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Malnutrition in Gastrointestinal Disorders
All patients with significant gastrointestinal disease should be clinically assessed for protein calorie malnutrition by using the Subjective Global Assessment. Blood tests for anemia, electrolytes, calcium, phosphorus, magnesium, ferritin, vitamin B12, and folate should be considered for assessment of major micronutrients. Where malabsorption or inflammatory bowel disease is diagnosed, bone mineral density using dual beam x-ray absorptiometry, 25-OH vitamin D levels, and measurement of other vitamins and trace elements should be considered. In addition, in at-risk patients, vitamin and trace element clinical deficiency sy...
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Khursheed N. Jeejeebhoy, Donald R. Duerksen Source Type: research

Enteral Access and Associated Complications
This article reviews the types of enteral access and the associated complications. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Mark H. DeLegge Source Type: research

Nutritional Therapy in Chronic Pancreatitis
Malnutrition is a frequent complication in patients with chronic pancreatitis. Maldigestion as a consequence of pancreatic exocrine insufficiency is the major cause of malnutrition in these patients. Together with that, toxic habits and alterations of the gastroduodenal transit may play a relevant role. Malnutrition in chronic pancreatitis is associated with osteoporosis, sarcopenia, poor quality of life, and increased mortality. An adequate nutritional evaluation including anthropometric, biochemical, and morphologic parameters is recommended in these patients. Nutritional advice and support together with an adequate panc...
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: J. Enrique Dom ínguez-Muñoz, Mary Phillips Source Type: research

Nutritional Consideration in Celiac Disease and Nonceliac Gluten Sensitivity
Celiac disease is an autoimmune disorder due to the inflammatory response to gluten in genetically predisposed individuals. It causes an enteropathy associated with several nutritional complications. Strict compliance to a gluten-free diet (GFD) is the current primary therapy. Nonceliac gluten sensitivity (NCGS) is a condition in which gluten ingestion leads to systemic symptoms but is not associated with small bowel atrophy or abnormal celiac serologies. A GFD heals celiac disease enteropathy and improves symptoms in NCGS. However, a long-term GFD can be associated with nutritional deficiencies and requires monitoring and...
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Rishi D. Naik, Douglas L. Seidner, Dawn W. Adams Source Type: research

Nutritional Interventions in the Patient with Inflammatory Bowel Disease
This article discusses the role of diets and dietary supplements in the treatment of IBD. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Berkeley N. Limketkai, Andrea Wolf, Joanna Ye, Maryam Tajamal, Alyssa M. Parian Source Type: research

Small Intestinal Bacterial Overgrowth
Small intestinal bacterial overgrowth (SIBO), characterized by the presence of excessive bacteria in the small intestine, is typically described as a malabsorptive syndrome occurring in the context of gut stasis syndromes. SIBO is now considered to be a disorder associated with diverse clinical conditions without classic risk factors for SIBO and a cause of several nonspecific gastrointestinal and nongastrointestinal symptoms. Because there is currently no gold standard for diagnosing SIBO, its prevalence and role in the pathogenesis of other diseases remain uncertain; as does optimal treatment of patients with relapsing s...
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Abimbola Adike, John K. DiBaise Source Type: research

Nutritional Therapy in Gastrointestinal Cancers
Malnutrition is the most frequent nutritional disorder in patients with gastrointestinal cancer and is associated with cachexia syndrome, worsening of prognosis, and shortened survival rate. Early nutrition screening, assessment, and intervention are able to favorably modify the clinical evolution of affected patients. The adequate provision of nutritional requirements has been associated with improvement of immunologic status, and avoidance of further complications related to poor nutritional status, surgical treatment, and anticancer therapy. In malnourished patients, the supplementation of perioperative immunonutrition ...
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Priscila Garla, Dan Linetzky Waitzberg, Alweyd Tesser Source Type: research

