MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Current Gastroenterology Reports' source. Sun, 21 Mar 2010 15:07:52 +0100 http://www.medworm.com/index.php?rid=3386409&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa05jx60876103331%2F Abstract  Acute pancreatitis is a common cause for hospitalization that carries a substantial burden of disease in the United States and worldwide. Recent reports have encompassed a wide array of topics including new insights into the acinar cell pH microenvironment, signal pathways for acinar cell fate, and the innate immune response. Clinical researchers have reported new methods to assess disease severity, innovative techniques for management of local complications, the importance of early recognition of pancreatic or extrapancreatic infection, and prevention of disease recurrence. Recent data also suggest that specialized centers may be of benefit for the management of severe acute pancreatitis. This review summarizes a number of recent advances in basic and clinical sc... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3386409 Thu, 18 Mar 2010 15:26:16 +0100 3386409 http://www.medworm.com/index.php?rid=3371714&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fbvp2x844k4464524%2F This article reviews the recognized findings, advantages, and disadvantages of the various imaging modalities in the management of chronic pancreatitis, specifically CT, MRI with or without MRCP and/or S-MRCP, ERCP, and EUS. Content Type Journal ArticleDOI 10.1007/s11894-010-0093-4Authors Nabil Elia Choueiri, Saint Louis University Health Sciences Center Division of Gastroenterology and Hepatology 3635 Vista Avenue at Grand Boulevard, 9th Floor Saint Louis MO 63110 USANuman Cem Balci, Saint Louis University Health Sciences Center Department of Radiology St. Louis MO USASamer Alkaade, Saint Louis University Health Sciences Center Division of Gastroenterology and Hepatology 3635 Vista Avenue at Grand Boulevard, 9th Floor Saint Louis MO 63110 USAFrank R. Burton, Saint Louis Universit... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3371714 Mon, 15 Mar 2010 18:00:22 +0100 3371714 http://www.medworm.com/index.php?rid=3371715&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj40x68n65792v71v%2F Abstract  Many childhood pancreatic disorders are rare, although they can represent significant and potentially severe disease. The spectrum of disease is very broad, ranging from the complex and bizarre congenital anomalies to the more typical acquired causes (eg, drug-induced pancreatitis or trauma injury). Genetics appears to play a major role in many childhood pancreas diseases, unlike adults where alcohol is a major factor. Nevertheless, there are similarities, and most of the disorders discussed here can be found in both the pediatric and adult age groups. Some of these disorders may be evolving and may be seen in both young and older patients. Newer imaging modalities and therapeutic endoscopy continue to be studied, although their ultimate role and utility in childr... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3371715 Mon, 15 Mar 2010 18:00:15 +0100 3371715 http://www.medworm.com/index.php?rid=3360809&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa521264v10842867%2F Abstract  Both autoimmune pancreatitis (AIP) and pancreatic cancer frequently present with obstructive jaundice. However, AIP is a rare disease and its diagnosis carries vastly different therapeutic and prognostic implications compared with that of pancreatic cancer. The clinical challenge is to distinguish AIP from pancreatic cancer, because the price of misdiagnosis can be heavy. Recently, two strategies for differentiating AIP from pancreatic cancer were published, one from Japan and the other from the United States. The Japanese strategy relies on cross-sectional imaging, endoscopic retrograde pancreatogram, and serum IgG4. The American strategy uses imaging (CT scan), serology (serum IgG4), and evidence of other organ involvement (on CT scan) as the first tier of tests... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3360809 Thu, 11 Mar 2010 18:26:57 +0100 3360809 http://www.medworm.com/index.php?rid=3360810&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg6j6n7064144254r%2F This article reviews current guidelines for the evaluation of pancreatic cystic lesions, underscores the challenges posed by these lesions, and discusses current and future studies that will aid in patient management. Content Type Journal ArticleDOI 10.1007/s11894-010-0097-0Authors Brian G. Turner, Massachusetts General Hospital Gastroenterology Unit, 55 Fruit Street Boston MA 02114 USAWilliam R. Brugge, Massachusetts General Hospital Gastroenterology Unit, 55 Fruit Street Boston MA 02114 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3360810 Thu, 11 Mar 2010 02:24:27 +0100 3360810 http://www.medworm.com/index.php?rid=3360812&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp06v5556h5w7h145%2F Abstract  Sphincter of Oddi dysfunction (SOD) is a poorly-understood disorder, typically presenting as postcholecystectomy, “biliary-type,” right-sided abdominal and/or chest wall pain. Most patients referred to specialist clinics for work-up of presumed SOD do not, in fact, have anything wrong with their bile ducts or biliary sphincter mechanisms. A careful history and focused physical examination will often identify the true source of the pain syndrome, ranging from chest wall costochondritis and nerve injury at surgical trochar sites, to gastroparesis and visceral hypersensitivity (“irritable bowel”). The Rome III classification of functional gallbladder and biliary disorders defines SOD as episodic (not daily) pain lasting more than 30 min, which is disrupt... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3360812 Thu, 11 Mar 2010 02:24:24 +0100 3360812 http://www.medworm.com/index.php?rid=3360811&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fyqu43665046q5290%2F Abstract  Current methods for imaging the biliary tree include ultrasound, CT, MRI, endoscopic retrograde cholangiography, and endoscopic ultrasound (EUS). Bile duct abnormalities may be identified during evaluation of patient symptoms or laboratory abnormalities, or incidentally during imaging for another problem. Biliary dilatation, when identified, may be separated into obstructive or nonobstructive causes. Clinical presentation should guide decisions on which, if any, additional investigations are necessary. Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state. Data are limited regarding the yield of further investigati... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3360811 Thu, 11 Mar 2010 02:24:24 +0100 3360811 http://www.medworm.com/index.php?rid=3360813&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft571r2w10p778t78%2F Abstract  Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure routinely performed by endoscopists. ERCP cannulation requires the insertion of a subcentimeter catheter through a tiny orifice at a distance of almost a meter from the operator. Only after successful cannulation of the bile duct can the real “business” of ERCP be performed (eg, sphincterotomy, stone extraction, stent placement). Selective bile duct cannulation is all the more exacting due to the occasional anatomic challenge (eg, postsurgical anatomy, duodenal stricture) or wayward catheter. Serious morbid complications can and do occur, even in the hands of the most gifted and facile endoscopists. Although there are some “tricks” to facilitate successful c... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3360813 Wed, 10 Mar 2010 16:20:22 +0100 3360813 http://www.medworm.com/index.php?rid=3328660&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff877x423478ug170%2F This article reviews existing data and focuses on established and emerging EUS techniques for accessing and draining the bile and pancreatic ducts. Content Type Journal ArticleDOI 10.1007/s11894-010-0090-7Authors Michael J. Levy, Mayo Clinic College of Medicine Division of Gastroenterology and Hepatology 200 First Street SW, Charlton 8 Rochester MN 55905 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3328660 Tue, 02 Mar 2010 10:08:00 +0100 3328660 http://www.medworm.com/index.php?rid=3315573&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg3848470mn581627%2F Abstract  Inherited syndromes of intrahepatic cholestasis and biliary atresia are the most common causes of chronic liver disease and the prime indication for liver transplantation in children. Our understanding of the pathogenesis of these diseases has increased substantially by the discovery of genetic mutations in children with intrahepatic cholestasis and the findings that inflammatory circuits are operative at the time of diagnosis of biliary atresia. Building on this solid foundation, recent studies provide new insight into genotype-phenotype relationships and how mutations produce altered bile composition and cholestasis. New evidence exists that although liver transplantation is curative for patients with end-stage liver disease owing to cholestasis, some patients m... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3315573 Thu, 25 Feb 2010 17:58:51 +0100 3315573 http://www.medworm.com/index.php?rid=3313058&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn8230p28153622v0%2F Abstract  Treatment for chronic hepatitis C virus (HCV) infection is the combination of a peginterferon and ribavirin. Although a fixed duration of treatment (24 weeks for patients with genotypes 2 and 3 and 48 weeks for patients with all other genotypes) has been advocated, the best results are likely to be achieved when the duration of therapy is adjusted based on the time to response. According to the principles of response-guided therapy, patients with rapid virologic response have a high rate of sustained virologic response (SVR) and a low rate of relapse, and can be treated for 24 weeks regardless of genotype. In contrast, patients who become HCV RNA undetectable at a slower rate need a longer duration of therapy. Direct-acting antiviral agents are curre... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3313058 Thu, 25 Feb 2010 08:02:45 +0100 3313058 http://www.medworm.com/index.php?rid=3308626&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu57874076j267261%2F Abstract  Lipid droplet accumulation and oxidant stress, once thought to play essential roles in the pathogenesis of nonalcoholic steatohepatitis (NASH), may actually represent parallel epiphenomena. Emerging data now point to nontriglyceride lipotoxicity and complex mechanisms of hepatocyte injury and apoptosis as the major contributors to the disease phenotype currently recognized as NASH. Although specific mediators of hepatic lipotoxicity have not been identified with certainty, abundant evidence from animal studies and recent data in humans indicate that free fatty acids in the liver can serve as substrates for formation of nontriglyceride lipotoxic metabolites that cause liver injury. The accumulation of triglyceride in droplets may actually be protective, and thus th... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3308626 Wed, 24 Feb 2010 06:55:54 +0100 3308626 http://www.medworm.com/index.php?rid=3247959&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp35744543m64k553%2F This article focuses on the common natural variants and those secondary to nucleos(t)ide therapy, as well as diagnostic methods to detect resistance. Content Type Journal ArticleDOI 10.1007/s11894-009-0088-1Authors Fred Poordad, Cedars-Sinai Medical Center David Geffen School of Medicine at UCLA, Hepatology and Liver Transplantation 8635 West Third Street, Suite 1060 Los Angeles CA 90048 USAGrace M. Chee, Cedars-Sinai Medical Center Hepatology and Liver Transplantation 8635 West Third Street, Suite 1060 Los Angeles CA 90048 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3247959 Fri, 05 Feb 2010 18:19:33 +0100 3247959 http://www.medworm.com/index.php?rid=3241327&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj218685686332l15%2F Abstract  Wilson disease, a genetic disorder of copper metabolism, presents typically in the second and third decades of life with hepatic or neuropsychiatric disease. Clinical presentations often vary depending on age and degree of onset; although clinical and biochemical testing can usually establish a diagnosis, the data are difficult to interpret in some patients. Correctly identifying patients from nonaffected carriers is important because treatment is lifelong. Genetic testing has greatly improved the ability to diagnose Wilson disease in affected patients and in their siblings even without clear-cut clinical and biochemical data. Direct sequencing of ATP7B for disease-specific mutations is now the standard for molecular diagnosis. However, haplotype analysis is useful... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3241327 Tue, 02 Feb 2010 18:32:07 +0100 3241327 http://www.medworm.com/index.php?rid=3224054&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx02r8g651648k253%2F Abstract  Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are the two most common causes of chronic cholestatic liver disease in adults. In PBC, therapy with ursodeoxycholic acid (UDCA) is safe and has been associated with tangible biochemical, histologic, and survival benefits. However, a need for different or adjuvant therapies remains for specific subsets of PBC patients, including those who do not respond to UDCA and those who have advanced histologic disease at presentation. Similarly, beneficial therapies for disease-related symptoms that do not typically respond to UDCA (eg, fatigue and pruritus) are still needed. In contrast to PBC, no medical therapy of proven benefit has been identified for patients with PSC. In PBC and PSC, adequate manag... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3224054 Thu, 28 Jan 2010 18:05:15 +0100 3224054 http://www.medworm.com/index.php?rid=3224056&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr55m4p552kr10023%2F Abstract  Cryptogenic cirrhosis remains a common clinical condition although recent advances have allowed for a better understanding of underlying conditions and associations. The evolving terminology applied to this condition has resulted in some confusion and persistent variation among pathologists and clinicians. Typical patients are middle aged with only minor liver enzyme abnormalities. Presentations range from incidentally discovered cirrhosis to complications of advanced portal hypertension and hepatocellular cancer. Clinicopathologic analysis of these patients indicates that the leading causes include previously unrecognized nonalcoholic steatohepatitis, silent autoimmune hepatitis, non-B, non-C viral hepatitis, and occult past ethanol exposure. In this article, we ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3224056 Wed, 27 Jan 2010 20:01:28 +0100 3224056 http://www.medworm.com/index.php?rid=3224055&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F25g827154j696057%2F Abstract  Progressive hepatic fibrosis is the final common pathway for most chronic liver injuries, leading to cirrhosis with risk of liver failure and hepatocellular carcinoma. It is now recognized that fibrosis is a dynamic process, and may be reversible prior to the establishment of advanced architectural changes to the liver. The most effective antifibrotic strategy is to cure the underlying disease process before advanced fibrosis has developed. Unfortunately, this is often not possible, and specific antifibrotic therapies are needed. Advances in the understanding of the pathogenesis of liver fibrosis have identified several potential novel therapeutic targets, but unfortunately clinical development has been disappointing. One major limitation has been the often prolon... