RESULTS: The optimal cut-off points of AFP were: (Q1) 252.3-4800.0 ng/ml, (Q2) 76.0-252.2 ng/ml, (Q3) 18.6-75.9 ng/ml, and (Q4) 0.7-18.5 ng/ml. B...
Source: Expert Review of Gastroenterology and Hepatology - January 6, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Hepcare Europe - bridging the gap in the treatment of hepatitis C: study protocol.
CONCLUSIONS: Hepcare has the potential to make an important impact on patient care for marginalised populations who might otherwise go undiagnosed and untreated. Lessons learned from the study can be incorporated into national and European guidelines and strategies for HCV. PMID: 29300496 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - January 6, 2018 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Hepatorenal syndrome: the clinical impact of vasoactive therapy.
Authors: Colle I, Laterre PF Abstract INTRODUCTION: Hepatorenal syndrome (HRS) is a unique form of acute kidney injury seen in cirrhotic patients and associated with significant mortality and morbidity. Despite its impact, diagnosis and treatment of HRS remains challenging and this review aims to assess and compare the available vasoconstrictors used as first-line treatment for HRS. Areas covered: A literature review was undertaken on the use of vasoconstrictors in HRS, using PubMed/Medline database searches of: 'hepatorenal syndrome', 'HRS' and 'vasoconstrictor'. Expert commentary: Current diagnosis criteria are b...
Source: Expert Review of Gastroenterology and Hepatology - December 21, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Non-endoscopic biopsy techniques: a review.
Authors: Otuya DO, Verma Y, Farrokhi H, Higgins L, Rosenberg M, Damman C, Tearney GJ Abstract INTRODUCTION: Diseases of the stomach and small intestine account for approximately 20% of all gastrointestinal (GI)-related mortality. Biopsy of the stomach and small intestine remains a key diagnostic tool for most of the major diseases that affect the GI tract. While endoscopic means for obtaining biopsy is generally the standard of care, it has several limitations that make it less ideal for pediatric patients and in low resource areas of the world. Therefore, non-endoscopic means for obtaining biopsy samples is of int...
Source: Expert Review of Gastroenterology and Hepatology - December 17, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Erratum.
Authors: PMID: 29237299 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - December 16, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Liver transplantation beyond or downstaging within the Milan criteria for hepatocellular carcinoma.
Authors: Rudnick SR, Russo MW Abstract INTRODUCTION: Unresectable hepatocellular carcinoma (HCC) is a common indication for liver transplantation (LT). The Milan criteria became standard criteria but expansion beyond the Milan criteria (tumor size and number) have resulted in similar post-transplant outcomes, thus suggesting LT is a viable treatment option for HCC presenting beyond the Milan criteria Areas covered: Expanded criteria and the use of downstaging therapies to meet Milan criteria are reviewed. Surrogates of tumor biology (including biomarkers and response to therapy) are described in detail. The controv...
Source: Expert Review of Gastroenterology and Hepatology - December 14, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Glucagon like peptide-2 and neoplasia; a systematic review.
Authors: Ring LL, Nerup N, Jeppesen PB, Svendsen LB, Achiam MP Abstract INTRODUCTION: Glucagon like peptide-2 is synthesized from enteroendocrine L cells primarily located in the ileum and large intestine. GLP-2 stimulates crypt cell proliferation, increases intestinal blood flow, enhances gut barrier function, induces mucosal healing, and exerts an anti-apoptotic effect. Due to these effects GLP-2 is used in the treatment of short bowel syndrome (SBS). Areas covered The aim of this systematic review was to provide information on the potential risk of intestinal neoplasia in patients receiving treatment with GLP-2....
Source: Expert Review of Gastroenterology and Hepatology - December 14, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Clinical relevance of liver histopathology and different histological classifications of NASH in adults.
We report on the individual histological features and scoring systems of NAFLD: the NAFLD activity score (NAS) introduced by the NASH-Clinical Research Network, the "Fatty Liver Inhibition of Progression" algorithm and Steatosis, Activity, and Fibrosis (SAF) score. Pros and cons of histological classifications in NASH are discussed. Special emphasis is given to liver histopathology in some high-risk patient groups, such as those with severe obesity and type 2 diabetes. Moreover, we also examine the relationship between liver histopathology and clinical features, and the impact of liver histopathology on the long-...