The Role of Prebiotics and Probiotics in Gastrointestinal Disease
With the advent of the scientific realization that the microbiota of the gastrointestinal tract was more than the cells that exist in the body, the full importance of prebiotics and probiotics has come forth. The importance has been stressed and is available in the new textbook entitled, “The Microbiota in Gastrointestinal Pathophysiology: Implication for Human Health, Prebiotics, Probiotics and Dysbiosis.” There is enough evidence now published in the literature so that the scientific world now believes that prebiotics and probiotics are important in gastrointestinal disease. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - December 6, 2017 Category: Gastroenterology Authors: Martin H. Floch Source Type: research

Nutritional Interventions in Chronic Intestinal Pseudoobstruction
This article defines the disorder and discusses the spectrum of disease and challenges to providing adequate nutrition to help improve a patient’s quality of life. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - December 2, 2017 Category: Gastroenterology Authors: Donald F. Kirby, Sulieman Abdal Raheem, Mandy L. Corrigan Source Type: research

Nutritional Considerations in Liver Disease
Malnutrition occurs in most patients with advanced liver diseases and is associated with higher rates of morbidity and mortality. In this article, the authors discuss the pathophysiology of malnutrition and methods to optimize nutrition status in liver disease and include a brief section on perioperative and postoperative nutrition. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - December 2, 2017 Category: Gastroenterology Authors: Asim Shuja, Miguel Malespin, James Scolapio Source Type: research

Nutritional Aspects of Acute Pancreatitis
The goal of nutritional support in acute pancreatitis is to reduce inflammation, prevent nutritional depletion, correct a negative nitrogen balance, and improve outcomes. Enteral nutrition (EN) in severe acute pancreatitis (SAP) should be preferred to parenteral nutrition. It maintains the integrity of the gut barrier, decreases intestinal permeability, downregulates the systemic inflammatory response, maintains intestinal microbiota equilibrium, and reduces the complications of the early phase of SAP, improving morbidity and possibly improving mortality, and it is less expensive. Further studies to understand optimal timi...
Source: Gastroenterology Clinics of North America - December 2, 2017 Category: Gastroenterology Authors: Kristen M. Roberts, Marcia Nahikian-Nelms, Andrew Ukleja, Luis F. Lara Source Type: research

Nutritional Therapy in Adult Short Bowel Syndrome Patients with Chronic Intestinal Failure
This article critically revises the gaps in and evidence for providing general nutritional therapy recommendations in the Short Bowel Syndrome-IF population. It addresses the need for an individualized approach, aiming to reduce or even eliminate the need for PS, and emphasizes a need to focus on effects of dietary interventions on the quality of life of these patients. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - December 2, 2017 Category: Gastroenterology Authors: Palle Bekker Jeppesen, Kristian Asp Fuglsang Source Type: research

Use of Complementary and Alternative Medicine in Inflammatory Bowel Disease Around the World
Use of complementary sand alternative medicine (CAM) is common among patients with inflammatory bowel disease (IBD). CAM can be broadly categorized as whole medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies. Most do not use it to treat IBD specifically, and most take it as an adjunct to conventional therapy not in place of it. However, patients are frequently uncomfortable initiating a discussion of CAM with their physicians, which may impact adherence to conventional therapy. A greater emphasis on CAM in medical education may facilitate patien...
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Petros Zezos, Geoffrey C. Nguyen Source Type: research

Complementary and Alternative Medicine Strategies for Therapeutic Gut Microbiota Modulation in Inflammatory Bowel Disease and their Next-Generation Approaches
The human gut microbiome exerts a major impact on human health and disease, and therapeutic gut microbiota modulation is now a well-advocated strategy in the management of many diseases, including inflammatory bowel disease (IBD). Scientific and clinical evidence in support of complementary and alternative medicine, in targeting intestinal dysbiosis among patients with IBD, or other disorders, has increased dramatically over the past years. Delivery of “artificial” stool replacements for fecal microbiota transplantation (FMT) could provide an effective, safer alternative to that of human donor stool. Neverthele...
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Abigail R. Basson, Minh Lam, Fabio Cominelli Source Type: research

Exercise and Inflammatory Bowel Disease
This article summarizes evidence regarding health benefits of exercise, guidelines regarding exercise in the general population and chronic inflammatory disorder populations, limitations regarding exercise capacity in patients with IBD, the association of lack of exercise with IBD pathogenesis, the role of exercise in beneficially modulating IBD clinical course, and extraintestinal benefits of exercise in patients with IBD. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Jana G. Hashash, David G. Binion Source Type: research