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3224055 Wed, 27 Jan 2010 20:01:28 +0100 3224055 http://www.medworm.com/index.php?rid=3224057&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F9135jg5504w27q00%2F Abstract  The Baby Boomer generation is composed of 78 million Americans who are just beginning to reach their retirement years. Most Boomers have at least one chronic health problem, and these significantly increase the expense of providing medical care. Liver disease is the 12th most common cause of death in the United States, representing a relatively small portion of overall healthcare costs compared with cardiovascular disease and malignancy. Nonetheless, hepatitis C and fatty liver disease are more common in the Boomers and may play a more dominant role as they age. As a consequence, primary liver cancer is likely to become more prevalent. As with most chronic illnesses, prevention rather than disease management is likely to have the greatest impact. For those already... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3224057 Wed, 27 Jan 2010 20:01:27 +0100 3224057 http://www.medworm.com/index.php?rid=3214089&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3266470226g81766%2F Abstract  Profound advances in our knowledge of hereditary hemochromatosis (HH) during the past 150 years have resulted in two distinct “iron ages”: the pre-HFE gene era and the post-HFE gene era. During these periods, family studies, HLA association studies, and ultimately HFE gene studies in various populations informed us of the genotypic prevalence as well as the clinical and biochemical penetrance of HH. We learned that HH has a highly variable clinical penetrance in susceptible individuals of Northern European ancestry. Further, we now recognize that the natural history of HH is not as discrete as previously believed, because genetic and environmental modifiers of disease penetrance are increasingly identified as influencing the clinical expression of HH. Co... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3214089 Tue, 26 Jan 2010 07:07:10 +0100 3214089 http://www.medworm.com/index.php?rid=3190952&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F32v7xm8705458162%2F Abstract  Hepatology has matured significantly over the past two decades, and most gastroenterologists now believe that it is a distinct subspecialty. An unmet public health need exists for professional expertise in the care of patients with liver diseases. However, our current training programs are struggling to adequately recruit and train physicians with the appropriate expertise in advanced and transplant hepatology. This review briefly summarizes the recent discoveries and developments in clinical hepatology, describes the past and current training paradigms, and suggests potential pathways to improve the number and quality of physicians trained in advanced and transplant hepatology. Content Type Journal ArticleDOI 10.1007/s11894-009-0086-3Authors Bruce A. Luxon, G... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3190952 Mon, 18 Jan 2010 18:25:28 +0100 3190952 http://www.medworm.com/index.php?rid=3041437&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk52u383614kw002t%2F Abstract  Nutritional status influences hormone secretion from specialized enteroendocrine cells within the gut mucosa. These hormones regulate food intake by mediating information to central neurocircuitries in the brainstem and forebrain (eg, hypothalamic nuclei). Intestinal enteroendocrine cells were believed to be the main source of gut peptides regulating food intake. However, recent evidence highlights a specific endocrine cell within the oxyntic glands of the stomach as an important player in appetite control. Acylated ghrelin is the only known orexigenic hormone peripherally produced in gastric X/A-like cells and centrally acting to stimulate food intake. Recent advances led to the assumption that des-acylated ghrelin, coreleased with acylated ghrelin, is also invol... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041437 Sun, 29 Nov 2009 09:36:54 +0100 3041437 http://www.medworm.com/index.php?rid=3041436&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu04j47121401q1g8%2F Abstract   Helicobacter pylori infection causes chronic active gastritis, ulcer disease, and gastric cancer. Current eradication regimens use a proton pump inhibitor (PPI) and two antibiotics. Triple therapy now has a success rate less than 80%, below the cutoff for efficacious eradication. Antibiotic resistance, inconsistent acid control by PPIs, and poor patient compliance contribute to the failure rate. H. pylori is a neutralophile that has developed special acid acclimation mechanisms to colonize its acidic gastric niche. Identifying the components of these mechanisms will provide novel bactericidal drug targets. Alternatively, better 24-hour acid control would increase the efficacy of antibiotics, leading to dual therapy with improved PPIs and amoxicillin. Studies of a... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041436 Sun, 29 Nov 2009 09:36:54 +0100 3041436 http://www.medworm.com/index.php?rid=3041440&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F214w566466061q14%2F Abstract  Autoimmune and antimicrobial antibodies currently play only an adjunctive role in the diagnosis of inflammatory bowel disease (IBD). Their sensitivity and specificity are not high enough to be relied upon alone to secure a diagnosis; however, their most promising role seems to be in identifying Crohn’s disease patients at a higher risk of progression to intestinal complications. Serum C-reactive protein (CRP) correlates well with other measures of biologic activity but not as well with clinical activity. CRP can help predict IBD relapses, and in patients with severely active ulcerative colitis may indicate which patients are most likely to progress to colectomy. Similarly, fecal lactoferrin and calprotectin are reasonably accurate and noninvasive measures of dis... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041440 Sun, 29 Nov 2009 09:36:53 +0100 3041440 http://www.medworm.com/index.php?rid=3041439&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa87k7p53418j02h2%2F Abstract  Conventional therapies remain the mainstay of treatment for most patients with inflammatory bowel disease (IBD), with only a minority of patients requiring biologic therapies. Recently, attention has focused on optimizing dosing strategies for biologic agents; however, of equal importance are recent advances in the optimization of conventional IBD therapies. Newer aminosalicylate formulations demonstrate similar efficacy with a reduced pill burden and less frequent dosing, while new corticosteroid preparations may retain efficacy with a significantly improved safety profile. The limited indications for antibiotics and probiotics have been further refined by recent data, although uncertainties remain. Advances in the understanding of thiopurine metabolism continue ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041439 Sun, 29 Nov 2009 09:36:53 +0100 3041439 http://www.medworm.com/index.php?rid=3041438&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj65p136324l7254r%2F This article summarizes recent knowledge on factors influencing the natural history of IBD, including the impact of treatment. Increased understanding of disease mechanisms is needed as a basis for new treatment strategies in the future. Content Type Journal ArticleDOI 10.1007/s11894-009-0073-8Authors Morten H. Vatn, University of Oslo, Medical Clinic, Oslo University Hospital, Rikshospitalet The Institute of Clinical Epidemiology and Molecular Biology (EpiGen), Faculty Division AHUS 0027 Oslo Norway Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 6 / December, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041438 Sun, 29 Nov 2009 09:36:53 +0100 3041438 http://www.medworm.com/index.php?rid=3041441&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh802428627600830%2F Abstract  Gastric acid hypersecretory states are characterized by basal hypersecretion of gastric acid and historically include disorders associated with hypergastrinemia, hyperhistaminemia, and those of unknown etiology. Although gastric acid secretion is infrequently measured, it is important to recognize the role of gastric hypersecretion in the symptoms of these disorders because they share several features of pathogenesis and treatment. In this article, recent important articles reporting insights into their diagnosis, pathogenesis, and treatment are reviewed. Particular attention is paid to Zollinger-Ellison syndrome, because it has the most extreme acid hypersecretion of this group of disorders and because numerous recent articles deal with various aspects of the dia... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041441 Sun, 29 Nov 2009 09:36:52 +0100 3041441 http://www.medworm.com/index.php?rid=3041443&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg032k79726768u10%2F Abstract  Upper gastrointestinal bleeding from peptic ulcer disease is a common clinical event, resulting in considerable patient morbidity and significant health care costs. Inhibiting gastric acid secretion is a key component in improving clinical outcomes, including reducing rebleeding, transfusion requirements, and surgery. Raising intragastric pH promotes clot stability and reduces the influences of gastric acid and pepsin. Patients with high-risk stigmata for ulcer bleeding (arterial bleeding, nonbleeding visible vessels, and adherent clots) benefit significantly from and should receive high-dose intravenous proton pump inhibitors (PPIs) after successful endoscopic hemostasis. For patients with low-risk stigmata (flat spots or clean ulcer base), oral PPI therapy alone... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041443 Sun, 29 Nov 2009 09:36:50 +0100 3041443 http://www.medworm.com/index.php?rid=3041442&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F156203001w72624q%2F Abstract  Successful management of the patient with inflammatory bowel disease (IBD) involves not only the induction and maintenance of remission, but also the optimization of the benefit-to-risk equation to achieve the greatest gain in quality of life. These risks range from intolerance to prescribed medications to potentially life-threatening sequelae (eg, sepsis) of immune suppression. A proper awareness of risk on the part of the physician and education of the patient can lead to early detection and institution of an appropriate management plan, including risk management and, optimally, primary prevention (eg, prophylactic vaccination). One should take the opportunity regularly to reassess the utility and efficacy of existing therapy, with the provision of ineffective t... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041442 Sun, 29 Nov 2009 09:36:50 +0100 3041442 http://www.medworm.com/index.php?rid=3041445&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp57p5375p221242g%2F This article focuses on the recent advances in understanding of IBD from the past year, including advances in genetics and immunobiology. Content Type Journal ArticleDOI 10.1007/s11894-009-0072-9Authors David Q. ShihStephan R. Targan, Cedars-Sinai Inflammatory Bowel Disease Center 8700 Beverly Boulevard, Suite D4063 Los Angeles CA 90048 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 6 / December, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041445 Sun, 29 Nov 2009 09:36:48 +0100 3041445 http://www.medworm.com/index.php?rid=3041444&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy120l75135438ml4%2F Abstract  The mechanisms by which the gut senses and responds to nutrients involve the interplay of multiple complex pathways. In addition to regulating digestion and absorption, the pathways stimulated by molecules in the gut lumen mediate gastric motility, food intake, and satiety. Furthermore, protective mechanisms are activated as necessary to prevent injury, promote healing, and limit intake and absorption of potentially toxic substances. This review provides an update on the current knowledge and recent findings related to gastric sensing of nutrients, highlighting recent research and future endeavors in the field. Content Type Journal ArticleDOI 10.1007/s11894-009-0068-5Authors Arushi deFonsekaJonathan Kaunitz, West Los Angeles VA Medical Center Building 114, Suit... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041444 Sun, 29 Nov 2009 09:36:48 +0100 3041444 http://www.medworm.com/index.php?rid=3041447&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn7x1534703gl4594%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0066-7Authors Joseph R. Pisegna, David Geffen School of Medicine at UCLA Los Angeles USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 6 / December, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041447 Sun, 29 Nov 2009 09:36:47 +0100 3041447 http://www.medworm.com/index.php?rid=3041446&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx5t5967563733395%2F Abstract  The introduction of biologic agents and particularly of anti-tumor necrosis factor antibodies dramatically changed the therapeutic algorithm in patients with inflammatory bowel diseases. Although the efficacy of these agents has been demonstrated clearly, optimal treatment strategies are debated. Recent trials advocate the introduction of biologic agents at an early stage to prevent debilitating complications. However, significant adverse events have led to careful selection of patients who will benefit most from long-term treatment with biologic agents. Once on biologic therapy, scheduled maintenance therapy is recommended to minimize the risk of loss of response. Nevertheless, treatment adaptation is frequently necessary in patients who lose response. Interventi... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=3041446 Sun, 29 Nov 2009 09:36:47 +0100 3041446 http://www.medworm.com/index.php?rid=2816229&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx26859w2343833t3%2F This article provides an update on the evaluation and treatment of common anorectal disorders. Content Type Journal ArticleDOI 10.1007/s11894-009-0062-yAuthors Brian E. Lacy, Dartmouth-Hitchcock Medical Center Division of Gastroenterology and Hepatology Area 4C, 1 Medical Center Drive Lebanon NH 03756 USAKirsten Weiser Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816229 Sun, 20 Sep 2009 05:37:47 +0100 2816229 http://www.medworm.com/index.php?rid=2816230&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn6346p8217234350%2F Abstract  Young women with inflammatory bowel disease (IBD) pose a unique set of challenges. These women and their treating physicians must make difficult choices in matters regarding conception, pregnancy, and breastfeeding. This review highlights recent evidence and management issues that arise when taking care of women with IBD in terms of fertility, outcomes, and medication safety in pregnancy and breastfeeding. Ultimately, treatment must be individualized for each patient based on the available evidence and the woman’s preferences. Content Type Journal ArticleDOI 10.1007/s11894-009-0059-6Authors Maria MoscandrewSunanda Kane, Mayo Clinic College of Medicine Division of Gastroenterology and Hepatology 200 First Street SW Rochester MN 55905 USA Journal Current... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816230 Sun, 20 Sep 2009 05:37:46 +0100 2816230 http://www.medworm.com/index.php?rid=2816233&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv750002n53076n40%2F Abstract   Clostridium difficile infection (CDI) is the most important cause of nosocomial diarrhea. The emergence of a hypervirulent strain and other factors including antibiotic overuse contribute to the increasing incidence and severity of this potentially lethal infection. CDI has been reported in persons previously considered as low risk, such as young healthy persons without exposure to health care settings or antibiotics, peripartum women, and children. In patients with inflammatory bowel disease, the risk of C. difficile infection is even greater, with higher rates of hospitalization, bowel surgery, and mortality. With increasing incidence and severity of disease, the need for improved diagnostic, treatment, and infection control strategies cannot be overstated. C... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816233 Sun, 20 Sep 2009 05:37:44 +0100 2816233 http://www.medworm.com/index.php?rid=2816232&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd2r7w776784g2843%2F Abstract  Serotonin (5-hydroxytryptamine, 5-HT) participates in several functions of the gastrointestinal tract. Receptors in seven families (5-HT1-5-HT7) were identified, many of which are present on enterocytes, intrinsic and extrinsic neurons, interstitial cells, and gut myocytes. Most 5-HT is released from enterochromaffin cells in response to physiologic and pathologic stimuli. Roles of 5-HT in health include control of normal gut motor activity, secretion, and sensation, and regulation of food intake and cell growth. Abnormalities of serotonergic function contribute to symptom genesis in functional bowel disorders, inflammatory and infectious diseases of the gut, emetic responses to varied stimuli, obesity, and dysregulation of cell growth. Therapies acting as agonists... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816232 Sun, 20 Sep 2009 05:37:44 +0100 2816232 http://www.medworm.com/index.php?rid=2816231&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm482716k16853678%2F Abstract  NSAIDs incur significant gastrointestinal (GI) side effects. The complication risk increases with history of peptic ulcer or older age. Helicobacter pylori infection and cardioprotective aspirin have independent and additive risks in the presence of NSAID use. NSAID enteropathy is increasingly recognized. Cardiovascular and GI risk stratification and H. pylori infection testing should be done before initiating NSAIDs. An NSAID combined with a proton pump inhibitor (PPI) is comparable to cyclooxygenase (COX)-2 inhibitors for gastroprotection, but for high-risk patients, COX-2 plus PPI should be considered. Aspirin and COX-2 inhibitors are associated with reduced colon adenoma risk, but higher dose and longer duration of treatment with aspirin appears effective. Henc... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816231 Sun, 20 Sep 2009 05:37:44 +0100 2816231 http://www.medworm.com/index.php?rid=2816234&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F420817135824q117%2F Abstract  Inflammatory markers play a key role in the evaluation of patients with gastrointestinal symptoms. For patients presenting with nonspecific symptoms of abdominal pain and diarrhea, distinguishing inflammatory bowel disease from other disorders can be difficult, and invasive diagnostic procedures may be required. Inflammatory markers can be useful to differentiate patients who may require further workup from those who do not. Several serum, fecal, and other markers are reviewed for their use in clinical practice. Although no single ideal marker exists, a few show promise in diagnosing inflammatory disease, monitoring disease activity, and predicting relapse. Content Type Journal ArticleDOI 10.1007/s11894-009-0055-xAuthors Bincy P. Abraham, Baylor College of Med... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816234 Sun, 20 Sep 2009 05:37:43 +0100 2816234 http://www.medworm.com/index.php?rid=2816236&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb364t60126436836%2F Abstract  In addition to their roles in facilitating lipid digestion and absorption, bile acids are recognized as important regulators of intestinal function. Exposure to bile acids can dramatically influence intestinal transport and barrier properties; in recent years, they have also become appreciated as important factors in regulating cell growth and survival. Indeed, few cells reside within the intestinal mucosa that are not altered to some degree by exposure to bile acids. The past decade saw great advances in the knowledge of how bile acids exert their actions at the cellular and molecular levels. In this review, we summarize the current understanding of the role of bile acids in regulation of intestinal physiology. Content Type Journal ArticleDOI 10.1007/s11894-009... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816236 Sun, 20 Sep 2009 05:37:42 +0100 2816236 http://www.medworm.com/index.php?rid=2816235&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk36528013n5381r4%2F This article focuses on the etiologies of diarrhea that are seen with higher incidence in diabetic patients. Content Type Journal ArticleDOI 10.1007/s11894-009-0054-yAuthors Milena GouldJoseph H. Sellin, Baylor College of Medicine Section of Gastroenterology 1709 Dryden Road, Suite 8.36 Houston TX 77030 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816235 Sun, 20 Sep 2009 05:37:42 +0100 2816235 http://www.medworm.com/index.php?rid=2816238&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj843754567321277%2F Abstract  Serrated adenomas are categorized as sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs). SSAs are more prevalent in the proximal colon and lack classic dysplasia, whereas TSAs are more prevalent in the rectosigmoid and have cytologic dysplasia. Serrated adenomas may progress to colorectal adenocarcinoma through diverse molecular alterations. Colonoscopy is the only test for the early detection of serrated adenomas that allows inspection of the entire colon and same-session biopsy sampling or polypectomy, if necessary. If an endoscopic biopsy at the right colon reveals SSA without cytologic dysplasia or biopsy at the rectosigmoid reveals SSA or TSA, those polyps should be excised or surgically resected as necessary. Postpolypectomy surveillan... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816238 Sun, 20 Sep 2009 05:37:41 +0100 2816238 http://www.medworm.com/index.php?rid=2816237&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft18g5qv48262u572%2F Abstract  Important dietary carbohydrates such as fructose and sorbitol are incompletely absorbed in the normal small intestine. This malabsorption is sometimes associated with abdominal complaints and diarrhea development, symptoms indistinguishable from those of functional bowel disease. Recently, polymerized forms of fructose (fructans) also were implicated in symptom production in patients with irritable bowel syndrome (IBS). Evidence from uncontrolled and controlled challenge studies suggests that malabsorbed sugars (fructose, sorbitol, lactose) and fructans may act as dietary triggers for clinical symptoms suggestive of IBS. Further placebo-controlled studies are needed to obtain definite conclusions about the role of dietary sugar malabsorption in functional bowel di... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816237 Sun, 20 Sep 2009 05:37:41 +0100 2816237 http://www.medworm.com/index.php?rid=2816239&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F234l330745584013%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0065-8Authors Alan B. R. Thomson, University of Alberta Division of General Internal Medicine, Department of Medicine Edmonton Canada Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816239 Sun, 20 Sep 2009 05:37:39 +0100 2816239 http://www.medworm.com/index.php?rid=2816240&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1x4r55854m25833r%2F This article provides a focused assessment of effectiveness, limitations, and alternative available screening methods. New modalities endorsed in the updated guidelines (eg, fecal immunochemical tests, fecal DNA, and CT colonography) are reviewed. In addition, advances and updates in existing tests (eg, guaiac-based fecal occult blood tests and colonoscopy) are evaluated. Content Type Journal ArticleDOI 10.1007/s11894-009-0061-zAuthors Hongha T. VuCarol A. Burke, Cleveland Clinic Foundation Digestive Disease Institute, Department of Gastroenterology and Hepatology 9500 Euclid Avenue, A-30 Cleveland OH 44195 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816240 Sun, 20 Sep 2009 05:37:38 +0100 2816240 http://www.medworm.com/index.php?rid=2816241&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq3h43h86u5427016%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0064-9Authors Joseph H. Sellin, Baylor College of Medicine Division of Gastroenterology Houston USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2816241 Sun, 20 Sep 2009 05:37:37 +0100 2816241 http://www.medworm.com/index.php?rid=2638923&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7768234387x23g26%2F Abstract  Functional gastrointestinal disorders (FGIDs), which include irritable bowel syndrome (IBS), encompass a heterogeneous group of diseases identified by chronic or recurrent symptom-based diagnostic criteria. Psychosocial factors are key components in the outcome of clinical manifestations of IBS symptoms. Anxiogenic and endocrine responses to stress are mediated by the corticotropin-releasing factor (CRF)-CRF1 receptor pathway. Preclinical studies show that activation of the CRF1 receptor by exogenous CRF or stress recapitulates many functional symptoms of IBS diarrhea-predominant patients as related to anxiogenic/hypervigilant behavior, autonomic nervous system alterations, induction of diarrhea, visceral hyperalgesia, enhanced colonic motility, mucus secretion, in... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638923 Wed, 22 Jul 2009 02:35:07 +0100 2638923 http://www.medworm.com/index.php?rid=2638924&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe648601k380m123m%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0049-8Authors Walter J. Coyle, Division of Gastroenterology and Hepatology LaJolla USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638924 Wed, 22 Jul 2009 02:35:06 +0100 2638924 http://www.medworm.com/index.php?rid=2638925&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc5t8rl27921442q3%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0051-1Authors Jeremy R. Stapleton, University of Louisville School of Medicine Division of Gastroenterology/Hepatology Louisville USAStephen A. McClave, University of Louisville School of Medicine Louisville USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638925 Wed, 22 Jul 2009 02:35:03 +0100 2638925 http://www.medworm.com/index.php?rid=2638926&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb042hw8413248520%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0052-0Authors Jeremy R. Stapleton, University of Louisville School of Medicine Division of Gastroenterology/Hepatology Louisville USAStephen A. McClave, University of Louisville School of Medicine Louisville USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638926 Wed, 22 Jul 2009 02:35:02 +0100 2638926 http://www.medworm.com/index.php?rid=2638927&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj52g274816876782%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0050-2Authors Jeremy R. Stapleton, University of Louisville School of Medicine Division of Gastroenterology/Hepatology Louisville USAStephen A. McClave, University of Louisville School of Medicine Louisville USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638927 Wed, 22 Jul 2009 02:35:01 +0100 2638927 http://www.medworm.com/index.php?rid=2638929&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff72608776r837500%2F Abstract  Acute kidney injury (AKI) is a frequently observed complication in critically ill patients. Its presentation may range from the early risk of renal dysfunction to complete renal failure. Morbidity and mortality in the AKI patient increase with the decline of renal function. Appropriate nutrition therapy is essential in the medical management of the AKI patient. Assessment of nutritional requirements should take into account the patient’s underlying complication, comorbid medical conditions, and severity of the renal dysfunction. Various stages of AKI determine the direction of nutrition therapy. Additionally, understanding the macro- and micronutrient modifications and electrolyte and vitamin alterations that should be implemented are vital for better patient ou... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638929 Wed, 22 Jul 2009 02:34:50 +0100 2638929 http://www.medworm.com/index.php?rid=2638928&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff478905k8606g5m4%2F Abstract  The human gut is a lush microbial ecosystem containing about 100 trillion microorganisms, whose collective genome, the microbiome, contains 100-fold more genes than the entire human genome. The symbiosis of our extended genome plays a role in host homeostasis and energy extraction from diet. In this article, we summarize some of the studies that have advanced the understanding of the microbiome and its effects on metabolism, obesity, and health. Metagenomic studies demonstrated that certain mixes of gut microbiota may protect or predispose the host to obesity. Furthermore, microbiota transplantation studies in germ-free murine models showed that the efficient energy extraction traits of obese-type gut flora are transmissible. The proposed methods by which the micr... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638928 Wed, 22 Jul 2009 02:34:50 +0100 2638928 http://www.medworm.com/index.php?rid=2638930&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx1642183n6t24507%2F Abstract  Pelvic floor disorders that affect defecation consist of structural disorders (eg, rectocele) and functional disorders (eg, dyssynergic defecation). Evaluation includes a thorough history and physical examination, a careful digital rectal examination, and physiologic tests such as anorectal manometry, colonic transit study, and balloon expulsion test. Defecography and dynamic MRI may facilitate detection of structural defects. Management consists of education and counseling regarding bowel function, diet, laxatives, and behavioral therapies. Recently, several randomized, clinical trials have shown that biofeedback therapy is effective in dyssynergic defecation. Dyssynergia may also coexist in structural disorders such as solitary rectal ulcer syndrome or rectocele... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638930 Wed, 22 Jul 2009 02:34:45 +0100 2638930 http://www.medworm.com/index.php?rid=2638931&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn2q381125029h77l%2F Abstract  The prevalence of dyspepsia in the general population is as high as 40%, and its management represents a considerable financial burden to the health care system. Causes of dyspepsia amenable to medical therapy include peptic ulcer and functional dyspepsia, and testing for Helicobacter pylori and treating positive individuals is beneficial in both conditions. Individuals presenting for the first time with uninvestigated dyspepsia, age greater than 50 years, or alarm features require upper gastrointestinal (GI) endoscopy to exclude gastroesophageal malignancy. Upper GI endoscopy for younger individuals without alarm features is not cost-effective compared with the “test and treat” approach. Test and treat and empirical acid-suppression using a proton pump inhibit... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638931 Wed, 22 Jul 2009 02:34:44 +0100 2638931 http://www.medworm.com/index.php?rid=2638932&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F6178378251v4171v%2F Abstract  Infections with Escherichia coli O157:H7 have gained media attention in recent years because of cases associated with unusual sources (eg, produce and swimming pools). Although most adults recover without sequelae, children and the elderly are more likely to develop complications (eg, hemolytic uremic syndrome and death). The diagnosis typically has been made by culture; however, newer handheld immunoassays and polymerase chain reaction technology have led to more rapid detection of this important pathogen in stools, food, and water. Treatment is largely supportive; nonetheless, new methods to neutralize or bind toxin, such as probiotics, monoclonal antibodies, and recombinant bacteria, are showing promise to treat patients infected with E. coli O157:H7. The role o... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638932 Wed, 22 Jul 2009 02:34:41 +0100 2638932 http://www.medworm.com/index.php?rid=2638933&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm27x325767j3k244%2F Abstract  Irritable bowel syndrome (IBS) is a prevalent and expensive condition that significantly impairs health-related quality of life (HRQOL) and reduces work productivity. Based on strict criteria, 7% to 10% of people have IBS worldwide. Community-based data indicate that IBS-diarrhea and IBS-mixed subtypes are more prevalent than IBS-constipation, and that patients may switch among subtype groups. IBS is 1.5 times more common in women than in men, more common in lower socioeconomic groups, and more commonly diagnosed in patients younger than 50 years of age. Patients with IBS visit the doctor more frequently, use more diagnostic tests, consume more medications, miss more workdays, have lower work productivity, are hospitalized more frequently, and consume more overall... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638933 Wed, 22 Jul 2009 02:34:39 +0100 2638933 http://www.medworm.com/index.php?rid=2638934&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F513571716201ml00%2F Abstract  Travelers’ diarrhea affects more than 10 million people per year and is usually contracted through the ingestion of microbially contaminated food or water. Although most cases resolve in 3 to 5 days, chronic conditions are associated with acute infections. Prevention encompasses avoidance of ingesting contaminated products and, in certain situations, taking prophylactic medications. The available prophylactic antibiotics are very effective in prevention, but are recommended only for specific at-risk individuals and are contraindicated for most travelers. Content Type Journal ArticleDOI 10.1007/s11894-009-0043-1Authors Emily Singh, Scripps Clinic 10666 North Torrey Pines Road La Jolla CA 92037 USADavid Redfield Journal Current Gastroenterology ReportsOn... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638934 Wed, 22 Jul 2009 02:34:38 +0100 2638934 http://www.medworm.com/index.php?rid=2638935&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl69k11tx720g508n%2F Abstract  Harmful and fatal outcomes related to specific herbal therapies are reported with increasing regularity. However, US physicians remain inadequately informed about potential toxicities. The purpose of this focused review is to highlight past and more recently recognized herbal therapies or complementary and alternative medicine (CAM) that are shown to cause hepatotoxicity. Where available, the proposed mechanisms for toxicity are discussed. An aggressive approach for more stringent regulation of CAM is needed, in addition to a systematic and scientific study of causality and underlying toxic mechanisms, to provide reliable information about the safety of CAM and enable practitioners to deliver effective remedies when toxicities occur. Content Type Journal Article... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638935 Wed, 22 Jul 2009 02:34:37 +0100 2638935 http://www.medworm.com/index.php?rid=2638936&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F46473mk521434156%2F Abstract  Americans spent 2.4 trillion dollars on health care in 2008. The massive size of this expenditure has led to perpetual efforts to improve health care quality while attempting to reduce overall cost. A recent development in reimbursement strategies is the “pay-for-performance” model. Retrospective reports showed variable success for this model for the treatment of acute myocardial infarction, pneumonia, and congestive heart failure. As the model gains popularity, there is pressure to apply pay for performance to an increasing number of diseases and treatment settings. In this article, we evaluate the appropriateness of the pay-for-performance model with regard to nutritional support in the hospitalized patient. Content Type Journal ArticleDOI 10.1007/s11894-0... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2638936 Wed, 22 Jul 2009 02:34:35 +0100 2638936 http://www.medworm.com/index.php?rid=2429598&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh3p1t71583h286g0%2F Abstract  Autoimmune hepatitis (AIH) is a common cause of acute and chronic hepatitis in childhood. Once the diagnosis is established, treatment with corticosteroid or corticosteroid and azathioprine is indicated. Most children with AIH respond to such therapy and experience remission from active disease. Eliminating drug therapy while maintaining remission is the ultimate goal of therapy. The optimal duration of therapy before drug elimination is unclear. Relapse rate is inversely related to therapy duration before drug withdrawal; thus, discontinuing immunosuppressive treatment is considered only after at least 1 to 2 years of complete remission. When applying a slow and systematic approach, many children with AIH can successfully be weaned off immunosuppression completel... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429598 Thu, 21 May 2009 06:02:48 +0100 2429598 http://www.medworm.com/index.php?rid=2429600&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg8714166917m563k%2F This article provides an update on these technologies in clinical practice and how they may be helpful in the future. Content Type Journal ArticleDOI 10.1007/s11894-009-0029-zAuthors John E. Pandolfino, Northwestern University, Feinberg School of Medicine Division of Gastroenterology, Department of Medicine 676 North St. Clair Street, Suite 1400 Chicago IL 60611 USAWilliam J. Bulsiewicz Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429600 Thu, 21 May 2009 06:02:47 +0100 2429600 http://www.medworm.com/index.php?rid=2429599&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F18571451424416l0%2F Abstract  Gastroesophageal reflux disease (GERD) is typically heralded by the substernal burning pain of heartburn. On endoscopic examination, about one third of GERD subjects with heartburn have erosive disease, and the remainder have nonerosive reflux disease (NERD). Unlike patients with erosive disease, those with NERD (∼ 50%) often do not respond to therapy with proton pump inhibitors (PPIs), raising the question of whether they have NERD and, if they do, whether the cause of their symptoms is similar to those who respond to PPIs. Recently, biopsies established that subjects with heartburn and PPI-responsive NERD, like those with erosive esophagitis, have lesions within the esophageal epithelium known as dilated intercellular space (DIS). In this article, we discuss t... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429599 Thu, 21 May 2009 06:02:47 +0100 2429599 http://www.medworm.com/index.php?rid=2429602&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8007041q71447g1t%2F Abstract  Eosinophilic esophagitis has become a prominent chronic esophageal disorder in clinical pediatric and adult gastroenterology. Its manifestations are protean in childhood, but dysphagia predominates the clinical presentation in adults. Adverse immune responsiveness to dietary antigens underlies most cases, as is reflected in clinical and histologic remission with appropriate diet management in the majority, although an understanding of the mechanisms underlying the inflammatory process remains incomplete. Intense investigations to explain the underpinnings of the disorder and to discover effective therapy are ongoing. Content Type Journal ArticleDOI 10.1007/s11894-009-0034-2Authors Philip E. Putnam, University of Cincinnati College of Medicine, Cincinnati Childr... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429602 Thu, 21 May 2009 06:02:46 +0100 2429602 http://www.medworm.com/index.php?rid=2429601&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F049p4782v234n551%2F Abstract  Upper gastrointestinal (GI) tract inflammation in inflammatory bowel disease has become increasingly recognized, even in the absence of specific localizing symptoms, as patients more frequently undergo upper endoscopy. Although the recent Montreal classification system allowed classification of upper GI involvement in Crohn’s disease (CD), independent of other locations, a consensus regarding the definition of what qualifies as significant “involvement” is still lacking. Reported incidence data vary considerably depending on the definitions used and the selected target population. Pediatric data suggest that upper endoscopy is useful in differentiating CD from ulcerative colitis, when inflammation is otherwise predominantly confined to the colon; however, th... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429601 Thu, 21 May 2009 06:02:46 +0100 2429601 http://www.medworm.com/index.php?rid=2429604&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx2r43525wt526135%2F Abstract  Colon polyps are a common finding in pediatrics and can present with rectal bleeding, abdominal pain, or polyp prolapse from the rectum. Histologically classified as hamartomas, these isolated pediatric polyps lack epithelial dysplasia and have no cancer risk. However, when polyps are present in greater numbers, or are associated with a family history of polyps or colon or other cancers, a polyposis or hereditary colorectal cancer syndrome should be considered. Using a casebased format, this article reviews the clinical features and provides updates on the three most common hamartomatous polyp syndromes of childhood: juvenile polyposis syndrome, Peutz-Jeghers syndrome, and the PTEN hamartoma tumor syndrome. Each syndrome has distinctive intestinal and extra-intest... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429604 Thu, 21 May 2009 06:02:45 +0100 2429604 http://www.medworm.com/index.php?rid=2429603&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff311x14j021l7m24%2F This article examines the currently available published trials studying probiotics for the treatment of IBD, with particular emphasis on their role in pediatric IBD patients. Content Type Journal ArticleDOI 10.1007/s11894-009-0037-zAuthors Ajay S. Gulati, University of North Carolina at Chapel Hill Department of Pediatrics, Division of Pediatric Gastroenterology 130 Mason Farm Road, 5143 Bioinformatics, CB-7229 Chapel Hill NC 27599 USAMarla C. Dubinsky Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429603 Thu, 21 May 2009 06:02:45 +0100 2429603 http://www.medworm.com/index.php?rid=2429605&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fnl786g935hkn83k8%2F Abstract  Eosinophilic esophagitis (EoE) is an increasingly recognized disease characterized by esophageal symptoms accompanied by increased esophageal mucosal eosinophilia. The reasons for the increasing prevalence and understanding of the pathogenesis of EoE are areas of active investigation. Food and environmental allergy, host immunologic predisposition, and interactions with gastroesophageal reflux disease have emerged as important aspects of the disease. The optimal management of EoE is controversial and evolving. Therapeutic options include medical therapy with acid suppression, corticosteroids, and biologic agents. Elimination diets and endoscopic esophageal dilation have shown effectiveness. Management strategies for individual patients range from clinical observat... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429605 Thu, 21 May 2009 06:02:44 +0100 2429605 http://www.medworm.com/index.php?rid=2429607&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F520075l114506042%2F Abstract  Irreversible intestinal failure in children is predominantly caused by surgical conditions such as volvulus, necrotizing enterocolitis, and gastroschisis. Functional intestinal failure from motility disorders such as intestinal pseudo-obstruction or enterocyte dysfunction with microvillus inclusion disease also may require intestine replacement. Approved indications for intestinal transplantation include liver dysfunction, loss of major venous access, frequent central line-related sepsis, and recurrent episodes of severe dehydration despite intravenous fluid management. Surgical options include transplantation of the isolated intestine, combined liver-intestine transplantation, or multivisceral transplantation of the stomach, duodenum, pancreas, and small bowel (w... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429607 Thu, 21 May 2009 06:02:42 +0100 2429607 http://www.medworm.com/index.php?rid=2429606&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw5007753qn204236%2F Abstract  Esophageal adenocarcinoma (EAC) is the most rapidly increasing cancer in the Western world and Barrett’s esophagus (BE) is the only known precursor lesion for this lethal cancer. Long-term survival may be improved if EAC is diagnosed early, providing an opportunity for early intervention. Screening for BE in patients with gastroesophageal reflux disease is not routinely recommended; however, if diagnosed, enrollment into a surveillance program may be beneficial. Surveillance of all patients with known BE is probably not costeffective and factors predictive of BE progression to dysplasia/EAC are poorly understood. Screening and surveillance examinations are also faced with challenges in the endoscopic detection of intestinal metaplasia and dysplasia. Future appli... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429606 Thu, 21 May 2009 06:02:42 +0100 2429606 http://www.medworm.com/index.php?rid=2429610&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F45m406n0378441u8%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0026-2Authors Susan R. Orenstein Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429610 Thu, 21 May 2009 06:02:41 +0100 2429610 http://www.medworm.com/index.php?rid=2429609&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F466170g210447734%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0027-1Authors Marcelo F. Vela Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429609 Thu, 21 May 2009 06:02:41 +0100 2429609 http://www.medworm.com/index.php?rid=2429608&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl5819431031737h6%2F Abstract  Recent studies demonstrate a bidirectional relationship between gastroesophageal reflux disease (GERD) and sleep in which nighttime reflux leads to sleep deprivation and sleep deprivation can exacerbate GERD by enhancing perception of intraesophageal stimuli. Current treatment primarily focuses on reducing nighttime reflux, thus improving sleep quality. Future studies are needed to further explore the relationship between GERD and sleep and the potential of novel therapeutic options to interrupt the vicious cycle between them. Content Type Journal ArticleDOI 10.1007/s11894-009-0032-4Authors Ronnie Fass, Southern Arizona VA Health Care System GI Section (1-111-GI) 3601 South Sixth Avenue Tucson AZ 85723 USA Journal Current Gastroenterology ReportsOnline I... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2429608 Thu, 21 May 2009 06:02:41 +0100 2429608 http://www.medworm.com/index.php?rid=2277383&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fbq47670w40487471%2F Abstract  In recent years, improved laparoscopic skill sets have expanded surgical management of pancreatic disease to encompass pancreatic resection, tumor enucleation, débridement, and drainage. With the aid of radio-logically guided drainage catheters, necrosectomy for acute pancreatitis can be delayed and accomplished laparoscopically in a select patient population. Pancreatic pseudocysts from chronic pancreatitis can now be approached via minimally invasive strategies, including emerging combined laparoendoscopic procedures and natural orifice transluminal endoscopic surgery. It is clear that laparoscopic pancreaticoduodenectomy is possible in experienced hands; pancreatic neoplasms in the body and tail are more suitable for laparoscopic procedures because distal panc... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277383 Tue, 17 Mar 2009 07:03:23 +0100 2277383 http://www.medworm.com/index.php?rid=2277384&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fjt335h50028r3h46%2F Abstract  Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors. The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and radiologic imaging. Signs and symptoms are usually related to hormone hypersecretion in the case of functioning tumors and to tumor size or metastases with nonfunctioning tumors. Surgical resection remains the treatment of choice even in the face of metastatic disease. Further development of novel diagnostic and treatment modalities offers potential to greatly improve quality of life an... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277384 Tue, 17 Mar 2009 07:03:22 +0100 2277384 http://www.medworm.com/index.php?rid=2277385&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr4npr52q44301102%2F Abstract  The management of infected peripancreatic or pancreatic necrosis in patients with severe pancreatitis has changed considerably in recent years. This review discusses the recent literature on prevention, detection, and management of infected necrosis. Though antibiotics, probiotics, and enteral nutrition have been tried to prevent infected necrosis, only enteral nutrition has consistently proven to be effective. Antibiotics and probiotics have not shown a consistent beneficial effect on outcome. Enteral nutrition reduced infectious complications and mortality in severe pancreatitis, compared with parenteral nutrition. The detection of infection of pancreatic necrosis is important for clinical decision making. Fine-needle aspiration may be used to confirm suspected ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277385 Tue, 17 Mar 2009 07:03:21 +0100 2277385 http://www.medworm.com/index.php?rid=2277387&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq705624180q76350%2F Abstract  Acute pancreatitis continues to be a diagnostic and therapeutic challenge for physicians and surgeons. It ranks third in the list of hospital discharges for gastro intestinal diseases. In most patients the cause is either gallstones or alcoholism. The overall mortality is less than 5%, but severe acute pancreatitis leads to prolonged hospitalization and much higher mortality. There are important differences in disease susceptibility and case fatality rates: the incidence is higher in blacks than in whites, and mortality is higher in older patients than in younger patients. Reports from various countries reveal that the frequency of acute pancreatitis is increasing, perhaps in relation to rising obesity rates, which would increase the likelihood of gallstone pancre... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277387 Tue, 17 Mar 2009 07:03:20 +0100 2277387 http://www.medworm.com/index.php?rid=2277386&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F9212v8x43252037r%2F Abstract  Chronic pancreatitis (CP) can cause failure of both the exocrine and endocrine portions of the gland. Pain is the most recalcitrant clinical complaint in CP. Generally, conservative measures are first attempted to manage pain. These include cessation of alcohol use and smoking, enzyme replacement therapy, and finally, opioid analgesia. Endoscopy can be employed to treat the pain and complications due to CP. The results of the only two prospective randomized controlled trials suggest that surgery has a more durable effect than endoscopic therapy in controlling pain. Both trials suffer from severe limitations, however, and endoscopy remains the preferred approach for many patients because of its minimally invasive nature. Endoscopic ultrasound celiac plexus block ha... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277386 Tue, 17 Mar 2009 07:03:20 +0100 2277386 http://www.medworm.com/index.php?rid=2277389&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp8073267x5140347%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0014-6Authors Christopher E. Forsmark, University of Florida Division of Gastroenterology, Hepatology, and Nutrition Florida USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277389 Tue, 17 Mar 2009 07:03:19 +0100 2277389 http://www.medworm.com/index.php?rid=2277388&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fgl71n100l8630311%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0015-5Authors John Baillie, Wake Forest University Health Sciences Section on Gastroenterology Winston-Salem USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277388 Tue, 17 Mar 2009 07:03:19 +0100 2277388 http://www.medworm.com/index.php?rid=2277391&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7040vl85736h4w86%2F Abstract  Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable tools in the diagnostic and therapeutic evaluation and management of a variety of pancreatobiliary disorders. Along with a significant refinement in the equipment and techniques used has come a recent trend toward aggressive therapeutic interventions. Because of the technical nature of these procedures and the characteristics of the patients, postprocedural complications may occur, ranging from minor (requiring brief hospitalization) to severe (causing permanent disability or death). This review summarizes these complications and outlines strategies to minimize them. Content Type Journal ArticleDOI 10.1007/s11894-009-0021-7Authors Olga BarkayMouen KhashabMohammad Al-... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277391 Tue, 17 Mar 2009 07:03:18 +0100 2277391 http://www.medworm.com/index.php?rid=2277390&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff048363377k47165%2F Abstract  The investigation of biliary dilatation forms a routine part of gastroenterology practice. In developed countries, biliary dilatation is usually the result of obstruction of bile flow by either stones or mitotic lesions of the pancreas or biliary tree, and standard radiologic and endoscopic techniques are used to identify and relieve the obstruction. In the absence of an obvious cause, however, the investigation and management of biliary dilatation can prove challenging, particularly while trying to minimize invasive studies. This review examines factors thought to influence bile duct size in the absence of obvious obstructing pathology and looks at some causes of biliary dilatation that are unusual and potentially difficult to diagnose. Content Type Journal Art... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277390 Tue, 17 Mar 2009 07:03:18 +0100 2277390 http://www.medworm.com/index.php?rid=2277392&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn70l4437j6r50642%2F This article examines the arguments for and against preoperative biliary drainage, the conflicting data on the subject, and the techniques used. Content Type Journal ArticleDOI 10.1007/s11894-009-0022-6Authors Alan Coss, University of British Columbia Division of Gastroenterology 5135-2775 Laurel Street Vancouver BC V5Z 1M9 CanadaMichael F. Byrne Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277392 Tue, 17 Mar 2009 07:03:17 +0100 2277392 http://www.medworm.com/index.php?rid=2277393&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd1716526r68573g1%2F Abstract  Gastroenterologists increasingly find themselves in the unenviable position of having to choose the optimal radiographic test to visualize the biliary tree and the liver. This dilemma is compounded by the rapid evolution of the available technologies and their ever-increasing resolution capabilities. Endoscopic ultrasound (EUS) has shown itself to be equally capable of providing detailed imaging of the biliary tree and of surrounding structures; its potential for evaluating liver lesions is just now being realized. EUS-fine needle aspiration (FNA) may supplant some of the existing technologies as it offers a way to sample masses, strictures, lymph nodes, and now certain segments of the liver and periportal regions. This review takes an in-depth look at the role of... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277393 Tue, 17 Mar 2009 07:03:15 +0100 2277393 http://www.medworm.com/index.php?rid=2277394&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F55w2017844052621%2F Abstract  Open cholecystectomy has been associated historically with 0.2% to 0.5% risk of postoperative biliary injury. Laparoscopic cholecystectomy, which has become the first-line surgical treatment of calculous gallbladder disease, has been associated with a 2.5-fold to fourfold increase in the incidence of postoperative bile duct injury. The biliary endoscopist can expect to see a varied spectrum of complications after cholecystectomy by either technique, including postoperative biliary strictures, bile leaks, and retained calculi in the biliary tree. Proper diagnosis and treatment are paramount in ensuring a satisfactory outcome after bile duct injury. Endoscopic retrograde cholangiopancreatography (ERCP) has become the primary modality for treatment and effectively ma... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2277394 Tue, 17 Mar 2009 07:03:14 +0100 2277394 http://www.medworm.com/index.php?rid=2116175&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F9j7r1v52712t2u4t%2F Abstract  Treatment of chronic hepatitis B virus (HBV) infection currently involves the use of immunomodulators such as interferon and nucleoside or nucleotide analogues. Treatment aims to suppress levels of HBV DNA and induce clearance of the hepatitis B e antigen (HBeAg) or surface antigen (HBsAg) and seroconversion. At present, no single treatment has been shown to reliably suppress HBV DNA and induce durable HBsAg loss. Nucleoside or nucleotide analogues induce the production of HBV-resistant mutations that may lead to virologic and clinical breakthrough. Combination therapy, using either immunomodulators in combination or with nucleoside or nucleotide analogues, represents an emerging strategy for treating chronic HBV infection. The theoretical benefits of combining ag... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116175 Sat, 17 Jan 2009 08:48:13 +0100 2116175 http://www.medworm.com/index.php?rid=2116176&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq2505731n46813k1%2F Abstract  Advanced liver disease and interferon-based treatment are both associated with varying degrees of cytopenia in patients with chronic hepatitis C. Growth factors to increase hemoglobin and neutrophils are commonly used in clinical practice, despite the absence of data to indicate benefits in terms of sustained viral response. Thrombocytopenia is observed frequently, is multifactorial in etiology, and may result in significant limitations on interventional and therapeutic options. A small-molecule thrombopoietin mimetic, eltrombopag, has demonstrated a dose-response associated increase in platelet count in a phase 2 study, allowing initiation and completion of a 12-week course of peginterferon plus ribavirin in 36%, 53%, and 65% of patients receiving 30 mg, 50 mg, o... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116176 Sat, 17 Jan 2009 08:48:12 +0100 2116176 http://www.medworm.com/index.php?rid=2116177&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg4738k220g6538m1%2F Abstract  Model for End-Stage Liver Disease (MELD) allocation has improved the process for ranking patients on the liver transplant list. One unintended consequence has been an increase in the number of simultaneous liver-kidney (SLK) transplants. Some have argued that the system unfairly advantages patients with kidney disease and that some kidneys are being prematurely placed in SLK transplantation. This review summarizes the MELD score, assessment of kidney function in cirrhosis, the impact of kidney function in liver disease, and changes in kidney function status in liver transplant recipients in the MELD era. Finally, recommendations regarding who should receive SLK transplants are reviewed. Content Type Journal ArticleDOI 10.1007/s11894-009-0012-8Authors Julie A. ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116177 Sat, 17 Jan 2009 08:48:11 +0100 2116177 http://www.medworm.com/index.php?rid=2116178&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F051471645q34850w%2F This article proposes goals for making a clinically useful BAL, with attention to systems biology and potential sources of hepatocytes. Content Type Journal ArticleDOI 10.1007/s11894-009-0010-xAuthors Norman L. Sussman, University of Utah 30 North 1900 East, SOM 4R118 Salt Lake City UT 84132-2410 USABrendan M. McGuireJames H. Kelly Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116178 Sat, 17 Jan 2009 08:48:10 +0100 2116178 http://www.medworm.com/index.php?rid=2116179&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F775574lt08251110%2F Abstract  Nonalcoholic fatty liver disease (NAFLD) is a very common cause of chronic liver disease in the United States. A large proportion of patients with NAFLD have coexisting metabolic syndrome, a major risk factor for cardiovascular disease. A strong association between NAFLD and cardiovascular disease has been long suspected, and recent studies have confirmed that cardiovascular disease is the single most important cause of mortality in this patient population. NAFLD may pose cardiovascular risk beyond the risk conferred by traditional factors such as dyslipidemia, diabetes, and smoking. Health care providers managing patients with NAFLD should recognize this increased cardiovascular risk and should undertake early, aggressive risk factor modification. Content Type ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116179 Sat, 17 Jan 2009 08:48:08 +0100 2116179 http://www.medworm.com/index.php?rid=2116183&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm6872w465028k60j%2F Abstract  Combination therapy includes the use of two or more antivirals for the treatment of chronic hepatitis B. No study has shown that combination therapy is superior to monotherapy in naive patients for achieving treatment end points, but combination appears to result in a lower incidence of resistance. Moreover, the higher-potency compounds have not yet been studied. Consideration should be given to treating lamivudine-resistant patients with combination therapy, preferably with a nucleotide analogue in conjunction with a nucleoside analogue. Combination therapy should be considered in patients with decompensated cirrhosis who are unable to achieve an undetectable viral level on monotherapy and in naive patients who still have a detectable viral level 6 to 12 months a... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116183 Sat, 17 Jan 2009 08:48:07 +0100 2116183 http://www.medworm.com/index.php?rid=2116182&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw64805540750x356%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0001-yAuthors Bruce R. Bacon Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 1 / February, 2009 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116182 Sat, 17 Jan 2009 08:48:07 +0100 2116182 http://www.medworm.com/index.php?rid=2116181&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F6194408117162270%2F Abstract  Patients with cholestatic liver tests and typical histologic features of primary sclerosing cholangitis (PSC) but a normal cholangiogram have been identified as having small-duct PSC. This subgroup of PSC has been less well characterized than the classic largeduct form. Some patients characterized as having small-duct PSC develop cholangiographic features of PSC during follow-up. Three papers published in 2002 on small-duct PSC patients suggested a better prognosis in patients with small-duct PSC than in those with large-duct PSC. However, these studies included a limited number of patients and had a short follow-up. A combined cohort of these patients with a prolonged follow-up recently confirmed these previous observations. However, some patients will suffer fro... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116181 Sat, 17 Jan 2009 08:48:07 +0100 2116181 http://www.medworm.com/index.php?rid=2116180&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe665j00852110q19%2F Abstract  A main target of specifically targeted antiviral therapy for hepatitis C (STAT-C) is the NS3-protease, which has key functions in the hepatitis C virus (HCV) replication cycle. HCV/NS3-protease inhibitors have shown high antiviral activity in vitro and in patients with chronic hepatitis C. Protease-resistant HCV variants occurred rapidly in patients receiving protease-inhibitor monotherapy. The development of resistance can be best explained by selection of preexisting resistant variants, which grow out under selective pressure. Numerous mutations associated with resistance were identified. Clinical trials showed that protease-resistant strains are sensitive to interferon and that a triple combination of protease inhibitors, peginterferon, and ribavirin may improv... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116180 Sat, 17 Jan 2009 08:48:07 +0100 2116180 http://www.medworm.com/index.php?rid=2116185&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Flv614l7h73k70954%2F Abstract  It has been widely accepted that development of porto pulmonary hypertension (POPH) is independent of the cause of portal hypertension. The degree of hepatic damage and liver function do not correlate with predisposition to POPH or its severity. However, portal hypertension has been confirmed as a prerequisite for developing pulmonary hypertension. Transthoracic echocardiography is the best screening test for the presence of POPH, but a diagnosis of POPH can be established only by right heart catheterization. Randomized controlled trials comparing the efficacy and safety of different pharmacologic strategies are lacking in patients with POPH. The general management includes diuretics and oxygen supplementation. Notably, moderate to severe POPH predisposes candidat... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116185 Sat, 17 Jan 2009 08:48:05 +0100 2116185 http://www.medworm.com/index.php?rid=2116184&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv1241q0p677ug111%2F Abstract  Hepatic granulomas are often encountered on liver biopsy and may represent a primary hepatic process, a manifestation of a systemic illness, or an innocent finding of no clinical relevance. Hepatic granulomas are a unique inflammatory response that may be idiopathic or may be a response to a bacterial, fungal, viral, or parasitic infection; a manifestation of drug-induced liver injury; or a manifestation of underlying malignancy. When granulomas are found on liver biopsy, clinicians must correlate the histologic findings with historical and clinical data to help provide an accurate diagnosis and guide management. Therapy may be warranted, either directly for the granulomatous inflammation of the liver or for a systemic process. For some patients, observation may b... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116184 Sat, 17 Jan 2009 08:48:05 +0100 2116184 http://www.medworm.com/index.php?rid=2116187&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk8q7258231222188%2F Abstract  Hepatocellular carcinoma, a significant health problem throughout the world, generally occurs in the setting of cirrhosis. Choice of treatment depends on the size and location of the tumor and hepatic reserve. Liver transplantation provides the best chance for long-term survival and can be performed regardless of hepatic reserve, but it requires small tumor sizes and is available to only a few patients. All other treatments require adequate hepatic reserve. Surgical resection, percutaneous ethanol injection, and radiofrequency ablation are effective treatments for patients with good hepatic reserve and small tumors isolated to the liver. For larger and multinodular tumors, chemoembolization is the best choice. With metastasis, portal vein invasion, or large biloba... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116187 Sat, 17 Jan 2009 08:48:03 +0100 2116187 http://www.medworm.com/index.php?rid=2116186&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu766575557p8g111%2F Abstract  The etiology of liver disease in childhood varies significantly from its etiology in the adult population. More children with complex diseases are surviving into adulthood, providing challenges to the primary care provider. Adults with pediatric liver disease differ in management, treatment, complications, and extrahepatic considerations. To provide these patients with an optimal transition into the adult health care system, the provider needs a comprehensive knowledge of the common causes of childhood liver disease and their implications and must understand the differences in caring for these patients. This review addresses some of the most common childhood liver diseases, their causes, presentation, evaluation, management, complications, and additional concerns.... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=2116186 Sat, 17 Jan 2009 08:48:03 +0100 2116186 http://www.medworm.com/index.php?rid=1991596&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F675k35398q26w787%2F Abstract  Although gastric acid is not essential for life, it facilitates the digestion of protein and the absorption of iron, calcium, vitamin B12, and thyroxin. It also prevents bacterial overgrowth and enteric infection. Gastric acid secretion must be precisely regulated, as too much acid may overwhelm mucosal defense mechanisms and lead to ulceration and maldigestion. The pathways regulating gastric acid secretion may be categorized as neural, paracrine, and hormonal; the hormonal pathways are the focus of this review. During meal ingestion, the main hormone responsible for stimulating acid secretion is gastrin, which acts primarily by releasing histamine from enterochromaffin-like cells. Ghrelin and orexin may also function as stimulatory hormones. Nutrients within the... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991596 Tue, 25 Nov 2008 06:58:24 +0100 1991596 http://www.medworm.com/index.php?rid=1991595&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn117n11080828013%2F Content Type Journal ArticleCategory Invited CommentaryDOI 10.1007/s11894-008-0094-8Authors Fergus Shanahan, University College Cork, National University of Ireland Department of Medicine and Alimentary Pharmabiotic Centre College Road Cork Ireland Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991595 Tue, 25 Nov 2008 06:58:24 +0100 1991595 http://www.medworm.com/index.php?rid=1991594&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ffp38684036lpm25n%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-008-0096-6Authors Joseph R. Pisegna Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991594 Tue, 25 Nov 2008 06:58:24 +0100 1991594 http://www.medworm.com/index.php?rid=1991593&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff11773t957272q7h%2F Content Type Journal ArticleDOI 10.1007/s11894-008-0095-7 Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991593 Tue, 25 Nov 2008 06:58:24 +0100 1991593 http://www.medworm.com/index.php?rid=1991601&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk5755632624h835q%2F Abstract  Upper gastrointestinal bleeding secondary to ulcer disease is common and results in substantial patient morbidity and medical expense. After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and identifies high-risk ulcer patients who are likely to rebleed with medical therapy alone and will benefit most from endoscopic hemostasis. For patients with major stigmata of ulcer hemorrhage—active arterial bleeding, nonbleeding visible vessel, and adherent clot—combination therapy with epinephrine injection and either thermal coagulation (multipolar or heater probe) or endoclips is recommended. High-dose intravenous proton pump inhibitors are recommended as concomitant therapy after successful endoscopic hemo... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991601 Tue, 25 Nov 2008 06:58:23 +0100 1991601 http://www.medworm.com/index.php?rid=1991600&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F442l114018206111%2F Abstract  Proton pump inhibitors profoundly affect the stomach and have been associated with carcinoid tumors in female rats. There is now sufficient experience with this class of drugs to allow reasonable estimation of their safety in terms of cancer development in humans. Long-term use of proton pump inhibitors is associated with an increase in gastric inflammation and development of atrophy among those with active Helicobacter pylori infections. The actual risk is unknown but is clearly low. However, it can be markedly reduced or eliminated by H. pylori eradication. It is thus recommended that patients being considered for long-term proton pump inhibitor therapy should be tested for H. pylori infection and, if present, this pathogen should be eradicated. Oxyntic cell hyper... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991600 Tue, 25 Nov 2008 06:58:23 +0100 1991600 http://www.medworm.com/index.php?rid=1991599&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fvr56141426036g44%2F Abstract  The inflammatory bowel diseases (IBDs), Crohn’s disease and ulcerative colitis, are chronic inflammatory disorders caused by dysregulated immune responses in genetically predisposed individuals. Although the precise etiology of IBD remains unclear, accumulating data, including genome-wide association studies, have advanced our understanding of its immunopathogenesis. This review highlights the role in gut homeostasis and IBD pathogenesis of autophagy, the interleukin (IL)-23/IL-17 axis, and a novel member of the tumor necrosis factor family, TL1A. It focuses on advances in our understanding of IBD from the past year, including advances in genetics and immunobiology. Content Type Journal ArticleDOI 10.1007/s11894-008-0104-xAuthors David Q. Shih, Cedars-Sinai ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991599 Tue, 25 Nov 2008 06:58:23 +0100 1991599 http://www.medworm.com/index.php?rid=1991598&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv3l02x6h12243wp2%2F Abstract  Gastrointestinal stromal tumors (GIST) are rare tumors of mesenchymal origin that may arise anywhere along the gastrointestinal tract or in the peritoneum. In most cases, GIST harbor mutations of KIT or PDGFRA. Imatinib mesylate (IM), a small-molecule tyrosine kinase inhibitor developed for the treatment of chronic myeloid leukemia, has been shown to be active against these mutations and has significant activity in patients with metastatic GIST. However, resistance to IM emerges after a median of 24 months of treatment. Sunitinib malate (SU) has been approved for the treatment of patients with IM-resistant advanced GIST, but the median progression-free survival in this setting is only 6 months. This article reviews the current knowledge regarding IM and SU resistan... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991598 Tue, 25 Nov 2008 06:58:23 +0100 1991598 http://www.medworm.com/index.php?rid=1991597&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm11422x121u11t72%2F Abstract  Recently, conventional therapies for inflammatory bowel disease (IBD) have not received the same amount of attention as biologic therapies, yet they remain the backbone of therapy for IBD because of their efficacy, safety, and relatively low cost. Advances in efficacy and safety continue because of modifications in drug dosing and monitoring. Higher doses of mesalamine per pill, together with once-daily dosing, may help to optimize drug delivery and patient compliance. Budesonide, an effective agent for both induction and short-term remission maintenance in Crohn’s disease, is devoid of many of the toxicities common to corticosteroids. Assessments of thiopurine methyltransferase and metabolite levels are helping to fine-tune dose optimization for the thiopurines... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991597 Tue, 25 Nov 2008 06:58:23 +0100 1991597 http://www.medworm.com/index.php?rid=1991604&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F2001372724160t8w%2F Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-008-0103-yAuthors Stephen B. Hanauer Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991604 Tue, 25 Nov 2008 06:58:22 +0100 1991604 http://www.medworm.com/index.php?rid=1991603&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj32190707348385r%2F This article also summarizes some new findings on the genetics of ulcer formation and the effects of age and gender on mucosal defense and touches on current developments in drugs, including considerations for future therapeutic agents. Content Type Journal ArticleDOI 10.1007/s11894-008-0101-0Authors Amy ZhuJonathan Kaunitz, West Los Angeles VA Medical Center Building 114, Suite 217 11301 Wilshire Boulevard Los Angeles CA 90073 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 6 / December, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991603 Tue, 25 Nov 2008 06:58:22 +0100 1991603 http://www.medworm.com/index.php?rid=1991602&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft16008551823r09t%2F Abstract  The gastric H,K-ATPase is the primary target for the treatment of acid-related diseases. Proton pump inhibitors (PPIs) are weak bases composed of two moieties, a substituted pyridine with a primary pKa of about 4.0, which allows selective accumulation in the secretory canaliculus of the parietal cell, and a benzimidazole with a second pKa of about 1.0. PPIs are acid-activated prodrugs that convert to sulfenic acids or sulfenamides that react covalently with one or more cysteines accessible from the luminal surface of the ATPase. Because of covalent binding, their inhibitory effects last much longer than their plasma half-life. However, the short half-life of the drug in the blood and the requirement for acid activation impair their efficacy in acid suppression, par... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991602 Tue, 25 Nov 2008 06:58:22 +0100 1991602 http://www.medworm.com/index.php?rid=1991608&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F0n72u3784076m343%2F Abstract  Each of the medical and surgical therapies for Crohn’s disease has inherent advantages and disadvantages that must be balanced for patients with moderate to severe disease. Most patients with Crohn’s disease require surgery at some point during the lifelong illness, but surgical therapy is not curative for most patients, as postoperative recurrence of Crohn’s disease is common and can pose diagnostic and therapeutic challenges. Disease monitoring and appropriate prophylaxis are necessary in patients at high risk. Content Type Journal ArticleDOI 10.1007/s11894-008-0109-5Authors Bo Shen, Cleveland Clinic Digestive Disease Institute 9500 Euclid Avenue Cleveland OH 44195 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991608 Tue, 25 Nov 2008 06:58:21 +0100 1991608 http://www.medworm.com/index.php?rid=1991607&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg2x3518332701801%2F Abstract  The idiopathic inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, may be complicated by extraintestinal manifestations (EIMs) in up to 40% of patients. Reports suggest that almost every organ system may be affected. The EIMs are a significant cause of morbidity and may be particularly distressing for the patient. Recent attempts have been made to define the phenotype of IBD in patients of different ethnicities. These studies have highlighted potential racial variations in the prevalence of specific EIMs, findings that are perhaps not surprising given the influence of genetic factors in their pathogenesis. Certain EIMs are related to the activity of the bowel disease, and their management often involves careful monitoring while the IBD is ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991607 Tue, 25 Nov 2008 06:58:21 +0100 1991607 http://www.medworm.com/index.php?rid=1991606&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F157622233w29255x%2F Abstract  Despite more than a decade of clinical experience in the treatment of inflammatory bowel disease with biologic agents, particularly anti-tumor necrosis factor (TNF) antibodies, optimal treatment strategies are still debated. Secondary loss of response due to immuno genicity is intrinsic to the use of therapeutic antibodies and has important implications. With the chimeric anti-TNF antibody, infliximab, scheduled maintenance therapy minimizes the risk of loss of response, and there is no clear evidence that concomitant immunosuppressives have added value in this setting. More humanized anti-TNF antibodies have entered clinical practice, opening new perspectives to patients with inflammatory bowel disease, but interventions in the dosing regimen remain necessary for... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991606 Tue, 25 Nov 2008 06:58:21 +0100 1991606 http://www.medworm.com/index.php?rid=1991605&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh7qh5t8212062113%2F This article reviews recent advances in epidemiology and diagnostics. The importance of Clostridium difficile is highlighted. State-of-the-art IBD diagnostic modalities include serology, fecal markers, and advanced radiologic or endoscopic techniques. These include wireless capsule endoscopy, balloon enteroscopy, chromoendoscopy, high-magnification endoscopy, and MRI. The increasing number of available modalities requires appreciation of their indications, strengths, and limitations. This article discusses these issues relevant to the clinician. Content Type Journal ArticleDOI 10.1007/s11894-008-0105-9Authors Sobia AliCyrus P. Tamboli, University of Iowa Carver College of Medicine 4614 JCP, Department of Internal Medicine 200 Hawkins Drive Iowa City IA 52242 USA Journal Curr... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1991605 Tue, 25 Nov 2008 06:58:21 +0100 1991605 http://www.medworm.com/index.php?rid=1901996&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa026l804v104l478%2F Abstract  The single biggest change in the approach to treating pediatric gastroesophageal reflux disease (GERD) in recent years has been the empiric use of proton pump inhibitors (PPIs) for symptoms suspected to be those of GERD. In other words, PPIs have been used increasingly as a first-line concurrent diagnostic test and treatment before any investigation. Although this approach is useful for some patients, there are a number of caveats about its application to children. In general, these caveats are related to age per se (eg, infancy) and to age-related symptoms and severity of GERD itself. The most important caveats relate to the prescription of empiric PPI therapy in infants—which generally is to be avoided—and to how PPIs are used in older children—specifically... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1901996 Tue, 21 Oct 2008 14:41:58 +0100 1901996 http://www.medworm.com/index.php?rid=1901995&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft87j208v41610005%2F Abstract  Acute mesenteric ischemia is caused by a critical reduction in intestinal blood flow that frequently results in bowel necrosis and is associated with a high mortality. Clinicians must maintain a high index of suspicion because a prompt diagnosis and early aggressive treatment before the onset of bowel infarction results in reduced mortality. Medical management includes aggressive rehydration and the use of antibiotics, anticoagulation, vasodilators, and inhibitors of reperfusion injury. If acute mesenteric ischemia is suspected, early angiography is imperative, as it permits accurate diagnosis and possible therapeutic intervention. Therapeutic options during angiography depend on the cause of ischemia and include administering intra-arterial vasodilators and/or th... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1901995 Tue, 21 Oct 2008 14:41:58 +0100 1901995 http://www.medworm.com/index.php?rid=1901994&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft4ml405942336747%2F Abstract  The term biliary dyskinesia commonly describes a motility disorder of the biliary tract that is divided into two main categories: gallbladder dyskinesia (GBD) and sphincter of Oddi dysfunction (SOD). SOD is further subdivided into biliary SOD and pancreatic SOD. GBD causes typical biliary colic without gallstones, whereas SOD typically presents with recurrent pancreatitis or chronic abdominal pain, usually after cholecystectomy. GBD and SOD are uncommon in children. Based on adult experience, this review discusses the diagnosis and treatment of GBD and SOD in the pediatric population. Content Type Journal ArticleDOI 10.1007/s11894-008-0064-1Authors Michael S. Halata, Maria Fareri Children’s Hospital, New York Medical College Department of Pediatric Gastroente... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1901994 Tue, 21 Oct 2008 14:41:58 +0100 1901994 http://www.medworm.com/index.php?rid=1902001&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy20587j525g27352%2F Content Type Journal ArticleDOI 10.1007/s11894-008-0058-zAuthors Susan R. Orenstein Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 3 / June, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902001 Tue, 21 Oct 2008 14:41:57 +0100 1902001 http://www.medworm.com/index.php?rid=1902000&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F83666456m224h312%2F Abstract  Functional gastrointestinal disorders (FGIDs) commonly affect children and are associated with short-and long-term morbidity. Although the pathogenesis of pain-related FGIDs remains incompletely understood, most investigators agree on a multifactorial etiology and the presence of an altered brain-gut interaction. A continuous interplay of genetic and environmental factors appears to shape the development of the central and enteric nervous systems. The biopsychosocial model is the current operational framework for children with FGIDs, as it recognizes the interaction between social and environmental influences and psychological and physiologic processes. The biopsychosocial model proposes that specific permutations of genetic susceptibility, early life experiences,... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902000 Tue, 21 Oct 2008 14:41:57 +0100 1902000 http://www.medworm.com/index.php?rid=1901999&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F866512301385574q%2F Abstract  Infliximab is approved for the induction and 1-year maintenance of remission in pediatric Crohn’s disease unresponsive to conventional therapy. Despite significant experience with the use of this agent in children and adolescents who have inflammatory bowel disease, many questions about its optimal use remain. Recent safety concerns raised debate over the common practice of using infliximab in combination with conventional immunomodulatory agents. Additionally, although regularly scheduled administration maintains remission more effectively than episodic therapy, it is not known whether all patients who start infliximab must continue it for maintenance. Some patients may be able to use infliximab for induction and another agent for maintenance. Finally, the opti... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1901999 Tue, 21 Oct 2008 14:41:57 +0100 1901999 http://www.medworm.com/index.php?rid=1901998&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1365564266338245%2F Abstract  Nonalcoholic fatty liver disease (NAFLD) is an obesity-associated liver disease found in 3% to 9% of children in the United States. NAFLD represents a spectrum of liver disease and is frequently associated with features of the metabolic syndrome. Nutrition’s role in NAFLD is complex. It does not appear that overweight children with NAFLD have an unusual diet compared with their overweight counterparts without NAFLD. It is more likely that they have increased genetic susceptibility to the general poor diet and state of positive calorie balance currently found in many children. The available treatment studies using nutrition counseling and increased physical activity are promising. We recommend initiating sustainable family-oriented lifestyle changes in all childr... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1901998 Tue, 21 Oct 2008 14:41:57 +0100 1901998 http://www.medworm.com/index.php?rid=1901997&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh7322p26xx334721%2F Abstract  This review focuses on the pathobiology of the gastrointestinal and hepatic manifestations of cystic fibrosis (CF) disease in relation to their genetic basis in mutations of the CF transmembrane conductance regulator (CFTR) gene. It reviews the nature of the CFTR protein, a categorization of the types of gene mutations underlying CF’s various manifestations, and the ways in which absent or reduced CFTR produces various functional abnormalities in the different organs affected by CF. Subsequently, the particular organ-related clinical manifestations of CF directly associated with loss of CFTR function are addressed. Thereafter, the review discusses some of the complexities of the genotype-phenotype relationships related to milder mutations or complex genetic disor... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1901997 Tue, 21 Oct 2008 14:41:57 +0100 1901997 http://www.medworm.com/index.php?rid=1902006&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F59t1662377221v11%2F Abstract  This review addresses current advances in the diagnosis of sleep-related gastroesophageal reflux using ambulatory esophageal pH monitoring and laboratory monitoring, which includes polygraphic assessment of the state of consciousness. This 24-hour pH monitoring uses a new strategy of interpretation that characterizes acidic reflux events and specifically assesses the patient’s position and state of consciousness. Thus, the recognition of reflux events during waking and sleep will add to the overall assessment of gastroesophageal reflux and its severity and clinical relevance. The pH testing, together with overnight polysomnography, offers an opportunity to link nighttime reflux with disease severity. The application of multichannel impedance with pH monitoring a... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902006 Tue, 21 Oct 2008 14:41:56 +0100 1902006 http://www.medworm.com/index.php?rid=1902005&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw82k377737u13045%2F Abstract  Gastroesophageal reflux monitoring is a key investigation in managing gastroesophageal reflux disease. Esophageal pH monitoring is used to quantify esophageal acid exposure and the association of symptoms with acidic reflux episodes. Recently available wireless pH monitoring systems allow reflux monitoring over prolonged periods and increase patient comfort during the procedure. Combined impedance-pH monitoring offers the ability to identify reflux episodes independently of their acid content, an important advantage when evaluating patients with symptoms persisting during acid-suppressive therapy. Content Type Journal ArticleDOI 10.1007/s11894-008-0054-3Authors Radu Tutuian, University Hospital Zurich Division of Gastroenterology and Hepatology Ramistrasse 100 ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902005 Tue, 21 Oct 2008 14:41:56 +0100 1902005 http://www.medworm.com/index.php?rid=1902004&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe81w6785485878m7%2F Abstract  Chronic laryngeal signs and symptoms associated with gastroesophageal reflux disease (GERD) are often referred to as reflux laryngitis or laryngopharyngeal reflux (LPR). It is estimated that up to 15% of all visits to otolaryngology offices are because of manifestations of LPR. Damage to laryngeal mucosa may be the result of reflux of gastroduodenal contents, whether chronic or a single incident. The most common presenting symptoms of LPR include hoarseness, sore throat, throat clearing, and chronic cough. The diagnosis of LPR is usually made on the basis of presenting symptoms and associated laryngeal signs, including laryngeal edema and erythema. The current recommendation for managing these patients is empiric therapy with twice-daily proton pump inhibitors for 1... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902004 Tue, 21 Oct 2008 14:41:56 +0100 1902004 http://www.medworm.com/index.php?rid=1902003&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn745j35577776303%2F This article discusses the current understanding of LPR pathophysiology, taking into account pepsin stability and reactivation. Content Type Journal ArticleDOI 10.1007/s11894-008-0056-1Authors Peter C. Belafsky, University of California, Davis School of Medicine Center for Voice and Swallowing, Department of Otolaryngology Head and Neck Surgery 2521 Stockton Boulevard, Suite 7200 Sacramento CA 95817 USACatherine J. Rees Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 3 / June, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902003 Tue, 21 Oct 2008 14:41:56 +0100 1902003 http://www.medworm.com/index.php?rid=1902002&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7742w0l7h6j36105%2F Abstract  Patients with refractory gastroesophageal reflux disease (GERD) are those who have persistent symptoms while being treated with proton pump inhibitors (PPIs). One third of GERD patients requiring a daily PPI are estimated to eventually experience treatment failure. These patients are usually referred for further investigation to confirm the presence of GERD or to identify other entities as the cause of symptoms. Tools that can be used in this diagnostic process include upper gastrointestinal endoscopy with analysis of esophageal biopsies, esophageal pH monitoring, impedance-pH monitoring, and esophageal bilirubin monitoring. The conventional diagnostic approach includes upper gastrointestinal endoscopy and ambulatory pH monitoring while receiving PPI therapy. New ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902002 Tue, 21 Oct 2008 14:41:56 +0100 1902002 http://www.medworm.com/index.php?rid=1902011&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj0r44jp6405t8253%2F Abstract  Histologic markers of reflux-induced mucosal injury are demonstrable in patients with nonerosive gastroesophageal reflux disease (neGERD). They include papillary elongation, basal cell hyperplasia, and dilation of intercellular spaces, especially of the prickle layer. These abnormalities are responsive to acid-suppressive therapy. Unfortunately, the longitudinal and circumferential distributions of these anomalies are nonuniform. They are presumably focalized on top of the esophageal folds, where the brunt of acid exposure and injury occurs. Therefore, based on current evidence, routine, random, nontargeted biopsies of the distal esophagus cannot be recommended in patients with neGERD. This may change if future studies reveal a high sensitivity and specificity of ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902011 Tue, 21 Oct 2008 14:41:55 +0100 1902011 http://www.medworm.com/index.php?rid=1902010&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F36111473k52q538r%2F This article summarizes recent progress in our understanding of the pathophysiology, diagnosis, and treatment of the reflux cough syndrome. Recent studies have provided further evidence for a role of weakly acidic gastroesophageal reflux in inducing cough. It has also been established that although reflux may induce cough, cough may also trigger reflux in some patients, and distinguishing between the two requires objective detection of cough burst (ie, by esophageal manometry). Treatment of the reflux cough syndrome is an issue of ongoing controversy and further studies. Content Type Journal ArticleDOI 10.1007/s11894-008-0049-0Authors Kathleen BlondeauDaniel SifrimLieven DupontJan Tack, University of Leuven Department of Pathophysiology, Division of Gastroenterology Herestraat 49... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902010 Tue, 21 Oct 2008 14:41:55 +0100 1902010 http://www.medworm.com/index.php?rid=1902009&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu5450461887g261r%2F Abstract  High-grade dysplasia is the last stage before the development of adenocarcinoma. Despite the fact that the lesion is not yet invasive, it has tremendous potential to become malignant. The approach to the disease has clinicians divided between immediate intervention with surgical resection or continued endoscopic surveillance proof of the unclear natural history. Much knowledge has been acquired recently regarding application of surveillance and outcomes of esophageal resection. Also, many endoscopic techniques for treating high-grade dysplasia have been studied in depth. Results on their safety, efficacy, and complication rates have recently become available. This review analyzes the progress in the understanding and treatment of high-grade dysplasia during the pa... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902009 Tue, 21 Oct 2008 14:41:55 +0100 1902009 http://www.medworm.com/index.php?rid=1902008&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fur003010g7g62248%2F Abstract  Gastroesophageal reflux is inherently mechanical in nature, driven by the pressure difference between the stomach and the esophagus in the setting of a relaxed or hypotensive sphincter. Recent advances in our understanding of esophagogastric junction (EGJ) biomechanics in the etiology of gastroesophageal reflux disease are highlighted here. We focus this review on three critical areas: the anatomy and physiology of the EGJ that predispose the junction to reflux, the mechanical compliance of the EGJ musculature that has significant pathophysiologic underpinnings, and the trans-sphincteric pressure gradients during gastro-esophageal reflux. We also examine the mechanistic basis of a higher incidence of reflux in obese patients and conclude with some observations on ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902008 Tue, 21 Oct 2008 14:41:55 +0100 1902008 http://www.medworm.com/index.php?rid=1902007&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Flm15v813n0tnr053%2F Abstract  Refractory gastroesophageal reflux disease (GERD) is very common and may affect up to 40% of patients who use a proton pump inhibitor (PPI) once daily. Refractory GERD can present as incomplete or lack of response to PPI therapy. The disorder is clearly driven by patients, who present with a wide range of symptom severity and frequency while on PPI treatment. Poor compliance and improper timing of PPI consumption should always be excluded before further evaluation of this patient population. The putative mechanisms for refractory GERD include weakly acidic reflux, duodenogastroesophageal/bile reflux, visceral hypersensitivity, delayed gastric emptying, psychological comorbidity, and concomitant functional bowel disorders. Reduced PPI bioavailability, rapid PPI met... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902007 Tue, 21 Oct 2008 14:41:55 +0100 1902007 http://www.medworm.com/index.php?rid=1902013&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F91608505g586h1x1%2F Abstract  Proton pump inhibitors (PPIs) have revolutionized the management of gastroesophageal reflux disease and peptic ulcer disease over the past two decades. Among the most commonly prescribed agents worldwide, PPIs’ overall safety profile is unquestionable. However, emerging evidence indicates that PPI therapy, particularly with long-term and/or high-dose administration, is associated with several potential adverse effects, including enteric infections (eg, Clostridium difficile), community-acquired pneumonia, and hip fracture, all of which have received much attention recently. We review the current data on these and other potential consequences of PPI therapy. More judicious use of PPIs (eg, administering them in no more than the minimum effective dose to older adul... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902013 Tue, 21 Oct 2008 14:41:54 +0100 1902013 http://www.medworm.com/index.php?rid=1902012&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F2k08320x7r2757g9%2F Abstract  Esophageal testing aims to quantify gastroesophageal reflux or characterize esophageal motility. Reflux monitoring traditionally has been based on the detection of acidic reflux by a transnasal catheter that measures esophageal pH. Recently there have been two major developments in this field: the wireless Bravo pH capsule (Medtronic, Inc., Minneapolis, MN), which allows catheter-free monitoring, and impedance-pH measurement, a catheter-based technique that enables detection of acidic and nonacidic reflux. The assessment of esophageal motility has relied on conventional manometry for many years. Two new proedures also recently became available to assess esophageal motility: high-resolution manometry, which uses many closely spaced pressure sensors and provides spa... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1902012 Tue, 21 Oct 2008 14:41:54 +0100 1902012 http://www.medworm.com/index.php?rid=1886713&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk510536m7134h113%2F Content Type Journal ArticleDOI 10.1007/s11894-008-0067-y Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886713 Thu, 16 Oct 2008 09:59:33 +0100 1886713 http://www.medworm.com/index.php?rid=1886712&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc1159h3773516316%2F Content Type Journal ArticleDOI 10.1007/s11894-008-0068-xAuthors Amy E. Foxx-Orenstein Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886712 Thu, 16 Oct 2008 09:59:33 +0100 1886712 http://www.medworm.com/index.php?rid=1886718&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1014567131617203%2F Abstract  Nontyphoidal salmonellosis is the leading cause of foodborne illness in the United States, causing about 1.4 million infections annually. Most cases of salmonellosis are due to ingestion of contaminated food items such as eggs, dairy products, and meats, but almost any foodstuff can be implicated, including peanut butter, as seen during a recent outbreak of more than 600 Salmonella infections. Although outbreaks often gain national media attention, the majority of nontyphoidal Salmonella infections in the United States occur sporadically. Risk factors for salmonellosis include gastric hypoacidity, recent use of antibiotics, extremes of age, and immunosuppressive conditions. Clinical manifestations of the infection most commonly involve self-limited gastroenteritis, ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886718 Thu, 16 Oct 2008 09:59:32 +0100 1886718 http://www.medworm.com/index.php?rid=1886717&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr82546178ml7804l%2F This article summarizes the evidence for and against a link between genes and IBS. In addition, a gene-environment paradigm is presented to combine the two opposing hypotheses, as IBS may represent a complex genetic disorder that results from the interaction of several genes and environmental risk factors. Content Type Journal ArticleDOI 10.1007/s11894-008-0069-9Authors Yuri A. Saito, Mayo Clinic Miles and Shirley Fiterman Center for Digestive Disease 200 First Street SW Rochester MN 55905 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886717 Thu, 16 Oct 2008 09:59:32 +0100 1886717 http://www.medworm.com/index.php?rid=1886716&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr1674k3471270u77%2F Content Type Journal ArticleCategory Invited CommentaryDOI 10.1007/s11894-008-0066-zAuthors Chris E. Forsmark, University of Florida Division of Gastroenterology, Hepatology, and Nutrition Box 100214 Gainesville FL 32610-0214 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886716 Thu, 16 Oct 2008 09:59:32 +0100 1886716 http://www.medworm.com/index.php?rid=1886715&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fjk0683n517910x98%2F This article reviews the evidence that serotonin, one of the better-understood neurotransmitters with respect to its role in human central and intestinal physiology, plays a role in IBS. Serotonin signaling is discussed, with a focus on receptor subtypes and the therapeutic agents that target these receptors. Evidence that IBS is associated with perturbations in serotonin metabolism at various steps in the signaling pathway is also addressed, along with the limitations on alteration in serotonin metabolism as the sole explanation for the constellation of symptoms observed in patients with IBS. Content Type Journal ArticleDOI 10.1007/s11894-008-0070-3Authors Brian GarvinJohn W. Wiley, University of Michigan Health System Department of Internal Medicine A7007 UH, 1500 East Medical ... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886715 Thu, 16 Oct 2008 09:59:32 +0100 1886715 http://www.medworm.com/index.php?rid=1886714&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F34q5850n65h1304h%2F Abstract  Visceral hypersensitivity has emerged as a key hypothesis in explaining the painful symptoms of irritable bowel syndrome (IBS), and it has been proposed as a “biologic marker” for the condition. Visceral hypersensitivity can be influenced by peripheral and central mechanisms affecting pain perception. The optimal method for its assessment in humans has not been determined. Current techniques include stimulation via the computerized barostat and electrical stimulation, response measures including the lower limb reflex, and brain imaging modalities such as functional MRI and positron emission tomography. It has been shown that IBS patients have decreased sensory thresholds to colonic and rectal balloon distention by barostat. Studies using electrical stimulation... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886714 Thu, 16 Oct 2008 09:59:32 +0100 1886714 http://www.medworm.com/index.php?rid=1886722&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7882k18k2085457l%2F Abstract  In their intestine, humans possess an “extended genome” of millions of microbial genes—the microbiome. Because this complex symbiosis influences host metabolism, physiology, and gene expression, it has been proposed that humans are complex biologic “superorganisms.” Advances in microbiologic analysis and systems biology are now beginning to implicate the gut microbiome in the etiology of localized intestinal diseases such as the irritable bowel syndrome, inflammatory bowel disease, and colon cancer. These approaches also suggest possible links between the gut and previously unassociated systemic conditions such as type 2 diabetes and obesity. The elucidation of the intestinal microbiome is therefore likely to underpin future disease prevention strategies... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886722 Thu, 16 Oct 2008 09:59:31 +0100 1886722 http://www.medworm.com/index.php?rid=1886721&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fywtn170681762138%2F Abstract  Cytomegalovirus (CMV) has emerged as a significant opportunistic pathogen in the era of immunosuppression. CMV was a common cause of gastrointestinal disease in AIDS patients, but the introduction of highly active antiretroviral therapy has led to a dramatic decline in AIDS-related disease. Among patients with solid organ transplants, CMV has become an increasingly important cause of gastrointestinal disease as more routine use of early CMV prophylaxis has increased delayed-onset disease, which is often tissue invasive at presentation. The role of CMV in inflammatory bowel disease is controversial; treatment may be indicated in selected cases of steroid-refractory disease with evidence of CMV. Diagnosis of gastrointestinal CMV disease generally requires endoscopic... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886721 Thu, 16 Oct 2008 09:59:31 +0100 1886721 http://www.medworm.com/index.php?rid=1886720&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F0506203132358021%2F Abstract   Clostridium difficile infection has become one of the most common causes of diarrhea in patients frequenting hospitals, skilled nursing facilities, and physicians’ offices. Although the pathogenesis and clinical description were well elucidated three decades ago, cure during the initial episode now occurs in fewer than two thirds of patients exhibiting clinical illness. The past decade has brought a new strain with more toxin. Frequent relapses in elderly patients are now the norm rather than a rarity. This review is intended to update clinicians regarding diagnosis, infection control, and treatment, including treatment of the difficult-to-treat patient with multiple relapses of C. difficile infection. Content Type Journal ArticleDOI 10.1007/s11894-008-0076-... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886720 Thu, 16 Oct 2008 09:59:31 +0100 1886720 http://www.medworm.com/index.php?rid=1886719&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg7k7t530110w7574%2F This article reviews the manifestations of HSV infection within the luminal gastrointestinal tract and options for diagnosis and treatment. Content Type Journal ArticleDOI 10.1007/s11894-008-0078-8Authors Eric A. LaveryWalter J. Coyle, Division of Gastroenterology and Hepatology Scripps Clinic Torrey Pines 10666 North Torrey Pines Road, N203 La Jolla CA 92037 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886719 Thu, 16 Oct 2008 09:59:31 +0100 1886719 http://www.medworm.com/index.php?rid=1886727&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl9712x4263113467%2F This article discusses the concept of intestinal permeability and the barrier function of the gut, elaborates on tight junction structure and the dynamic nature of its composition, outlines the methods for evaluating intestinal permeability, and explores abnormal intestinal permeability in clinical disease, emphasizing its possible role in the pathogenesis of autoimmune conditions. Evidence is provided from several representative diseases for a proposed model of abnormal intestinal permeability in autoimmune disease, including a description of a molecular pathway involving a signaling protein called zonulin, which appears to regulate intestinal permeability. Finally, we speculate on mechanisms that may be responsible for increasing intestinal permeability and consider clinical implic... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886727 Thu, 16 Oct 2008 09:59:30 +0100 1886727 http://www.medworm.com/index.php?rid=1886726&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F564n00898017887j%2F Abstract  Necrotizing enterocolitis (NEC) is the most common severe gastrointestinal emergency that affects newborns. Its etiology is still undetermined. Most of our knowledge of this disease stems from epidemiologic studies, clinical experience, and studies using animal models that do not directly represent the disease in premature infants. An immature intestine that is colonized by bacteria is a prerequisite for the pathogenesis of NEC. Although causative microbes have not been found, newly developed analytic techniques now allow the detection of noncultivatable microbes and the determination of their overall diversity and metabolic capabilities. The National Institutes of Health Human Microbiome Road-map Project is likely to generate new information highly germane to und... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886726 Thu, 16 Oct 2008 09:59:30 +0100 1886726 http://www.medworm.com/index.php?rid=1886725&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw4h8m1540230q67m%2F Abstract  A rationale for the use of probiotics for a number of functional gastrointestinal symptoms and syndromes can be developed, and an experimental basis for their use continues to emerge, but data from well-conducted clinical trials of probiotics in this area remain scarce. Irritable bowel syndrome (IBS) has attracted the most attention; recent revelations regarding the potential pathogenic roles of the enteric flora and immune activation have led to reawakened interest in bacteriotherapy for this common and challenging disorder. Some recent randomized, controlled studies attest to the efficacy of some probiotics in alleviating individual IBS symptoms, and selected strains have a more global impact. Evidence for long-term efficacy is also beginning to emerge, though m... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886725 Thu, 16 Oct 2008 09:59:30 +0100 1886725 http://www.medworm.com/index.php?rid=1886724&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe646247115l14060%2F Abstract  Histopathologic data demonstrate low-grade mucosal inflammation in a subset of patients with irritable bowel syndrome (IBS). This inflammatory infiltrate is mainly represented by increased numbers of T lymphocytes and mast cells lying in the lamina propria. The close apposition of immunocytes to gut nerves supplying the mucosa provides a basis for neuroimmune cross-talk, which may explain gut sensorimotor dysfunction and related symptoms in patients with IBS. A previous gastroenteritis (due to Campylobacter jejuni, Salmonella, Shigella, Escherichia coli, and, likely, viruses) is now an established etiologic factor for IBS (hence, postinfectious IBS). Other putative causes, such as undiagnosed food allergies, genetic abnormalities, stress, or bile acid malabsorption,... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886724 Thu, 16 Oct 2008 09:59:30 +0100 1886724 http://www.medworm.com/index.php?rid=1886723&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn1774w2536k6r781%2F Content Type Journal ArticleDOI 10.1007/s11894-008-0074-zAuthors Walter J. Coyle Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Gastroenterology Reports) Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886723 Thu, 16 Oct 2008 09:59:30 +0100 1886723 http://www.medworm.com/index.php?rid=1886731&cid=s_35933_17_f&fid=35933&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa1356q728623u642%2F This article describes the history of the serrated adenoma (both the traditional serrated adenoma and the sessile serrated adenoma) as well as the histology and endoscopic appearance of these lesions in comparison with hyperplastic polyps and mixed polyps. Although the exact pathway is the subject of ongoing research, compelling histologic associations and molecular phenotypes that define the model of the serrated polyp-carcinoma sequence, including microsatellite instability, BRAF/KRAS mutations, and CpG island methylator phenotype, provide strong evidence that this is a genuine pathway. Management of serrated neoplasia of the colon includes careful colonoscopy, complete removal of colonic polyps, sampling fields of diminutive polyps of the rectosigmoid, and basing surveillance on h... Current Gastroenterology Reports journals http://www.medworm.com/rss/comments.php?id=1886731 Thu, 16 Oct 2008 09:59:29 +0100 1886731