Source: Expert Review of Gastroenterology and Hepatology - December 13, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Survival in signet ring cell carcinoma varies based on primary tumor location: a Surveillance, Epidemiology, and End Results database analysis.
Authors: Wu SG, Chen XT, Zhang WW, Sun JY, Li FY, He ZY, Pei XQ, Lin Q Abstract BACKGROUND: The aim of this study was to investigate the survival of patients with signet ring cell carcinoma (SRCC) based on primary tumor location. METHODS: Patient data were obtained from the Surveillance, Epidemiology, and End Results database (1988-2012) with ≥200 cases per tumor location. Cox regression analysis was used to investigate prognostic factors of cause-specific survival (CSS). RESULTS: We identified 24,171 patients. Of the patients, 63.4% had gastric SRCC, followed by colon (18.2%), esophageal (5.0%), rectal ...
Source: Expert Review of Gastroenterology and Hepatology - December 13, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Utility of point shear wave elastography in characterisation of focal liver lesions.
Authors: Hasab-Allah M, Salama RM, Marie MS, Mandur AAM, Omar H PMID: 29219625 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - December 10, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Validation of the 8th AJCC staging system for gastric cancer in a population-based setting.
Authors: Abdel-Rahman O Abstract OBJECTIVE: To validate the prognostic value 8th edition American Joint Committee on Cancer (AJCC) staging system for gastric cancer. METHODS: Through SEER*Stat program, Surveillance, epidemiology and end results database (2010-2013) was accessed and 8th AJCC stages were reconstructed. Cancer-specific survival analyses according to both 7th and 8th editions were conducted through Kaplan-Meier analysis/log-rank testing and multivariate analysis was conducted through a Cox model. RESULTS: Among pathologically-staged patients, P values for pairwise comparisons among different 8t...
Source: Expert Review of Gastroenterology and Hepatology - December 6, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis.
CONCLUSIONS: LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices. PMID: 29186994 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - December 1, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Glecaprevir + pibrentasvir (ABT493 + ABT-530) for the treatment of Hepatitis C.
Authors: Hubbard H, Lawitz E Abstract INTRODUCTION: Glecaprevir (formerly ABT-493, pangenotypic NS3/4A protease inhibitor) and pibrentasvir (formerly ABT-530, pangenotypic NS5A inhibitor) are second generation direct acting antivirals (DAA) for the treatment of chronic Hepatitis C (HCV). It is a fixed dose ribavirin (RBV)-free regimen with activity against genotypes (GT) 1-6. In vitro the two antivirals have synergistic activity with a high barrier to resistance and potent activity against common polymorphisms. It is once daily oral dosing with minimal absorption, primary biliary excretion, and negligible renal exc...
Source: Expert Review of Gastroenterology and Hepatology - December 1, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Apprenticeship-based training in neurogastroenterology and motility.
We describe the training model, learning experiences, and outcomes of one-month apprenticeship-based training in NGM at a center of excellence, using a detailed individual observer account and data from 12 consecutive trainees that completed the program. During a one-month training period, 302 procedures including; breath tests (BT) n=132, anorectal manometry (ARM) n=29 and esophageal manometry (EM) n=28, were performed. Post-training, all trainees (n=12) knew indications for motility tests, and the majority achieved independence in basic interpretation of BT, EM and ARM. Additionally, in a multiple-choice NGM written-test...
Source: Expert Review of Gastroenterology and Hepatology - November 17, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

New insights into the role of vitamin D in hepatocellular carcinoma.
Authors: Wu DB, Wang ML, Chen EQ, Tang H Abstract INTRODUCTION: In addition to being crucial for host immune defense, vitamin D is involved in cell proliferation, apoptosis, differentiation, inflammation, invasion and metastasis, angiogenesis and micro-RNA modulation. To date, clinical studies have demonstrated that vitamin D deficiency is common not only in patients with chronic liver diseases but also in those with hepatocellular carcinoma (HCC). Experimental studies have also demonstrated that vitamin D and its receptors are related to the occurrence of HCC and the prognoses of patients with HCC. Areas covered: ...
Source: Expert Review of Gastroenterology and Hepatology - November 17, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Practical gastrointestinal investigation of iron deficiency anaemia.