The Practical Pros and Cons of Complementary and Alternative Medicine in Practice
Complementary and alternative medicine (CAM) is changing health care for individuals with inflammatory bowel disease. The move toward increasing patient autonomy and addressing lifestyle and psychosocial factors contributes to this shift. Numerous clinics and centers are offering new models to incorporate these elements. There is need for better and more robust data regarding CAM efficacy and safety. CAM offers a test kitchen for new approaches to care and care delivery, which are now being developed and studied, and has the possibility to affect patient quality of life, disease morbidity, cost, and use of health care. (So...
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Rachel W. Winter, Joshua R. Korzenik Source Type: research

Sleep and Circadian Hygiene and Inflammatory Bowel Disease
There is increasing evidence that sleep and circadian disruption can worsen the disease course in inflammatory bowel disease (IBD). Sleep and circadian disruption are prevalent in society and are associated with worse outcomes in IBD. Emerging research suggests sleep and circadian disruption can impact key components in IBD disease flares, including intestinal permeability, translocation of bacterial endotoxins, intestinal dysbiosis, and proinflammatory cytokines. Much of this research has been conducted in animal models. There is a clear need for large randomized controlled trials in human patients with IBD, where the pot...
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Garth R. Swanson, Helen J. Burgess Source Type: research

Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease
There are many mechanisms to explain how food may drive and ameliorate inflammation. Although there are no consistent macronutrient associations inflammatory bowel disease (IBD) development, many exclusion diets have been described: IgG-4 guided exclusion diet; semivegetarian diet; low-fat, fiber-limited exclusion diet; Paleolithic diet; Maker ’s diet; vegan diet; Life without Bread diet; exclusive enteral nutrition (EEN), the Specific Carbohydrate Diet (SCD) and the low FODMAP diet. The literature on diet and IBD is reviewed with a particular focus on EEN, SCD, and low FODMAP diets. Lessons learned from the existing...
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Samir Kakodkar, Ece A. Mutlu Source Type: research

Complementary and Alternative Medicine in Inflammatory Bowel Disease
GASTROENTEROLOGY CLINICS OF NORTH AMERICA (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Authors: Ali Keshavarzian, Ece A. Mutlu Source Type: research

Copyright
Elsevier (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Source Type: research

Contributors
ALI KESHAVARZIAN, MD, FRCP, FACP, AGAF, MACG (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Source Type: research

Contents
Ali Keshavarzian and Ece A. Mutlu (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Source Type: research

Forthcoming Issues
Nutritional Management of Gastrointestinal Disease (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 23, 2017 Category: Gastroenterology Source Type: research

Complementary and Alternative Treatments Are Needed to Enhance the Care of the Inflammatory Bowel Disease Patient
Inflammatory bowel disease (IBD) is a complex chronic disorder with a rising number of patients in the United States and worldwide. Those of us who are taking care of the IBD patient recognize daily the limitations of standard medical therapies that we have to treat this disease. Current therapies are only partially effective even when it comes to controlling patient symptoms, targeting primarily one aspect of the disease pathogenesis (ie immune activation), and are also woefully inadequate, inducing mucosal healing by eliminating the inflammatory ulcerations in the gastrointestinal track in a significant majority. (Source...
Source: Gastroenterology Clinics of North America - October 6, 2017 Category: Gastroenterology Authors: Ali Keshavarzian, Ece A. Mutlu Tags: Preface Source Type: research

Probiotics in Inflammatory Bowel Disease
Evidence indicates that the gut microbiota and/or interactions between the microbiota and the host immune system are involved in the pathogenesis of inflammatory bowel disease (IBD). Strategies that target the microbiota have emerged as potential therapies and, of these, probiotics have gained the greatest attention. Data derived from animal models of IBD have revealed the potential of several bacterial strains to modify the natural history of IBD. However, there has been little indication that probiotics exert any benefit in Crohn disease. More targeted approaches involving live bacteria, genetically modified bacteria, an...
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Bincy P. Abraham, Eamonn M.M. Quigley Source Type: research

