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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

Crohn's Disease
Since the discovery of the first Crohn ’s disease (CD) gene NOD2 in 2001, 140 genetic loci have been found in whites using high-throughput genome-wide association studies. Several genes influence CD subphenotypes and treatment response. With the observations of increasing prevalence in Asia and developing countries and the incomplete e xplanation of CD variance, other underexplored areas need to be integrated through novel methodologies. Algorithms that incorporate specific genetic risk alleles with other biomarkers will be developed and used to predict CD disease course, complications, and response to specific thera...
Source: Gastroenterology Clinics of North America - July 19, 2017 Category: Gastroenterology Authors: Ming-Hsi Wang, Michael F. Picco Source Type: research

Epidemiology, Natural History, and Risk Stratification of Chron'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

The Microbiome in Crohn's Disease
This article summarizes the existing literature on the role of the gut microbiome and its manipulation in development and management of Crohn disease. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - July 19, 2017 Category: Gastroenterology Authors: Sahil Khanna, Laura E. Raffals Source Type: research

Sexuality, Fertility, and Pregnancy in Crohn's Disease
Many factors influence the sexual health of people with Crohn disease but active disease and depression play key roles. The fertility rate in nonoperated patients with inflammatory bowel disease with quiescent disease is similar to the general population. Crohn disease can increase the risk for adverse pregnancy outcomes, but being in remission on a stable, steroid-free medication regimen for at least 3 months before conception and adhering to the treatment throughout pregnancy can improve outcomes. Infants with intrauterine exposure to anti –tumor necrosis factor medications should avoid live vaccines for the first ...
Source: Gastroenterology Clinics of North America - July 19, 2017 Category: Gastroenterology Authors: Jill K.J. Gaidos, Sunanda V. Kane Source Type: research

Targeting Specific Immunologic Pathways in Crohn's Disease
Understanding the immunologic pathways in intestinal inflammation is crucial for the development of new therapies that can maximize patient response and minimize toxicity. Targeting integrins and cytokines is intended to control leukocyte migration to effector sites or inhibit the action of proinflammatory cytokines. New approaches to preventing leukocyte migration may target integrin receptors expressed on the intestinal vascular endothelium. The IL-12/IL-23 pathway has been a therapeutic target of interest in controlling active Crohn disease (CD). New therapeutic approaches in CD may involve the enhancement of antiinflam...
Source: Gastroenterology Clinics of North America - July 19, 2017 Category: Gastroenterology Authors: Guilherme Piovezani Ramos, William A. Faubion, Konstantinos A. Papadakis Source Type: research

IgG4-related Disease and the Liver
This article focuses on helping pathologists diagnose IgG4-related disease in the hepatobiliary system. Missing the diagnosis can result in unnecessary organ damage and/or unnecessary surgical and cancer therapy. In the liver, tumefactive lesion(s) involving the bile ducts with storiform fibrosis and an IgG4-enriched lymphoplasmacytic infiltrate are highly concerning for IgG4-related disease. The recent identification of oligoclonal populations of T  cells and B cells in IgG4-related disease may lead to molecular tests, new therapeutics, and a greater mechanistic understanding of the disease. (Source: Gastroenterology...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Jonathan H. Chen, Vikram Deshpande Source Type: research

Current Concepts in Pediatric Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disease. Its increasing prevalence is a direct result of historically high rates of obesity. Hepatocyte lipid accumulation is the first step in a cascade of metabolic and inflammatory events thought to precipitate NAFLD. Histologic findings provide insight into these events. Lifestyle modification remains the primary therapy in children. Current recommendations include vitamin E treatment in those with biopsy-proven NASH. Trials of novel drugs are ongoing in adults. As efficacy/safety are established, these therapies may be tenable for use in children. At th...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Sarah E. Fleet, Jay H. Lefkowitch, Joel E. Lavine Source Type: research

Hepatocellular Adenomas
Hepatocellular adenomas (HCAs) are rare benign tumors. This single entity has been split into 3 subtypes corresponding to specific mutations: HNF1 α-inactivated HCA; inflammatory HCA related to different mutations, all leading to activation of STAT3 pathway; and β-catenin–activated HCA related to CTNNB1 mutations. The risk of malignant transformation depends on the level of β-catenin activation, reported mainly for exon 3, including S45. It is possible using specific immunohistochemical markers to identify the 3 different HCA subtypes and the level of β-catenin activation. Fewer than 10% of HCAs ...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Paulette Bioulac-Sage, Christine Sempoux, Charles Balabaud Source Type: research

Drug-induced Liver Injury
The evaluation of liver biopsies in suspected drug-induced liver injury (DILI) can be complex. The biopsy may be approached systematically, by identification of histologic lesions and then identification of the overall pattern of injury. Potential DILI must be separated from concomitant non-DILI liver disease. The findings can be analyzed with respect to the various prescription and nonprescription medications and dietary supplements under suspicion to provide a complete interpretation of the findings. The pathologic findings, the histologic differential diagnosis, and expert interpretation are part of a complete biopsy as...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: David E. Kleiner Source Type: research

Antibody-Mediated Rejection After Liver Transplant
Antibody-mediated rejection (AMR) in liver transplants is a field in its infancy compared with its allograft cohorts of the kidney and lung. Acute AMR is diagnosed based on specific clinical and histopathologic criteria: serum donor specific antibodies, C4d staining, histopathologic findings on liver biopsy, and exclusion of other entities. In contrast, the histologic features of chronic AMR are not as specific and it is a more challenging diagnosis to make. Treatments of acute and chronic AMR include some combination of steroids, immune-modulating agents, intravenous immunoglobulin, plasmapheresis, and proteasome inhibito...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Michael Lee Source Type: research