Authors: Banerjee AK, Celentano V, Khan J, Longcroft-Wheaton G, Quine A, Bhandari P Abstract INTRODUCTION: About 10% of oesophagogastroduodenoscopies (OGDs) and colonoscopies are done for investigation of iron deficiency anemia (IDA) . Much of the existing guidance on investigation of IDA predates CRC screening, which has driven significant improvements in colonoscopy quality and completion rates, as well as a reduction in Helicobacter pylori prevalence and increase in PPI usage, and therefore probably needs re-consideration. New investigations, e.g. CT colonography, enteroscopy and capsule endoscopy have also been...
Source: Expert Review of Gastroenterology and Hepatology - November 14, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Outcomes of treatment with sorafenib in Egyptian patients with hepatocellular carcinoma: a retrospective cohort study.
CONCLUSION: Sorafenib use should be limited to patients with Child A, PS 0-1, and low disease burden. PMID: 29124987 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - November 11, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Advances in mesenchymal stromal cell therapy in the management of Crohn's disease.
Authors: Ibraheim H, Giacomini C, Kassam Z, Dazzi F, Powell N Abstract INTRODUCTION: The aim of therapy in Crohn's disease (CD) is induction and maintenance of remission, promotion of mucosal healing and restoration of quality of life. Even the best treatment regimes, including combinations of biologics and immunomodulators lack durable efficacy and have well documented side effects. Accordingly, there is an unmet need for novel therapies. Mesenchymal stromal cells (MSCs) are a subset of non-hematopoietic stem cells that home to sites of inflammation where they exert potent immunomodulatory effects and contribute t...
Source: Expert Review of Gastroenterology and Hepatology - November 4, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Nasogastric aspiration/lavage in patients with gastrointestinal bleeding: a review of the evidence.
Authors: Karakonstantis S, Tzagkarakis E, Kalemaki D, Lydakis C, Paspatis G Abstract INTRODUCTION: The usefulness of nasogastric aspiration and nasogastric lavage in patients with gastrointestinal bleeding is controversial, as evidenced by conflicting recommendations, both among and within society guidelines. Areas covered: Considering these controversies, we reviewed the evidence regarding the following questions: 1) Can nasogastric lavage stop or slow down the bleeding and improve subsequent endoscopic visualization? 2) Is nasogastric aspiration helpful for the localization of bleeding? 3) Can nasogastric aspirat...
Source: Expert Review of Gastroenterology and Hepatology - November 4, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The biological challenges and pharmacological opportunities of orally administered nanomedicine delivery.
Authors: Moss DM, Curley P, Kinvig H, Hoskins C, Owen A Abstract INTRODUCTION: Nano-scale formulations are being developed to improve the delivery of orally administered medicines, and the interactions between nanoformulations and the gastrointestinal luminal, mucosal and epithelial environment is currently being investigated. The mucosal surface of the gastrointestinal tract is capable of trapping and eliminating large particles and pathogens as part of the natural defences of the body, it is becoming clearer that nanoformulation properties such as particle size, charge, and shape, as well as mucous properties suc...
Source: Expert Review of Gastroenterology and Hepatology - November 3, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

The use of obeticholic acid for the management of non-viral liver disease: current clinical practice and future perspectives.
Authors: Gitto S, Guarneri V, Sartini A, Andreone P Abstract INTRODUCTION: Farnesoid X nuclear receptor is involved in the regulation of lipid and glucose metabolism, though mainly in the homeostasis of bile acids. Indeed, the agonists of farnesoid X nuclear receptor represent promising drugs. Areas covered: Obeticholic acid, a novel semi-synthetic analogue of the naturally occurring bile acid, has led to encouraging preliminary results in both cholestatic and metabolic liver disease. In patients with primary biliary cholangitis, obeticholic acid determines a significant biochemical improvement although the effects...
Source: Expert Review of Gastroenterology and Hepatology - October 31, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Management of gastrointestinal complications in hereditary transthyretin amyloidosis: a single-center experience over 40 years.
This article presents our experience with diagnosing and treating the GI symptoms of ATTRm amyloidosis patients at our center over the last 40 years, in the Swedish clustering area of the disease. Our aim is to help other physicians to better manage GI complications in patients with this rare but widespread condition. Expert commentary: GI symptoms are debilitating complications for ATTRm amyloidosis patients to experience, yet with the appropriate questioning and diagnosis methods, symptomatic treatments of these symptoms can be implemented to provide relief. Further, patients with fewer GI complications and a good nutrit...