Prebiotics and Inflammatory Bowel Disease
Dietary fiber, specifically prebiotics, is the primary source of energy for the gut microbiota and thus has the potential to beneficially modify microbiota composition. Prebiotics have been used in both in  vitro studies and with animal models of colitis with largely positive results. Human studies are few and have been conducted with only a few select prebiotics, primarily fructan-containing fibers. Although disease activity and inflammatory markers have improved, more needs to be learned about the specific prebiotic compounds and how they can be used to best improve the gut microbiota to counter changes induced by i...
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Heather E. Rasmussen, Bruce R. Hamaker Source Type: research

Fecal Transplant in Inflammatory Bowel Disease
This article reviews the evidence supporting FMT in IBD, including case reports, case series, and randomized controlled trials. The article also focuses on questions of safety and speculates on the future of this therapy. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Alexander S. Browne, Colleen R. Kelly Source Type: research

The Brain-Gut Axis and Stress in Inflammatory Bowel Disease
The brain-gut axis serves as a circuit that incorporates the human experience, the state of mind, the gut microbiome, and the immune response that ultimately drives the phenotypic expression of inflammatory bowel disease (IBD). There are several biological pathways through which stress can play a deleterious role, including through increasing intestinal permeability, which can facilitate intestinal translocation of bacteria. Stress has an impact on symptoms in IBD; however, there is limited evidence that stress triggers increased intestinal inflammation. Although attention to stress and psychiatric comorbidity is important...
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Charles N. Bernstein Source Type: research

Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care
The presence of psychological comorbidities, specifically anxiety and depression, is well documented in inflammatory bowel disease (IBD). The drivers of these conditions typically reflect 4 areas of concern: disease impact, treatment concerns, intimacy, and stigma. Various demographic and disease characteristics increase risk for psychological distress. However, the risk for anxiety and depression is consistent throughout IBD course and is independent of disease activity. Early intervention before psychological distress becomes uncontrolled is ideal, but mental health often is unaddressed during patient visits. Understandi...
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Tiffany H. Taft, Sarah Ballou, Alyse Bedell, Devin Lincenberg Source Type: research

Mindfulness-Based Interventions in Inflammatory Bowel Disease
This article reviews eight studies, assessing seven psychosocial interventions, which include mindfulness and/or meditation components. Strongest effects of the interventions were found in quality of life and anxiety/depression, with inconsistent or minimal changes in other psychosocial areas, such as perceived stress and in disease-related outcomes and other physiologic functioning. Mindfulness interventions for patients with inflammatory bowel disease may be a supplemental treatment option to improve quality of life and distress in this population, although results are preliminary and interventions require additional tes...
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Megan M. Hood, Sharon Jedel Source Type: research

Herbs and Inflammatory Bowel Disease
Although herbal preparations are widely used by patients with inflammatory bowel disease (IBD), evidence for their efficacy is limited and they may not always be safe. Mainly small studies of varying quality have suggested that several herbal preparations could be of benefit in IBD, but larger better-designed trials are needed to establish their place in inducing and maintaining remission. Patients and health care workers need to be made more aware of the limitations and risks of using herbal products for IBD. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Gregory M. Sebepos-Rogers, David S. Rampton Source Type: research

Vitamins and Minerals in Inflammatory Bowel Disease
This article describes some aspects of vitamin and mineral deficiencies in IBD and summarizes results of supplementation. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Fayez K. Ghishan, Pawel R. Kiela Source Type: research

Dietary Therapies in Pediatric Inflammatory Bowel Disease
This article evaluates current literature regarding the role of diet and nutrition in pathogenesis of disease, as well as the role of diet as primary therapy for pediatric IBD. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Erin R. Lane, Dale Lee, David L. Suskind Source Type: research