Immunohistochemistry in the Diagnosis of Hepatocellular Carcinoma
This article describes advantages and disadvantages of immunohistochemical markers that are most commonly used to distinguish between these lesions. Diagnostic workup of malignant liver mass (HCC and its histologic variants vs metastatic tumor) as well as well-differentiated hepatocellular lesion (well-differentiated HCC vs focal nodular hyperplasia vs hepatocellular adenoma) is also discussed. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Won-Tak Choi, Sanjay Kakar Source Type: research

Human Immunodeficiency Virus Infection, Antiretroviral Therapy, and Liver Pathology
The improvement in antiretroviral therapy has significantly impacted the lives of people living with human immunodeficiency virus (HIV). In high-income countries, HIV deaths are predominated by liver disease consequent to viral hepatitis coinfection, alcohol, and nonalcoholic fatty liver disease. Published liver pathology findings have shifted from being predominated by opportunistic infections to the metabolic effects of HIV and antiretroviral therapy as well as drug-induced liver injuries. Differences remain between high-income and low-income countries, where opportunistic infections and immune reconstitution syndromes, ...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Mark W. Sonderup, Helen Cecilia Wainwright Source Type: research

Autoimmune Hepatitis Overlap Syndromes and Liver Pathology
Autoimmune hepatitis (AIH) may have an atypical serum alkaline phosphatase elevation, antimitochondrial antibodies, histologic features of bile duct injury/loss, or cholangiographic findings of focal biliary strictures and dilations. These manifestations characterize the overlap syndromes. Patients can be classified as having AIH with features of primary biliary cholangitis, primary sclerosing cholangitis, or a cholestatic syndrome. The gold standard of diagnosis is clinical judgment. Histologic evaluation is a major diagnostic component. Treatment is based on algorithms; outcomes vary depending on the predominant disease ...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Albert J. Czaja, Herschel A. Carpenter Source Type: research

Morphologic Subtypes of Hepatocellular Carcinoma
Hepatocellular carcinomas can be further divided into distinct subtypes that provide important clinical information and biological insights. These subtypes are distinct from growth patterns and are on based on morphologic and molecular findings. There are 12 reasonably well-defined subtypes as well as 6 provisional subtypes, together making up 35% of all hepatocellular carcinomas. These subtypes are discussed, with an emphasis on their definitions and the key morphologic findings. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Michael S. Torbenson Source Type: research

Hepatitis E Virus and the Liver
Infection with hepatitis E virus (HEV) is a leading cause of acute hepatitis worldwide, now increasingly recognized also in nonendemic regions. Clinical manifestation of hepatitis E includes mostly asymptomatic/subclinical presentations or acute, self-limiting hepatitis, but also potentially fatal liver failure or chronic hepatitis in immunocompromised individuals. Accordingly, hepatitis E histolpathologic patterns range from an unremarkable histology over acute (cholestatic) hepatitis with variable degree of necrosis to chronic hepatitis with fibrosis. Awareness of hepatitis E and its differential diagnoses, knowledge of ...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Daniela Lenggenhager, Achim Weber Source Type: research

Hepatic Progenitor Cells
Liver regeneration is a fascinating and complex process with many medical implications. An important component of this regenerative process is the hepatic progenitor cell (HPC). These appealing cells are able to participate in the renewal of hepatocytes and cholangiocytes when the normal homeostatic regeneration is exhausted. Moreover, the HPC niche is of vital importance toward the activation, differentiation, and proliferation of the HPC. This niche provides a rich microenvironment for the regulation of the HPC, thanks to the intercellular secretion of molecules. New findings indicate that the regenerative possibilities ...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Matthias Van Haele, Tania Roskams Source Type: research

Heart Disease and the Liver
This article discusses the concepts of acute cardiogenic liver injury (ACLI) and cardiac or congestive hepatopathy (CH) along with their clinical manifestations and sequelae. Histologically, ACLI manifests as centrilobular hepatocellular necrosis, whereas CH is associated with centrilobular hepatocyte atrophy, dilated sinusoids, and perisinusoidal fibrosis, progressing to bridging fibrosis and ultimately cirrhosis. ACLI is associated with marked increases in aminotransferase levels, whereas CH is associated with a cholestatic pattern of laboratory tests. Certain cardiac medications have also been implicated as a cause of l...
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Anne Knoll Koehne de Gonzalez, Jay H. Lefkowitch Source Type: research

Contemporary Evaluation of the Pediatric Liver Biopsy
Liver disease in the neonate, infant, child, and adolescent may manifest differently depending on the type of disorder. These disorders show marked overlap clinically and on light microscopy. Histology and ultrastructural examination are used in tandem for the diagnosis of most disorders. A final diagnosis or interpretation of the pediatric liver biopsy depends on appropriate and adequate clinical history, laboratory test results, biochemical assays, and molecular analyses, as indicated by the light microscopic and ultrastructural examination. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Deborah A. Schady, Milton J. Finegold Source Type: research

Liver Pathology
GASTROENTEROLOGY CLINICS OF NORTH AMERICA (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Authors: Jay H. Lefkowitch Source Type: research

Copyright
Elsevier (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Source Type: research

Contributors
JAY H. LEFKOWITCH, MD (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Source Type: research

Contents
Jay H. Lefkowitch (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Source Type: research

Forthcoming Issues
Crohn's Disease (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Source Type: research

Index
Note: Page numbers of article titles are in boldface type. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 13, 2017 Category: Gastroenterology Source Type: research