Source: Expert Review of Gastroenterology and Hepatology - October 28, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Indeterminate biliary strictures: a simplified approach.
Authors: Xie C, Aloreidi K, Patel B, Ridgway T, Thambi-Pillai T, Timmerman G, Khan A, Atiq M Abstract INTRODUCTION: Pre-operative evaluation of biliary strictures remains challenging. The dilemma that exists is how to balance the risk of failing to detect malignancy and the potential morbidity caused by unnecessary surgery in patients with benign etiologies. With emerging novel diagnostic modalities, this study aims to assess the efficacy of diagnostic techniques and facilitate a clinical approach to indeterminate biliary strictures. Areas covered: Conventional imaging modalities are crucial in identifying the loca...
Source: Expert Review of Gastroenterology and Hepatology - October 18, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Endoscopy for patients affected by inflammatory bowel disease: bowel preparation and sedation.
Authors: Bezzio C, Andreozzi P, Casini V, Manes G, Saibeni S Abstract INTRODUCTION: Endoscopy has a key role in the management of inflammatory bowel disease (IBD). It is helpful in the diagnosis, in case of relapse, refractoriness, before therapeutic changes, after surgery as well as in the assessment of mucosal healing and in the surveillance of colo-rectal cancer. Patients IBD are intended to undergo several times the examination during their lifespan. Bowel preparation and sedation highly contribute to high-quality colonoscopy. Areas covered: Few studies addressed preparation and sedation in the field of inflamm...
Source: Expert Review of Gastroenterology and Hepatology - October 13, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Pharmacological treatments and infectious diseases in pediatric inflammatory bowel disease.
Authors: Dipasquale V, Romano C Abstract INTRODUCTION: The incidence of pediatric inflammatory bowel disease (IBD) is rising, as is the employment of immunosuppressive and biological drugs. Most patients with IBD receive immunosuppressive therapies during the course of the disease. These molecules are a double-edged sword; while they can help control disease activity, they also increase the risk of infections. Therefore, it is important that pediatricians involved in primary care, pediatric gastroenterologists, and infectious disease physicians have a thorough knowledge of the infections that can affect patients wi...
Source: Expert Review of Gastroenterology and Hepatology - October 11, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Overview of small bowel angioectasias: clinical presentation and treatment options.
Authors: Chetcuti Zammit S, Koulaouzidis A, Sanders DS, McAlindon ME, Rondonotti E, Yung DE, Sidhu R Abstract INTRODUCTION: Elderly patients with multiple co-morbidities are at an increased risk of developing small bowel angioectasias. Treating these lesions can be both challenging and costly with patients requiring extensive investigations and recurrent admissions for iron infusions and blood transfusions as well as invasive procedures. This review presents treatment options and describes in detail drugs that should be considered whilst taking into account their effectiveness and their safety profile. Areas covere...
Source: Expert Review of Gastroenterology and Hepatology - October 11, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Preventing liver fibrosis in patients with NAFLD and the road ahead.
Authors: Nobili V, Miele L, Alisi A PMID: 28994314 [PubMed - as supplied by publisher] (Source: Expert Review of Gastroenterology and Hepatology)
Source: Expert Review of Gastroenterology and Hepatology - October 11, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research

Tenofovir alafenamide as compared to tenofovir disoproxil fumarate in the management of chronic hepatitis B with recent trends in patient demographics.
Authors: Hsu YC, Wei MT, Nguyen MH Abstract INTRODUCTION: Tenofovir alafenamide (TAF) has recently been approved for chronic hepatitis B (CHB). It is more stable than tenofovir disoproxil fumarate (TDF) in the plasma and can provide similar efficacy with lower circulating concentration in patients with hepatitis B virus (HBV) infection. Areas covered: This synopsis will review the current anti-HBV standard practice and the changing epidemiology of CHB, specifically the controversies surrounding the renal and bone safety associated with TDF use in the context of an aging CHB population. We will review data from phas...
Source: Expert Review of Gastroenterology and Hepatology - October 4, 2017 Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research