Massage Acupuncture, Moxibustion, and Other Forms of Complementary and Alternative Medicine in Inflammatory Bowel Disease
Complementary and alternative medicine is frequently used by inflammatory bowel disease (IBD) patients; most common are massage, acupuncture, and moxibustion therapy. Massage therapy is poorly studied in IBD patients; therefore, its benefits remain unknown. Acupuncture and moxibustion therapy have been shown to improve inflammation and symptoms in animal and human studies. However, current clinical trials of acupuncture and moxibustion are of insufficient quality to recommend them as alternative therapy. Nonetheless, because these therapies seem generally to be safe, they may have a role as complementary to conventional th...
Source: Gastroenterology Clinics of North America - October 4, 2017 Category: Gastroenterology Authors: Daniel J. Stein Source Type: research

Endoscopic and Radiographic Assessment of Crohn's Disease
Crohn ’s disease is a chronic inflammatory disorder that can progress to obstructive and penetrating complications. Although clinical symptoms are an important component of therapy, they correlate poorly with objective measures of inflammation. The treatment targets have evolved from clinical improvemen t only to the addition of more objective measures, such as endoscopic mucosal healing and radiologic response, which have been associated with favorable long-term outcomes, including reduced hospitalizations, surgeries, and need for corticosteroids. There are multiple endoscopic and radiologic scori ng systems that ca...
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Badr Al-Bawardy, Stephanie L. Hansel, Jeff L. Fidler, John M. Barlow, David H. Bruining Source Type: research

Intestinal and Nonintestinal Cancer Risks for Patients with Crohn's Disease
Crohn ’s disease (CD) is a chronic inflammatory disease that confers a higher risk of cancer than in the general population. New, large, population-based studies in the past decade show that patients with CD are at higher risk of colorectal, small bowel, melanoma, and cervical cancer. Patients who use thiopurines are at additional risk of development of lymphoma and nonmelanoma skin cancer. Preventive surveillance for cancers of the colorectum, skin, and uterine cervix is advised. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Sushil K. Garg, Fernando S. Velayos, John B. Kisiel Source Type: research

Interdisciplinary Management of Perianal Crohn's Disease
Perianal disease is a common manifestation of Crohn disease (CD) that results in significant morbidity and decreased quality of life. Despite several medical and surgical options, complex perianal CD remains difficult to treat. Before the advent of biologic therapy, antibiotics were the mainstay of medical treatment. Infliximab remains the most well-studied medical therapy for perianal disease. Surgical interventions are limited by the risk of nonhealing wounds and potential incontinence. When treatment options fail, fecal diversion or proctectomy may be necessary. Stem cell therapies may offer improved results and seem to...
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Amy L. Lightner, William A. Faubion, Joel G. Fletcher Source Type: research

The Evolution of Treatment Paradigms in Crohn's Disease
Despite advances in care, most patients with Crohn ’s disease (CD) develop complications, such as fistulas, or require surgery. Given the recent advances in drug therapy, an opportunity exists to optimize the management of this chronic disease through early use of effective therapies, clear definition of treatment targets, and application of the p rinciples of personalized medicine. In this article, the authors discuss the evolution of treatment algorithms for CD to incorporate these strategies. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Reena Khanna, Vipul Jairath, Brian G. Feagan Source Type: research

Management of Crohn's Disease After Surgical Resection
Approximately 25% to 35% of patients with Crohn ’s disease (CD) who undergo surgery require repeat surgery. Active smoking, multiple prior surgeries, and penetrating or perianal disease are risk factors for recurrence of CD after surgical resection. Early initiation of prophylactic therapy is effective in decreasing the risk of recurrence. Acti ve colonoscopic surveillance for the early detection of endoscopic recurrence within 6 to 12 months of surgery is recommended. In symptomatic patients without evidence of endoscopic recurrence, noninflammatory causes should be sought. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Siddharth Singh, Geoffrey C. Nguyen Source Type: research

Use of Anti –Tumor Necrosis Factors and Anti-Integrins in the Treatment of Crohn's Disease
In patients with Crohn ’s disease (CD), anti–tumor necrosis factor (TNF) therapy is efficacious for the induction and maintenance of clinical remission, mucosal healing, reducing rates of surgery and hospitalizations, and improving health-related quality of life. The decision between anti-TNFs and anti-integrins as fi rst-line treatment in CD depends on disease severity, safety concerns, and prescription coverage. Given the existing data on long-term outcomes and safety, anti-TNFs are often preferred to anti-integrins. Additional clinical experience and preferably prospective, head-to-head studies will be impor...
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Raina Shivashankar, Darrell S. Pardi Source Type: research

Ustekinumab and Anti-Interleukin-23 Agents in Crohn's Disease
This article reviews the available data regarding the efficacy of ustekinumab across published randomized clinical trials and open-label experience from tertiary medical centers, safety data, including in pregnancy, and its use in patients who have failed tumor necrosis factor (TNF) antagonists as well as patients who have not failed TNF antagonists. We have proposed an algorithm for positioning the use of ustekinumab among other agents (TNF antagonists, vedolizumab) in moderate-severe Crohn ’s disease. The article also enumerates drugs that are specific interleukin-23 blockers, including brazikumab (MEDI2070), risan...
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Parakkal Deepak, William J. Sandborn Source Type: research

Update on Therapeutic Drug Monitoring in Crohn's Disease
In patients with Crohn ’s disease on biologic medications, the use of therapeutic drug monitoring leads to a personalized approach to optimize treatment. Using an algorithmic approach, measurement of drug concentrations and anti–drug antibodies can be used to improve treatment outcomes. Therapeutic drug concentrations and absence of antibodies are associated with improved clinical and endoscopic outcomes. In clinical practice, therapeutic drug monitoring has been shown to be clinically useful and cost-effective in patients experiencing a loss of response to treatment. This review highlights the available data o...
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Val érie Heron, Waqqas Afif Source Type: research

Janus Kinase Antagonists and Other Novel Small Molecules for the Treatment of Crohn's Disease
There is an ongoing, unmet need for effective therapies for Crohn ’s disease. Treatments for Crohn’s disease continue to evolve from the traditional biologics to novel small molecules, with targeted mechanisms directed toward pathways that are dysregulated in Crohn’s disease. There are multiple emerging mechanisms of action, including Janus kinase inhibition , Smad7 inhibition, and sphingosine-1-phosphate receptor modulators, that are administered as oral medications, and small molecules represent the next generation of therapies for Crohn’s disease. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Brigid S. Boland, S éverine Vermeire Source Type: research

Crohn's Disease: Etiology, Complications, Assessment, Therapy, and Management
It has been over 100 years since the Scottish surgeon Sir T. Kennedy Dalziel described several cases of “chronic interstitial enteritis” resulting in diarrhea, abdominal pain, and intestinal obstruction, and 75 years since Drs Burrill B. Crohn, Leon Ginzburg, and Gordon Oppenheimer from Mount Sinai Hospital in New York published their case series of “terminal ileitis” in the Journal of the Ame rican Medical Association. What we now call “Crohn's disease” has evolved from a rare medical curiosity to an all-too-common diagnosis in not only North America and Europe but also the rest of the ...
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Edward V. Loftus Tags: Preface Source Type: research

Crohn's Disease
GASTROENTEROLOGY CLINICS OF NORTH AMERICA (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Authors: Edward V. Loftus Source Type: research

Copyright
ELSEVIER (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Source Type: research

Contributors
EDWARD V. LOFTUS Jr, MD (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Source Type: research

Contents
Edward V. Loftus Jr (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Source Type: research

Forthcoming Issues
Complementary and Alternative Medicine in Inflammatory Bowel Disease (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2017 Category: Gastroenterology Source Type: research

Epidemiology, Natural History, and Risk Stratification of Crohn's Disease
Crohn disease (CD) is a chronic condition that can result in significant morbidity and disability. By studying the association between demographics and initial clinical features and subsequent natural history, we may be able to stratify patients by their risks of clinical relapse, hospitalization, and surgery. Understanding the potential environmental risk factors and natural history of CD in a given patient guides the physician when counseling the patient and selecting a treatment strategy. In this review, updated data regarding the incidence and prevalence of CD, important environmental risk factors, natural history of t...
Source: Gastroenterology Clinics of North America - July 19, 2017 Category: Gastroenterology Authors: Satimai Aniwan, Sang Hyoung Park, Edward V. Loftus Source Type: research