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 'Gastroenterology Clinics of North America' source. Sun, 29 Jan 2012 16:27:59 +0100 http://www.medworm.com/index.php?rid=5432339&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000987%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432339 Tue, 22 Nov 2011 09:27:11 +0100 5432339 http://www.medworm.com/index.php?rid=5432338&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000872%2Fabstract%3Frss%3Dyes Chronic intestinal pseudo-obstruction (CIPO) is today a significant indication for home parenteral nutrition (HPN) in both adults and children. CIPO refers to a heterogeneous group of disorders characterized by symptoms of intestinal obstruction in the absence of mechanical evidence of obstruction. It is caused by ineffective intestinal contractions. CIPO may be classified either as a primary disease, which is usually limited to the hollow viscera, or as a secondary disease, which is associated with an existing systemic disorder. CIPO may predominate as a “total” gut disease from esophagus to anal sphincter or as a “localized” disease, which is gastric and intestinal or intestinal alone; with the exception of an isolated megaduodenum, segmental gut disease is not a feature. Recurre... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432338 Tue, 22 Nov 2011 09:27:11 +0100 5432338 http://www.medworm.com/index.php?rid=5432337&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000781%2Fabstract%3Frss%3Dyes A subset of patients with chronic constipation, up to 50% at tertiary centers, have difficult defecation, which can be suspected by clinical features and confirmed by anorectal tests. Symptoms of difficult defecation (ie, defecatory disorders) may occur in isolation or in association with symptoms of irritable bowel syndrome. Patients with defecatory disorders may have normal or slow colonic transit. Defecatory disorders should be recognized early because pelvic floor retraining by biofeedback therapy is superior to laxatives for management. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432337 Tue, 22 Nov 2011 09:27:11 +0100 5432337 http://www.medworm.com/index.php?rid=5432336&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000835%2Fabstract%3Frss%3Dyes Esophageal motility disorders may be an explanation of dysphagia in patients after exclusion of esophageal structural lesions by endoscopy and radiography and eosinophilic esophagitis by histology. The best defined motility disorder is achalasia; however, other motility disorders such as diffuse esophageal spasm (DES), hypercontractile esophagus, and absent or weak peristalsis have also been reported with dysphagia. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432336 Tue, 22 Nov 2011 09:27:11 +0100 5432336 http://www.medworm.com/index.php?rid=5432335&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000793%2Fabstract%3Frss%3Dyes The population of the Western world is abundantly exposed to food. Together with the introduction of fast food, this situation has contributed to an exponential increase in morbid obesity. Similarly, the prevalence of gastroesophageal reflux disease (GERD) has increased significantly in the past decades, representing one of the most common gastrointestinal (GI) disorders in the Western world. The fact that morbid obesity is a significant risk factor for GERD certainly contributes to this tendency. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432335 Tue, 22 Nov 2011 09:27:11 +0100 5432335 http://www.medworm.com/index.php?rid=5432334&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000823%2Fabstract%3Frss%3Dyes Functional gastrointestinal disorders range from highly prevalent, but generally benign conditions, eg, functional dyspepsia and irritable bowel syndrome, to rare and potentially life-threatening diseases, eg, intestinal pseudo-obstruction syndromes. The term “intestinal pseudo-obstruction” was introduced in the late 1950s by Dudley and Colleagues who reviewed their own series observed over the years of thirteen cases with intestinal obstruction unexplained by any mechanical cause (notably, some of them originally referred to as “spastic ileus”). Subsequently, the existence of intestinal pseudo-obstruction syndromes has been confirmed and extended by other Authors. It is now established that pseudo-obstruction refers to a condition characterized by symptoms and signs (both clinical... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432334 Tue, 22 Nov 2011 09:27:11 +0100 5432334 http://www.medworm.com/index.php?rid=5432333&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000811%2Fabstract%3Frss%3Dyes Gastrointestinal (GI) symptoms occur commonly in patients with cancer and may reflect dysfunction throughout the gut (). Many potential causes exist for these symptoms including GI dysmotility. Although symptoms referable to disturbances in GI motor function are frequently encountered in patients with neoplasms, they are notoriously nonspecific and discrete disorders based on well-defined myoneural pathology are distinctly uncommon. Paraneoplastic neurologic syndromes are a heterogeneous group of rare disorders () related to an underlying malignancy but caused by mechanisms other than metastases, metabolic and nutritional deficits, infections, ischemia, or side effects of cancer treatment. A variety of antibodies directed against antigens expressed by both the tumor and the nervous system ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432333 Tue, 22 Nov 2011 09:27:11 +0100 5432333 http://www.medworm.com/index.php?rid=5432332&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000860%2Fabstract%3Frss%3Dyes Down syndrome (DS) is the most common chromosomal abnormality occurring in humans. In Europe, DS accounts for 8% of all registered cases of congenital anomalies. Throughout the world, the overall prevalence of DS is 10 per 10,000 live births, although in recent years this figure has been increasing. DS is characterized by several dysmorphic features, delayed psychomotor development, and low muscle tone in early infancy. DS is associated with dysfunctions that might affect almost every organ and system, including the gut. It has been reported that more than 77% of DS affected neonates have, or develop, associated gastrointestinal (GI) disorders. These conditions can be classified into mechanical and functional disorders and can be primary or secondary. (Source: Gastroenterology Clinics of N... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432332 Tue, 22 Nov 2011 09:27:11 +0100 5432332 http://www.medworm.com/index.php?rid=5432331&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000859%2Fabstract%3Frss%3Dyes As populations age, the prevalence of neurologic disease in the community continues to increase, and consultations relating to gastrointestinal motility problems in the patient afflicted with a neurologic disorder become ever more common. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432331 Tue, 22 Nov 2011 09:27:11 +0100 5432331 http://www.medworm.com/index.php?rid=5432330&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531100080X%2Fabstract%3Frss%3Dyes Gastrointestinal motility can be markedly deranged in critical illness. This can have a number of important clinical sequelae—the most obvious of which is impaired delivery of enteral nutrition, which can result in malnutrition, if not recognized and treated. Impaired gastric emptying and lower esophageal sphincter function may allow reflux of gastric contents into the esophagus during enteral feeding, especially in the recumbent position. This situation, combined with the loss of normal airway reflexes in the sedated and sometimes paralyzed patient, results in aspiration, which can be subclinical and therefore unrecognized, impairing respiratory function and predisposing to ventilator-associated pneumonia. Another proposed consequence of gastrointestinal dysmotility in the critically il... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432330 Tue, 22 Nov 2011 09:27:11 +0100 5432330 http://www.medworm.com/index.php?rid=5432329&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000884%2Fabstract%3Frss%3Dyes Gastrointestinal motility disorders affect the neuromuscular functions needed for movement of contents through the gastrointestinal tract. This definition excludes strictures and other mechanical causes for impaired passage from the concept of motility disorders. Functional gastrointestinal disorders (FGID), on the other hand, have traditionally been believed to arise from a gastrointestinal tract with an intact neuromuscular function. Most definitions of FGID include the absence of structural changes, but the depth of the search for such changes has varied. The latest version of the Rome Criteria for functional bowel disorders states that “research will likely confirm that functional gut disorders manifest such (structural or biochemical) findings”. (Source: Gastroenterology Clinics o... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432329 Tue, 22 Nov 2011 09:27:11 +0100 5432329 http://www.medworm.com/index.php?rid=5432328&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000847%2Fabstract%3Frss%3Dyes This issue of Gastroenterology Clinics of North America is focused on challenges faced in everyday clinical practice. Thus rather than reviewing the evolving research literature that details the many experimental models of enteric neuromuscular disease, this article considers the problems faced by the practicing pathologist, who, faced with a single tight-focus histologic “snapshot” of surgically derived tissue must decide whether disease of nerve, smooth muscle, or interstitial cells of Cajal (ICC) are present. This raises several technical and interpretational challenges (). Several of these points have been addressed in recent publications of an International Working Group (IWG) for GI neuromuscular pathology, and much of this review draws on the IWG's important contributions to con... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432328 Tue, 22 Nov 2011 09:27:11 +0100 5432328 http://www.medworm.com/index.php?rid=5432327&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000902%2Fabstract%3Frss%3Dyes Please note a correction is necessary in the article, “Hepatorenal Syndrome: Do the Vasoconstrictors Work?” by Drs Wesley Leung and Florence Wong, which published in the September 2011 issue of Gastroenterology Clinics of North America (40:3, pp 581–598). Following are the corrected source lines for Figures 2 and 3: (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432327 Tue, 22 Nov 2011 09:27:11 +0100 5432327 http://www.medworm.com/index.php?rid=5432326&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000896%2Fabstract%3Frss%3Dyes The study of gastrointestinal motility and those disorders that result from its disordered function has, for far too long, been a much neglected component of every gastroenterology curriculum. Clinicians are “put off” by discussions of motility that, in their view, appear to focus on details of gut electrophysiology, neurotransmitter function, and enteric neural morphology, while, in “real life,” disorders apparently resulting from pathology or dysfunction of enteric nerve and muscle and/or of the factors that control them go ignored. This neglect has been unfortunate given rapid progress in our understanding of the molecular and morphological basis of motor activity and of the physiology and basic pharmacology of motility, the advent of new approaches to the clinical assessment of... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432326 Tue, 22 Nov 2011 09:27:11 +0100 5432326 http://www.medworm.com/index.php?rid=5432325&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000975%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432325 Tue, 22 Nov 2011 09:27:11 +0100 5432325 http://www.medworm.com/index.php?rid=5432324&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000963%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432324 Tue, 22 Nov 2011 09:27:11 +0100 5432324 http://www.medworm.com/index.php?rid=5432323&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000951%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5432323 Tue, 22 Nov 2011 09:27:11 +0100 5432323 http://www.medworm.com/index.php?rid=5196952&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000720%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196952 Wed, 31 Aug 2011 23:00:00 +0100 5196952 http://www.medworm.com/index.php?rid=5196951&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000586%2Fabstract%3Frss%3Dyes According to the United States Department of Health and Human Services, from 1988 to 2010, the number of annual liver transplants has increased from 1713 to 6291. Patient survival rates have ranged from 66% to 71% at 7 years and graft survival rates have ranged from 58% to 61% at 7 years. Both the increase in frequency of liver transplantation and the improved survival of transplant recipients are great achievements of modern medicine. With this increase in the number of successful outcomes, there are more liver transplant recipients living both longer and with an improved quality of life. The responsibility for the long-term care for these patients often falls on the shoulders of the practicing gastroenterologist. The identification and treatment of long-term comorbidities such as hyperte... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196951 Wed, 31 Aug 2011 23:00:00 +0100 5196951 http://www.medworm.com/index.php?rid=5196950&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000598%2Fabstract%3Frss%3Dyes Liver transplantation has evolved since Dr. Thomas Starzl performed the first orthotopic liver transplant (OLT) over 4 decades ago. Advances in immunosuppressive therapy, medical management, surgical technique, and identification of appropriate indications for OLT have resulted in significant improvements in patients' survival and universal recognition of the procedure as preferred therapy for those suffering from hepatic failure. The number of patients awaiting primary or repeat OLT in the United States has tripled to 18,000 in the last 2 decades. Over the same period, organ availability increased from 1700 to 6200 grafts annually; however, the concurrent increase in organ availability has not significantly impacted the rate of wait-list mortality; deaths on the waiting list have increase... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196950 Wed, 31 Aug 2011 23:00:00 +0100 5196950 http://www.medworm.com/index.php?rid=5196949&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000604%2Fabstract%3Frss%3Dyes Alcoholic hepatitis (AH) is a distinct subset of patients with alcoholic liver disease and has a potential for high mortality within 3 to 6 months after clinical presentation. Mild forms of AH usually improve with conservative management. However, patients with severe AH have been reported to have 30-day mortality of up to 50%. Therefore, assessment of the disease severity becomes an important and practical issue for clinicians involved in the management of patients with AH. Many scoring systems have been developed for use in clinical practice. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196949 Wed, 31 Aug 2011 23:00:00 +0100 5196949 http://www.medworm.com/index.php?rid=5196948&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000550%2Fabstract%3Frss%3Dyes Hepatocellular carcinoma (HCC) is the sixth most common cancer and is the third leading cause of cancer-related deaths worldwide. The continued rise in HCC incidence and mortality emphasizes the need for novel therapeutic approaches. The ability to significantly impact disease epidemiology hinges on 2 important factors: cancer screening and surveillance programs and the existence of effective therapeutic tools. The success of any cancer screening program relies on principles of early detection of cancer among at-risk populations affording greater therapeutic options and more effective treatment potential. Many factors can influence HCC risk, chief among them HCC etiology, and recent updates by the American Association for the Study of Liver Diseases attempt to better define at risk groups ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196948 Wed, 31 Aug 2011 23:00:00 +0100 5196948 http://www.medworm.com/index.php?rid=5196947&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531100063X%2Fabstract%3Frss%3Dyes Hepatorenal syndrome (HRS) is a potentially reversible clinical syndrome that occurs in patients with cirrhosis, ascites and liver failure, as well as in patients with acute liver failure or alcoholic hepatitis. It is characterized by impaired renal function, marked alterations in cardiovascular function and overactivity of the sympathetic nervous (SNS) and renin–angiotensin–aldosterone systems. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196947 Wed, 31 Aug 2011 23:00:00 +0100 5196947 http://www.medworm.com/index.php?rid=5196946&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000549%2Fabstract%3Frss%3Dyes Up to 50% of patients with cirrhosis have esophageal varices at initial endoscopy, and nearly all patients with varices have a high portal pressure, that is, an hepatic venous pressure gradient (HVPG) of 12 mmHg or higher (normal, 3–5). In patients without varices, esophageal varices develop and grow in size at a rate of about 7% per year as a result of ongoing portal hypertension. It has been shown that varices develop at a significantly higher rate in patients with a baseline HVPG above 10 mmHg and in patients in whom the HVPG increases by more than 10% in the first year. Without treatment, varices rupture in about one third of patients, with the highest rates observed in patients with large varices, red wale marks. and/or in Child C patients. In the past, and before the use of drugs, ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196946 Wed, 31 Aug 2011 23:00:00 +0100 5196946 http://www.medworm.com/index.php?rid=5196945&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000537%2Fabstract%3Frss%3Dyes The association of hepatic steatosis with inflammatory changes and fibrosis in obese patients was first described over half a century ago. Although initially thought to be a relatively benign entity, reports began emerging that in some circumstances fat in the liver could lead to cirrhosis or liver failure, as in patients undergoing surgical jejunoileal bypass for morbid obesity. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196945 Wed, 31 Aug 2011 23:00:00 +0100 5196945 http://www.medworm.com/index.php?rid=5196944&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000616%2Fabstract%3Frss%3Dyes This article summarizes current practice and recent advances in the management of ALF. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196944 Wed, 31 Aug 2011 23:00:00 +0100 5196944 http://www.medworm.com/index.php?rid=5196943&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000628%2Fabstract%3Frss%3Dyes Often regarded as the gold standard for fibrosis assessment, liver biopsy does carry associated risks given its invasive nature. Moreover, liver biopsy is not a true gold standard owing to interobserver and intra-observer variability and the small amount of tissue that is typically obtained with this procedure. Advances in the development of serologic tests and conventional imaging techniques have been shown to reduce the need for liver biopsy for diagnosing hepatic fibrosis. More commonly, it is a tool that is now reserved for evaluating indeterminate noninvasive tests or excluding features of particular diseases (eg, autoimmune hepatitis, steatohepatitis). (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196943 Wed, 31 Aug 2011 23:00:00 +0100 5196943 http://www.medworm.com/index.php?rid=5196942&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000562%2Fabstract%3Frss%3Dyes The ultimate goal of treating a chronic infectious disease is the eradication of the infectious agent to prevent organ damage or death. The natural history of untreated chronic hepatitis B may result in the development of cirrhosis, followed by hepatic decompensation and death. Hepatocellular carcinoma (HCC) can also occur in patients with chronic hepatitis B virus (HBV) infection, with or without the presence of cirrhosis. Antiviral therapy with oral nucleos(t)ide analog (NUC) agents suppress viral replication but do not directly act on the covalently closed circular DNA that resides within infected hepatocytes; thus, current oral therapy rarely eradicates HBV infection. Although these oral antiviral agents are well-tolerated with minimal side effects, prolonged viral suppression runs the... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196942 Wed, 31 Aug 2011 23:00:00 +0100 5196942 http://www.medworm.com/index.php?rid=5196941&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000574%2Fabstract%3Frss%3Dyes Infection with hepatitis C virus (HCV) is a worldwide epidemic affecting up to 3% of the world's population. Approximately 80% of people infected with HCV will go on to develop chronic disease. Of these individuals, approximately 25% develop cirrhosis and are vulnerable to its complications, including hepatocellular carcinoma. Treatment for HCV can be curative, and successful treatment improves the quality of life of HCV infected individuals as well as prevents progression of liver disease and its associated morbidity and mortality. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196941 Wed, 31 Aug 2011 23:00:00 +0100 5196941 http://www.medworm.com/index.php?rid=5196940&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000641%2Fabstract%3Frss%3Dyes It is my distinct privilege to be the guest editor of the September 2011 issue of Gastroenterology Clinics of North America entitled, “Hepatology Update: Current Management and New Therapies.” It has been seven years since an issue of Gastroenterology Clinics has been exclusively dedicated to the field of hepatology. The scope of practice of a busy gastroenterologist includes managing patients with complex liver diseases. This issue offers comprehensive reviews by many of the world's leading authorities on a potpourri of topics in hepatology and liver transplantation. As is evident from the titles of each of these articles, the focus of this issue is on “management” and the goal is to deliver an authoritative, up-to-date, and evidence-based text to the practicing gastroenterologist... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196940 Wed, 31 Aug 2011 23:00:00 +0100 5196940 http://www.medworm.com/index.php?rid=5196939&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000719%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196939 Wed, 31 Aug 2011 23:00:00 +0100 5196939 http://www.medworm.com/index.php?rid=5196938&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000707%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196938 Wed, 31 Aug 2011 23:00:00 +0100 5196938 http://www.medworm.com/index.php?rid=5196937&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000690%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5196937 Wed, 31 Aug 2011 23:00:00 +0100 5196937 http://www.medworm.com/index.php?rid=4865014&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000471%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865014 Thu, 26 May 2011 17:09:59 +0100 4865014 http://www.medworm.com/index.php?rid=4865008&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000215%2Fabstract%3Frss%3Dyes Inflammatory bowel diseases (IBD), namely Crohn disease (CD) and ulcerative colitis (UC), are common in Western society. Because at least half of the patients suffering from these diseases are women, it is important that physicians are aware of their gender-specific needs. There are multiple important concerns for women with UC and CD including issues of body image and sexuality, menstruation, contraception, screening for cervical cancer, matters related to menopause and hormone replacement therapy, osteoporosis, and the overlap seen between IBS and IBD. In this article, we have addressed these important, non–pregnancy-related issues faced by women with IBD. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865008 Thu, 26 May 2011 17:09:59 +0100 4865008 http://www.medworm.com/index.php?rid=4865006&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000239%2Fabstract%3Frss%3Dyes Hepatitis B virus (HBV) during pregnancy presents unique management challenges. Varying aspects of care must be considered, including the effects of HBV on maternal and fetal health, effects of pregnancy on the course of HBV infection, treatment of HBV during and after pregnancy, and prevention of perinatal infection. Antiretroviral therapy has not been associated with increased risk of birth defects or toxicity, but despite studies designed to elucidate the drug efficacy and safety in affected individuals and the developing fetus, recommendations are inconclusive. Clinicians and patients must make individualized decisions after carefully evaluating the risks and benefits summarized in this article. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865006 Thu, 26 May 2011 17:09:59 +0100 4865006 http://www.medworm.com/index.php?rid=4865005&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000288%2Fabstract%3Frss%3Dyes This article briefly discusses gestational physiologic changes and thereafter reviews liver diseases during pregnancy, which are divided into 3 main categories. The first category includes conditions that are unique to pregnancy and generally resolve with the termination of pregnancy, the second category includes liver diseases that are not unique to the pregnant population but occur commonly or are severely affected by pregnancy, and the third category includes diseases that occur coincidentally with pregnancy and in patients with underlying chronic liver disease, with cirrhosis, or after liver transplant who become pregnant. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865005 Thu, 26 May 2011 17:09:59 +0100 4865005 http://www.medworm.com/index.php?rid=4865004&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000276%2Fabstract%3Frss%3Dyes This article reviews the epidemiology, pathology, diagnosis, outcomes, and treatment of NVP and HG. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865004 Thu, 26 May 2011 17:09:58 +0100 4865004 http://www.medworm.com/index.php?rid=4865003&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531100029X%2Fabstract%3Frss%3Dyes Irritable bowel syndrome (IBS) is a highly prevalent disorder characterized by nonspecific symptoms that can mimic other common medical conditions. A careful history and physical examination may reveal clues that suggest a coexisting or alternative diagnosis, such as small intestinal bacterial overgrowth or celiac disease (CD). Testing for bacterial overgrowth has limitations, but emerging data suggest that antibiotics may be of some benefit in patients with IBS with diarrhea and bloating. CD seems to have a higher prevalence in patients with IBS. Some patients with IBS may have symptomatic improvement on gluten-restricted diets, without histologic or serologic evidence of CD. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865003 Thu, 26 May 2011 17:09:58 +0100 4865003 http://www.medworm.com/index.php?rid=4865002&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000306%2Fabstract%3Frss%3Dyes Irritable bowel syndrome (IBS) is a complex clinical process with multiple pathophysiologic mechanisms. There has recently been a shift in the treatment of patients with severe IBS symptoms to disease-modifying therapies as opposed to symptomatic treatment. Because pathophysiologic differences exist between men and women, so does the efficacy of treatment options. These differences could further explain gender-related differences in disease prevalence and treatment response. A brief discussion of the definition, epidemiology, and diagnostic criteria of IBS is followed by a comprehensive review of the current treatment choices and potential future therapeutic options of IBS in women. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865002 Thu, 26 May 2011 17:09:58 +0100 4865002 http://www.medworm.com/index.php?rid=4865001&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000318%2Fabstract%3Frss%3Dyes Discussions of gastrointestinal gender-related issues have lagged behind other fields and may be the result of the previous domination of men within the field of gastroenterology. With the more recent influx of women into gastroenterology, gender-specific gastrointestinal disorders have been increasingly exposed, researched, and discussed. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865001 Thu, 26 May 2011 17:09:58 +0100 4865001 http://www.medworm.com/index.php?rid=4865000&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531100046X%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865000 Thu, 26 May 2011 17:09:58 +0100 4865000 http://www.medworm.com/index.php?rid=4864999&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000458%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4864999 Thu, 26 May 2011 17:09:58 +0100 4864999 http://www.medworm.com/index.php?rid=4864998&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000446%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4864998 Thu, 26 May 2011 17:09:58 +0100 4864998 http://www.medworm.com/index.php?rid=4865013&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000252%2Fabstract%3Frss%3Dyes This article comprehensively reviews gastrointestinal issues that commonly afflict the elderly female population. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865013 Wed, 13 Apr 2011 23:00:00 +0100 4865013 http://www.medworm.com/index.php?rid=4865011&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000203%2Fabstract%3Frss%3Dyes This article discusses global variations of inflammatory bowel disease, Helicobacter pylori, irritable bowel disease, fecal incontinence, hepatitis B, and hepatocellular cancer. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865011 Wed, 13 Apr 2011 23:00:00 +0100 4865011 http://www.medworm.com/index.php?rid=4865010&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000197%2Fabstract%3Frss%3Dyes This article reviews these issues. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865010 Wed, 13 Apr 2011 23:00:00 +0100 4865010 http://www.medworm.com/index.php?rid=4865007&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000264%2Fabstract%3Frss%3Dyes Primary biliary cirrhosis is a chronic autoimmune inflammatory disease of the liver with a striking female preponderance. It has an insidious onset and typically affects middle-aged women. The disease manifests gradually with symptoms of fatigue, pruritis, and increased alkaline phosphatase levels on laboratory evaluation. The hallmark of the disease is the circulating antimitochondrial antibody. Histology is characterized by inflammation of the bile ducts, destruction of cholangiocytes, and subsequent cholestasis, progressing to biliary cirrhosis. The standard treatment for primary biliary cirrhosis is ursodeoxycholic acid, which improves survival, but the disease can still lead to cirrhosis and liver failure over decades. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865007 Wed, 13 Apr 2011 23:00:00 +0100 4865007 http://www.medworm.com/index.php?rid=4865012&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000227%2Fabstract%3Frss%3Dyes Women have started to enter gastroenterology (GI) in significant numbers over the past 5 years, although they are still underrepresented compared with the proportion of female graduating medical students. This underrepresentation is most likely caused by the culture of GI where female students and residents have felt undervalued and unwelcome. This type of discrimination is difficult to fight because it is behind the scenes. However, with increasing female role models in GI, this underrepresentation will likely change in the coming years. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865012 Thu, 07 Apr 2011 23:00:00 +0100 4865012 http://www.medworm.com/index.php?rid=4865009&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000240%2Fabstract%3Frss%3Dyes Crohn disease and ulcerative colitis commonly affect women in their childbearing years. Fortunately, advances in the field of inflammatory bowel disease have made successful pregnancy outcomes a reality for many women. These advances have led to family planning as a common discussion between gastroenterologists and inflammatory bowel disease patients. Common discussion topics are fertility, conception, medication safety, pregnancy, delivery, and breastfeeding although there are limited available data. Education and patient awareness have become vital factors in successful pregnancy outcomes. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4865009 Thu, 07 Apr 2011 23:00:00 +0100 4865009 http://www.medworm.com/index.php?rid=4596161&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000112%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596161 Tue, 01 Mar 2011 00:00:00 +0100 4596161 http://www.medworm.com/index.php?rid=4596160&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001299%2Fabstract%3Frss%3Dyes This article reviews current evidence supporting the use of CAM in IBS, with a focus on prebiotics, acupuncture, and herbal medicines. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596160 Tue, 01 Mar 2011 00:00:00 +0100 4596160 http://www.medworm.com/index.php?rid=4596159&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001263%2Fabstract%3Frss%3Dyes This article reviews the IBS drugs that have reached phase II or III clinical trials. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596159 Tue, 01 Mar 2011 00:00:00 +0100 4596159 http://www.medworm.com/index.php?rid=4596158&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001330%2Fabstract%3Frss%3Dyes Several recent observations have raised the possibility that disturbances in the gut microbiota and/or a low-grade inflammatory state may contribute to symptomatology and the etiology of irritable bowel syndrome (IBS). Consequent on these hypotheses, several therapeutic categories have found their way into the armamentarium of those who care for IBS sufferers. These agents include probiotics, prebiotics, antibiotics, and anti-inflammatory agents. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596158 Tue, 01 Mar 2011 00:00:00 +0100 4596158 http://www.medworm.com/index.php?rid=4596157&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001275%2Fabstract%3Frss%3Dyes Irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders typically defy traditional diagnostic methods based on structural abnormalities, and has led to the emergence of the discipline of neurogastroenterology or the study of the “brain-gut axis,” which is based on dysregulation of neuroenteric pathways as a key pathophysiological feature of IBS. Centrally acting treatments can influence these pathways and improve the clinical manifestations of pain and bowel dysfunction associated with this disorder. To successfully implement these treatment strategies, it is important to recognize their dual effects on brain and gut, understanding the nature and severity of the GI symptoms and their psychosocial concomitants, and applying them within the context of the pati... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596157 Tue, 01 Mar 2011 00:00:00 +0100 4596157 http://www.medworm.com/index.php?rid=4596156&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001329%2Fabstract%3Frss%3Dyes Gut-acting therapies are common therapies for irritable bowel syndrome (IBS). Most of these peripheral acting agents are primarily targeted at individual symptoms. The evidence supporting the use of these agents in IBS is largely anecdotal. Serotonergic agents and the chloride channel activator lubiprostone have shown efficacy in treating symptoms of IBS. The clinical evidence supporting the use of these agents is based on data from high-quality clinical trials. The use of serotonergic agents for IBS in the United States is limited to the 5-hydroxytryptamine-3 antagonist alosetron in the treatment of women with severe IBS with diarrhea refractory to traditional therapy. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596156 Tue, 01 Mar 2011 00:00:00 +0100 4596156 http://www.medworm.com/index.php?rid=4596155&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001366%2Fabstract%3Frss%3Dyes This article reviews the literature supporting a causal link between food and the symptoms of IBS as well as the evidence supporting dietary interventions as a means of managing IBS symptoms. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596155 Tue, 01 Mar 2011 00:00:00 +0100 4596155 http://www.medworm.com/index.php?rid=4596154&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000021%2Fabstract%3Frss%3Dyes A “biomarker” (biological marker) is an indicator of a bodily function that can be objectively measured. A wide range of possible biomarkers for IBS have been considered but at present only gut transit measured using radio-isotope markers meet the criteria of reproducibility and availability. While barostat studies perform reasonably in expert centers, to do them reproducibly requires considerable effort and standardization. This makes them unsuitable for widespread use. However radio-isotope tests are expensive and of limited availability so the search for other more convenient markers including blood and stool tests is still an important goal for the future. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596154 Tue, 01 Mar 2011 00:00:00 +0100 4596154 http://www.medworm.com/index.php?rid=4596153&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001251%2Fabstract%3Frss%3Dyes This article discusses the diagnostic criteria and processes applicable to irritable bowel syndrome (IBS). The authors describe the various diagnostic criteria with a focus on the Rome criteria for IBS and the judicious application of historical information such as alarm features and the yield of various diagnostic modalities such as blood, stool, breath, and endoscopic tests. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596153 Tue, 01 Mar 2011 00:00:00 +0100 4596153 http://www.medworm.com/index.php?rid=4596152&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001317%2Fabstract%3Frss%3Dyes Medical students are taught that 90% of all diagnoses are made through careful assessment of the patients' symptoms. Clinicians now rely heavily on techniques such as endoscopy or radiology before making a definitive diagnosis of organic disease. Most gastroenterologists would require endoscopic confirmation before labeling a patient as having peptic ulcer disease and would make a diagnosis of Crohn disease based on small bowel radiology or colonoscopy. However, the most common causes of symptoms of the gastrointestinal tract are functional. It is important that clinicians obtain a thorough history so that the disorder of the patient can be accurately defined. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596152 Tue, 01 Mar 2011 00:00:00 +0100 4596152 http://www.medworm.com/index.php?rid=4596151&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001342%2Fabstract%3Frss%3Dyes This article reviews the evidence for a bacterial concept in IBS and begins to formulate a hypothesis of how these bacterial systems could integrate in a new pathophysiologic mechanism in the development of IBS. Data suggesting an interaction between this gut flora and inflammation in the context of IBS is also presented. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596151 Tue, 01 Mar 2011 00:00:00 +0100 4596151 http://www.medworm.com/index.php?rid=4596150&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001354%2Fabstract%3Frss%3Dyes Irritable bowel syndrome (IBS) is a common disorder that has been shown to aggregate in families and to affect multiple generations, but not in a manner consistent with a major Mendelian effect. Relatives of an individual with IBS are 2 to 3 times as likely to have IBS, with both genders being affected. To date, more than 100 genetic variants in more than 60 genes from various pathways have been studied in a number of candidate gene studies, with several positive associations reported. These findings suggest that there may be distinct, as well as shared, molecular underpinnings for IBS and its subtypes. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596150 Tue, 01 Mar 2011 00:00:00 +0100 4596150 http://www.medworm.com/index.php?rid=4596149&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001287%2Fabstract%3Frss%3Dyes The pathogenesis of symptoms in irritable bowel syndrome (IBS) is multifactorial and varies from patient to patient. Disturbances of motor function in the small intestine and colon and smooth-muscle dysfunction in other gut and extraintestinal regions are prominent. Abnormalities of sensory function in visceral and somatic structures are detected in most patients with IBS, which may relate to peripheral sensitization or altered central nervous system processing of afferent information. Contributions from psychosocial disturbances are observed in patients from tertiary centers and primary practice. Proof of causation of symptom genesis for most of these factors is limited. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596149 Tue, 01 Mar 2011 00:00:00 +0100 4596149 http://www.medworm.com/index.php?rid=4596148&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001378%2Fabstract%3Frss%3Dyes Irritable bowel syndrome (IBS) is a highly prevalent condition with a large health economic burden of illness marked by impaired health-related quality of life (HRQOL), diminished work productivity, and high expenditures. Clinicians should routinely screen for diminished HRQOL by performing a balanced biopsychosocial history rather than focusing just on bowel symptoms. HRQOL decrements should be acknowledged and addressed when making treatment decisions. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596148 Tue, 01 Mar 2011 00:00:00 +0100 4596148 http://www.medworm.com/index.php?rid=4596147&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001305%2Fabstract%3Frss%3Dyes Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder. Because not everyone needs to seek care, population-based studies are needed to truly understand the epidemiology of IBS. About 10% of the population has IBS at any one time and about 200 people per 100,000 will receive an initial diagnosis of IBS over the course of a year. IBS patients are more frequently younger in age, and a female predominance has been observed in Western countries and tertiary care settings. IBS patients commonly report overlapping upper GI, as well as a variety of non-GI, complaints. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596147 Tue, 01 Mar 2011 00:00:00 +0100 4596147 http://www.medworm.com/index.php?rid=4596146&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000033%2Fabstract%3Frss%3Dyes It is with great pride that I introduce this issue of Gastroenterology Clinics of North America, which presents state-of-the-art clinical reviews on Irritable Bowel Syndrome or IBS. It has been more than 5 years since Gastroenterology Clinics last reviewed this prevalent but vexing disorder. In that period of time, much has been learned about a variety of topics relevant to IBS. A search of the term “irritable bowel syndrome” on ISI Web of Knowledge, limited to GI specialty journals, yields over 1,800 published articles over the past 5 years. In the following pages, the world’s leading experts summarize and place into clinical perspective much of the most important emerging evidence on IBS. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596146 Tue, 01 Mar 2011 00:00:00 +0100 4596146 http://www.medworm.com/index.php?rid=4596145&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000100%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596145 Tue, 01 Mar 2011 00:00:00 +0100 4596145 http://www.medworm.com/index.php?rid=4596144&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000094%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596144 Tue, 01 Mar 2011 00:00:00 +0100 4596144 http://www.medworm.com/index.php?rid=4596143&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855311000082%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4596143 Tue, 01 Mar 2011 00:00:00 +0100 4596143 http://www.medworm.com/index.php?rid=4184499&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000107X%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184499 Sat, 20 Nov 2010 06:07:05 +0100 4184499 http://www.medworm.com/index.php?rid=4184496&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000725%2Fabstract%3Frss%3Dyes Computed tomographic (CT) colonography is a noninvasive method to evaluate the colon and has received considerable attention in the last decade as a colon-imaging tool. The technique has also been proposed as a potential primary colon cancer–screening method in the United States. The accuracy of the technique for the detection of large lesions seems to be high, perhaps in the range of colonoscopy. Overall, the field is rapidly evolving. Available data suggest that CT colonography, although a viable colon cancer screening modality in the United States, is not ready for widespread implementation, largely because of the lack of standards for training and reading and the limited number of skilled readers. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184496 Sat, 20 Nov 2010 06:07:04 +0100 4184496 http://www.medworm.com/index.php?rid=4184495&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000750%2Fabstract%3Frss%3Dyes This article reviews and assesses the latest developments in colonoscopy including wide-angle optics, endoscope caps and hoods, retroflexion and the use of the third eye retroscope. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184495 Sat, 20 Nov 2010 06:07:04 +0100 4184495 http://www.medworm.com/index.php?rid=4184493&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000695%2Fabstract%3Frss%3Dyes Recent progress of the data processing applied to ultrasonographic (US) examination has made it possible to develop new software. The US workstation of the last generation thus incorporated in their center a computer allowing a precise treatment of the US image. This advancement has made it possible to work out new images such as 3-dimensional (3D) US, contrast harmonic US associated with the intravenous injection of contrast agents, and even more recently, elastography. These techniques, quite elaborate in percutaneous US at present, are to be adapted and evaluated with endoscopic US (EUS). The contribution of contrast agents of US to pancreatic EUS and then 3D EUS are successively approached in this article. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184493 Sat, 20 Nov 2010 06:07:04 +0100 4184493 http://www.medworm.com/index.php?rid=4184491&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000683%2Fabstract%3Frss%3Dyes Video capsule endoscopy (VCE) that was launched 10 years ago has become a first-line procedure for examining the small bowel, especially in the case of obscure gastrointestinal bleeding. Other major indications include Crohn disease (CD), celiac disease, and intestinal polyposis syndrome. In the case of small bowel diseases, the use of VCE must be integrated in a global diagnostic and therapeutic approach. More recently, wireless endoscopy has been adapted for examining the colon, opening up larger perspectives for colorectal cancer screening or colon examination. Technologic modifications of the second-generation colon capsule increase the sensitivity of this method for detecting polyps. Other new developments, including remote magnetic manipulation, power management, drug delivery caps... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184491 Sat, 20 Nov 2010 06:07:03 +0100 4184491 http://www.medworm.com/index.php?rid=4184489&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000658%2Fabstract%3Frss%3Dyes In vivo histologic diagnosis of gastric intestinal metaplasia (GIM) and gastric cancer (GC) can be achieved by confocal laser endomicroscopy (CLE). This review describes the endomicroscopic features of GIM and GC and reviews their clinical applications. Differentiation of phenotypes of GIM and GC by using CLE is also discussed. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184489 Sat, 20 Nov 2010 06:07:03 +0100 4184489 http://www.medworm.com/index.php?rid=4184487&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000749%2Fabstract%3Frss%3Dyes This article discusses the scientific literature related to clinical use of CLE for BE, the techniques for performing CLE in the esophagus, and the potential future directions for CLE in BE and esophageal cancer diagnosis and treatment. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184487 Sat, 20 Nov 2010 06:07:03 +0100 4184487 http://www.medworm.com/index.php?rid=4184484&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001068%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184484 Sat, 20 Nov 2010 06:07:03 +0100 4184484 http://www.medworm.com/index.php?rid=4184483&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001056%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184483 Sat, 20 Nov 2010 06:07:03 +0100 4184483 http://www.medworm.com/index.php?rid=4184482&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310001044%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184482 Sat, 20 Nov 2010 06:07:03 +0100 4184482 http://www.medworm.com/index.php?rid=4184498&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000737%2Fabstract%3Frss%3Dyes Somatostatin-receptor scintigraphy has become an obligatory molecular imaging method in the management of patients with neuroendocrine tumors when metastatic disease is suspected. Using positron emission tomography and new somatostatin analogues, sensitivity of somatostatin receptor imaging has further increased. With a combination of morphologic imaging methods, such as hybrid imaging by PET/CT, this method represents the method of choice in many centers and efforts are under way to translate somatostatin receptor imaging onto a cellular level by endoscopic confocal microscopy. Other clinically relevant functional pathways in neuroendocrine tumors that are accessible by PET imaging are glucose metabolism and amine precursor uptake and decarboxylation. (Source: Gastroenterology Clinics of ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184498 Mon, 11 Oct 2010 00:00:00 +0100 4184498 http://www.medworm.com/index.php?rid=4184497&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000671%2Fabstract%3Frss%3Dyes One of the major proceedings in the field of gastrointestinal endoscopy has been the advent of molecular imaging, which possesses the potential to have a significant effect on the existing diagnostic and therapeutic paradigms. Molecular imaging encompasses different methods that enable the visualization of disease-specific morphologic or functional alterations of the mucosa based on the molecular signature of individual cells. This development has been made possible by advancements in basic science coupled with technological innovations in endoscopy, both facilitating the identification and characterization of mucosal lesions in vivo based on the lesions' molecular composition rather than their morphologic structure alone. Novel studies based on fluorescent antibody imaging pave the road t... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184497 Mon, 11 Oct 2010 00:00:00 +0100 4184497 http://www.medworm.com/index.php?rid=4184494&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000646%2Fabstract%3Frss%3Dyes New high-resolution colonoscopes and filter technologies are allowing us to visualize more lesions and better characterize lesions within the gastrointestinal tract. In light of recent findings that flat and serrated lesions are more likely to contain invasive cancer and that even small lesions (5–10 mm) may contain advanced histology, detecting these lesions earlier with improved optical technologies may help decrease the rate of interval cancers after colonoscopy. With the limited accuracy of white-light colonoscopy (59%–84%) in distinguishing non-neoplastic lesions from neoplastic lesions, these new technologies can help us improve our abilities to risk stratify patients and determine more precise surveillance intervals. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184494 Mon, 11 Oct 2010 00:00:00 +0100 4184494 http://www.medworm.com/index.php?rid=4184492&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000713%2Fabstract%3Frss%3Dyes In the evaluation of biliary diseases, cholangioscopy is considered as complementary procedure to radiographic imaging. Direct visualization of the bile duct is the premier advantage of cholangioscopy over indirect imaging techniques. However, cholangioscopy has not gained wide acceptance because of several technical limitations such as scope fragility, impaired steerability, limited irrigation, and suction capabilities, as well as the need for two experienced endoscopists. Recent innovations such as the implementation of electronic video cholangioscopes and the development of single-operator systems facilitate the procedure, and promise to increase the diagnostic and therapeutic yield of cholangioscopy. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184492 Mon, 11 Oct 2010 00:00:00 +0100 4184492 http://www.medworm.com/index.php?rid=4184490&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000066X%2Fabstract%3Frss%3Dyes Nowadays, 5 nonsurgical flexible endoscopic techniques are available for small bowel endoscopy: push enteroscopy (PE), balloon-assisted enteroscopy using 2 balloons (double-balloon enteroscopy [DBE]) or 1 balloon (single-balloon enteroscopy [SBE]), balloon-guided enteroscopy (BGE), and spiral enteroscopy (SE). PE is a cost-saving, easy, and fast procedure for the examination of the proximal jejunum, but for a deep small bowel endoscopy, the other flexible enteroscopic techniques are required. BGE does not play a considerable role in deep small bowel endoscopy. DBE is the oldest flexible enteroscopic technique. Actually, the balloon-assisted enteroscopy (BAE) techniques with one balloon (SBE) or two balloons (DBE) are the mainly used techniques. DBE has become established throughout the wor... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184490 Mon, 11 Oct 2010 00:00:00 +0100 4184490 http://www.medworm.com/index.php?rid=4184488&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000701%2Fabstract%3Frss%3Dyes Gastric cancer is the third common cancer and is the second leading cause of cancer deaths worldwide. Endoscopy is being increasingly used for gastric cancer screening because of a high detection rate. Despite promising data, the technique depends heavily on the availability of endoscopic instruments and expertise for mass screening. Furthermore, the introduction of various new endoscopic devices and techniques may enhance the value of endoscopy in efficacious cancer screening. High-definition endoscopy and image-enhanced endoscopy, including narrow band imaging, are the key modalities in advanced endoscopic imaging in gastric cancer. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184488 Mon, 11 Oct 2010 00:00:00 +0100 4184488 http://www.medworm.com/index.php?rid=4184485&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000762%2Fabstract%3Frss%3Dyes As Guest Editor, it is my great pleasure to introduce this issue of Gastroenterology Clinics of North America devoted to Advanced Imaging in Gastroenterology. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184485 Mon, 11 Oct 2010 00:00:00 +0100 4184485 http://www.medworm.com/index.php?rid=4184486&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000634%2Fabstract%3Frss%3Dyes This review discusses the application of 2 novel imaging techniques in Barrett's esophagus: autofluorescence imaging and narrow band imaging (NBI). Autofluorescence as well as NBI may help to direct endoscopic therapy for early neoplasia in Barrett's esophagus; their value in daily practice, however, seems to be limited and needs further evaluation. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4184486 Fri, 01 Oct 2010 00:00:00 +0100 4184486 http://www.medworm.com/index.php?rid=4078827&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000907%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078827 Tue, 31 Aug 2010 23:00:00 +0100 4078827 http://www.medworm.com/index.php?rid=4078826&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000488%2Fabstract%3Frss%3Dyes The viewpoints of enthusiasts and skeptics in relation to the role of probiotics should not be allowed to distract clinicians from the bigger issue, which is the pivotal role of the microbiota in the protection against many disorders and in the pathogenesis of others. However, all probiotics, like all bacteria, are not created equal, and therapeutic deployment in a generic sense is as absurd as the administration of pills or tablets without regard for the nature of the active ingredient and the intended effect. The rationale for therapeutic manipulation or supplementation of the microbiota is sound in conditions where the intestinal ecosystem is poorly developed, such as in low birth weight neonates, or where it is profoundly disturbed, such as after broad-spectrum antibiotics. In other co... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078826 Tue, 31 Aug 2010 23:00:00 +0100 4078826 http://www.medworm.com/index.php?rid=4078825&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000622%2Fabstract%3Frss%3Dyes This article is focused on drugs for digestive disorders that have entered the marketplace recently, or are expected to reach the marketplace within the next 1 to 2 years. Although advances have been made in understanding gastrointestinal motility, visceral pain, mucosal inflammation, and tissue repair, the major gastrointestinal diseases remain as significant therapeutic challenges. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078825 Tue, 31 Aug 2010 23:00:00 +0100 4078825 http://www.medworm.com/index.php?rid=4078824&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000567%2Fabstract%3Frss%3Dyes This article highlights breakthroughs in our understanding of the potential roles of PPARs in inflammatory bowel disease and colorectal cancer. PPARs might hold the key to some of the questions that are pertinent to the pathophysiology of inflammatory diseases and colorectal cancer and could possibly serve as drug targets for new antiinflammatory therapeutic and anticancer agents. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078824 Tue, 31 Aug 2010 23:00:00 +0100 4078824 http://www.medworm.com/index.php?rid=4078823&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000579%2Fabstract%3Frss%3Dyes This article reviews the pathophysiologic bases of the different pharmacologic treatments for portal hypertension in patients with cirrhosis and places them in the context of the natural history of varices and variceal hemorrhage. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078823 Tue, 31 Aug 2010 23:00:00 +0100 4078823 http://www.medworm.com/index.php?rid=4078822&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000543%2Fabstract%3Frss%3Dyes This article discusses the mechanisms of action, pharmacokinetics, optimal dose, clinical efficacy, and side effects of medications used for the treatment of CHB. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078822 Tue, 31 Aug 2010 23:00:00 +0100 4078822 http://www.medworm.com/index.php?rid=4078821&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000506%2Fabstract%3Frss%3Dyes This article discusses the pharmacokinetics and pharmacodynamics of the 2 peginterferons and their combination with ribavirin. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078821 Tue, 31 Aug 2010 23:00:00 +0100 4078821 http://www.medworm.com/index.php?rid=4078820&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000464%2Fabstract%3Frss%3Dyes A spectrum of oncologic treatments including chemotherapy, radiotherapy, and molecular targeted therapies is available to combat cancer. These treatments are associated with adverse effects in several organ systems including the gastrointestinal (GI) tract. The immunocompromised state induced by oncologic therapy is also an important contributing factor underlying GI complications. This review discusses common GI complications that can result from cancer therapy. The pathologic mechanisms underlying each complication and the pharmacology of the agents used to treat these complications are discussed. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078820 Tue, 31 Aug 2010 23:00:00 +0100 4078820 http://www.medworm.com/index.php?rid=4078819&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000555%2Fabstract%3Frss%3Dyes This article describes the current options for systemic therapy for GEP-NETs within the framework of the current World Health Organization classification system. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078819 Tue, 31 Aug 2010 23:00:00 +0100 4078819 http://www.medworm.com/index.php?rid=4078818&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000592%2Fabstract%3Frss%3Dyes The treatment of colorectal cancer (CRC) has evolved substantially during the past decade with the advent of molecular targeted therapies. Inhibitors to the vascular endothelial growth factor and epidermal growth factor receptor (EGFR) pathways have been shown to enhance the efficacy of cytotoxic chemotherapy in patients with advanced CRC, and anti-EGFR antibodies demonstrate modest activity as monotherapeutic agents. These biologic agents have improved patient outcomes and survival and have been incorporated into routine clinical practice establishing a new standard of care. Molecular markers have recently been adopted into clinical practice with the finding that the KRAS oncogene is a predictive biomarker for anti-EGFR therapy, whereby the therapeutic benefit of anti-EGFR treatment is re... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078818 Tue, 31 Aug 2010 23:00:00 +0100 4078818 http://www.medworm.com/index.php?rid=4078817&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000531%2Fabstract%3Frss%3Dyes This article serves as a review of the different 5-aminosalicylic acid compounds, release formulations, use and dosing in the treatment of IBD, in particular ulcerative colitis. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078817 Tue, 31 Aug 2010 23:00:00 +0100 4078817 http://www.medworm.com/index.php?rid=4078816&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000609%2Fabstract%3Frss%3Dyes This article provides an overview of the current knowledge regarding anti-TNF-α therapies for clinicians caring for patients with Crohn's disease and ulcerative colitis. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078816 Tue, 31 Aug 2010 23:00:00 +0100 4078816 http://www.medworm.com/index.php?rid=4078815&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000518%2Fabstract%3Frss%3Dyes Medicines are frequently used in the management of acid-related disorders and functional gastrointestinal disorders. With the exception of complicated peptic ulcer disease, these disorders are not associated with appreciable mortality. Drug treatments have consequently been held to the highest standards of safety. Some medicines have been withdrawn or restricted based on assessments and perceptions of risk. However, the risk of serious toxicity is low for most of the agents discussed in this article. Assessments are made of the safety and adverse-event profiles of certain drug classes and, where appropriate, individual medicines. For conditions with a low risk of mortality or serious morbidity, clinicians need to balance the risks of potential adverse events with the anticipated benefits o... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078815 Tue, 31 Aug 2010 23:00:00 +0100 4078815 http://www.medworm.com/index.php?rid=4078814&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000439%2Fabstract%3Frss%3Dyes This article focuses on the pharmacology of traditional and newer agents for the treatment of constipation. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078814 Tue, 31 Aug 2010 23:00:00 +0100 4078814 http://www.medworm.com/index.php?rid=4078813&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000452%2Fabstract%3Frss%3Dyes According to the World Health Organization, there are approximately 2 billion annual cases of diarrhea worldwide. Diarrhea is the leading cause of death in children younger than 5 years and kills 1.5 million children each year. It is especially prevalent in the developing world, where mortality is related to dehydration, electrolyte disturbance, and the resultant acidosis, and in 2001, it accounted for 1.78 million deaths (3.7% of total deaths) in low- and middle-income countries. However, diarrhea is also a common problem in the developed world, with 211 million to 375 million episodes of infectious diarrheal illnesses in the United States annually, resulting in 73 million physician consultations, 1.8 million hospitalizations, and 3100 deaths. Furthermore, 4% to 5% of the Western populati... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078813 Tue, 31 Aug 2010 23:00:00 +0100 4078813 http://www.medworm.com/index.php?rid=4078812&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000476%2Fabstract%3Frss%3Dyes Dyspepsia is a highly prevalent condition characterized by symptoms originating in the gastroduodenal region without underlying organic disorder. Treatment modalities include acid-suppressive drugs, gastroprokinetic drugs, Helicobacter pylori eradication therapy, tricyclic antidepressants, and psychological therapies. Irritable bowel syndrome is a multifactorial, lower functional gastrointestinal disorder involving disturbances of the brain-gut axis. The pathophysiology provides the basis for pharmacotherapy: abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, intraluminal changes, and mucosal immune activation. Medications targeting chronic constipation or diarrhea may also relieve irritable bowel syndrome. Novel approaches to treatment require appr... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078812 Tue, 31 Aug 2010 23:00:00 +0100 4078812 http://www.medworm.com/index.php?rid=4078811&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000049X%2Fabstract%3Frss%3Dyes The commonly used regimens for the eradication of Helicobacter pylori infection consist of administration of proton pump inhibitors (PPIs) and 1 to 3 antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, fluoroquinolone, or tetracycline. Each agent has its own pharmacologic characteristics. PPIs are metabolized by cytochrome P450 2C19 (CYP2C19), which is polymorphic. CYP2C19 genotypic differences in the pharmacokinetics and pharmacodynamics of PPIs influence the eradication rates of H pylori infection by PPI-containing regimens. Amoxicillin is a time-dependent antibiotic, whereas clarithromycin, metronidazole, tetracycline, and fluoroquinolone are not. The plasma half-life of antimicrobial agents also differs among these antibiotics. To achieve consistently high eradic... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078811 Tue, 31 Aug 2010 23:00:00 +0100 4078811 http://www.medworm.com/index.php?rid=4078810&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000052X%2Fabstract%3Frss%3Dyes Increasing life expectancy in developed countries has led to a growing prevalence of arthritic disorders, which has been accompanied by increasing prescriptions for nonsteroidal antiinflammatory drugs (NSAIDs). These are the most widely used agents for musculoskeletal and arthritic conditions. Although NSAIDs are effective, their use is associated with a broad spectrum of adverse reactions in the liver, kidney, cardiovascular system, skin, and gut. Gastrointestinal (GI) side effects are the most common. The dilemma for the physician prescribing NSAIDs is, therefore, to maintain the antiinflammatory and analgesic benefits, while reducing or preventing GI side effects. The challenge is to develop safer NSAIDs by shifting from a focus on GI toxicity to the increasingly more appreciated cardi... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078810 Tue, 31 Aug 2010 23:00:00 +0100 4078810 http://www.medworm.com/index.php?rid=4078809&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000440%2Fabstract%3Frss%3Dyes This article discusses the available data on the use of antisecretory regimens in the management of patients with bleeding peptic ulcers, which are a major cause of non-variceal upper gastrointestinal bleeding, and briefly addresses other medications used in this acute setting. The most important clinically relevant data are presented, favoring fully published articles. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078809 Tue, 31 Aug 2010 23:00:00 +0100 4078809 http://www.medworm.com/index.php?rid=4078808&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000610%2Fabstract%3Frss%3Dyes This article highlights current and emerging pharmacological treatments for gastroesophageal reflux disease (GERD), opportunities for improving medical treatment, the extent to which improvements may be achieved with current therapy, and where new therapies may be required. These issues are discussed in the context of current thinking on the pathogenesis of GERD and its various manifestations and on the pharmacologic basis of current treatments. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078808 Tue, 31 Aug 2010 23:00:00 +0100 4078808 http://www.medworm.com/index.php?rid=4078807&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000580%2Fabstract%3Frss%3Dyes The evolution of drug therapy moves rapidly and it is often difficult for the practitioner to keep up with the introduction of new drugs or the subtle changes in regimen or dose to optimize clinical outcomes. This is especially true for diseases managed by gastroenterologists, who often look after the full spectrum of cases ranging from upper GI disorders to inflammatory bowel disease, GI bleeding, those with hepatobiliary and pancreatic disease, and increasingly, patients with GI oncology diagnoses. Regrettably, there is less emphasis in the current curricula of many medical schools on clinical pharmacology and the teaching of therapeutics or materia medica, as it was often called. Thus, many busy clinicians find that managing optimal treatments for such a wide range of GI problems is ver... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078807 Tue, 31 Aug 2010 23:00:00 +0100 4078807 http://www.medworm.com/index.php?rid=4078806&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000890%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078806 Tue, 31 Aug 2010 23:00:00 +0100 4078806 http://www.medworm.com/index.php?rid=4078805&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000889%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078805 Tue, 31 Aug 2010 23:00:00 +0100 4078805 http://www.medworm.com/index.php?rid=4078804&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000877%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4078804 Tue, 31 Aug 2010 23:00:00 +0100 4078804 http://www.medworm.com/index.php?rid=3571246&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000361%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571246 Tue, 18 May 2010 13:16:37 +0100 3571246 http://www.medworm.com/index.php?rid=3571245&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000166%2Fabstract%3Frss%3Dyes Functional gallbladder disorder, commonly referred to as gallbladder dyskinesia, is characterized by the occurrence of abdominal pain resembling gallbladder pain but in the absence of gallstones. The diagnosis and management of this condition can be confusing even for the most astute clinician. The aim of this article is to clarify the identification and management of patients with suspected functional gallbladder disorder. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571245 Tue, 18 May 2010 13:16:37 +0100 3571245 http://www.medworm.com/index.php?rid=3571244&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000154%2Fabstract%3Frss%3Dyes This article discusses the clinical presentation, diagnosis, and natural history of gallbladder polyps and risk factors for malignant polyps and indications for cholecystectomy. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571244 Tue, 18 May 2010 13:16:37 +0100 3571244 http://www.medworm.com/index.php?rid=3571243&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000269%2Fabstract%3Frss%3Dyes Acute acalculous cholecystitis (ACC) can develop with or without gallstones after surgery and in critically ill or injured patients. Diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, shock, and cardiac arrest also have been associated with AAC. The pathogenesis of AAC is complex and multifactorial. Ultrasound of the gallbladder is most accurate for the diagnosis of AAC in the critically ill patient. CT is probably of comparable accuracy, but carries both advantages and disadvantages. Rapid improvement may be expected when AAC is diagnosed correctly and cholecystostomy is performed timely. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571243 Tue, 18 May 2010 13:16:37 +0100 3571243 http://www.medworm.com/index.php?rid=3571242&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000208%2Fabstract%3Frss%3Dyes Resection is a means of improving survival in patients with gallbladder cancer. A more aggressive surgical approach, including resection of the gallbladder, liver, and regional lymph nodes, is advisable for patients with T1b to T4 tumors. Aggressive resection is necessary because a patient's gallbladder cancer stage determines the outcome, not the surgery itself. Therefore, major resections should be offered to appropriately selected patients. Patients with advanced tumors or metastatic disease are not candidates for radical resection and thus should be directed to more suitable palliation. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571242 Tue, 18 May 2010 13:16:36 +0100 3571242 http://www.medworm.com/index.php?rid=3571241&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000257%2Fabstract%3Frss%3Dyes Gallbladder cancer is the most common biliary tract cancer. The highest incidence rates occur in Chile, which also has the highest mortality rates. This lethal gastrointestinal cancer has a predilection among adult women and older subjects of both sexes, and also among populations throughout central and Eastern Europe and certain racial groups, such as Native American Indians. Unfortunately, prospects are poor for preventing this form of cancer. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571241 Tue, 18 May 2010 13:16:36 +0100 3571241 http://www.medworm.com/index.php?rid=3571240&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000282%2Fabstract%3Frss%3Dyes This article reviews the use of EUS in these diseases of the gallbladder. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571240 Tue, 18 May 2010 13:16:36 +0100 3571240 http://www.medworm.com/index.php?rid=3571239&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000233%2Fabstract%3Frss%3Dyes This article describes recent technical advances in ultrasonography, multidetector computed tomography, magnetic resonance imaging, positron emission tomography, and scintigraphy, which have significantly improved the accuracy of noninvasive imaging of benign and malignant gallbladder disease. The imaging findings of common gallbladder disorders are presented, and the role of each of the imaging modalities is placed in perspective for optimizing patient management. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571239 Tue, 18 May 2010 13:16:36 +0100 3571239 http://www.medworm.com/index.php?rid=3571238&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000191%2Fabstract%3Frss%3Dyes Gallstone disease is a frequent condition throughout the world and, cholesterol stones are the most frequent form in Western countries. The standard treatment of symptomatic gallstone subjects is laparoscopic cholecystectomy. The selection of patients amenable for nonsurgical, medical therapy is of key importance; a careful analysis should consider the natural history of the disease and the overall costs of therapy. Only patients with mild symptoms and small, uncalcified cholesterol gallstones in a functioning gallbladder with a patent cystic duct are considered for oral litholysis by hydrophilic ursodeoxycholic acid, in the hope of achieving cholesterol desaturation of bile and progressive stone dissolution. Recent studies have raised the possibility that cholesterol-lowering agents that ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571238 Tue, 18 May 2010 13:16:36 +0100 3571238 http://www.medworm.com/index.php?rid=3571237&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000018X%2Fabstract%3Frss%3Dyes Currently there is no evidence for prophylactic cholecystectomy to prevent gallstone formation (grade B). Cholecystectomy cannot be recommended for any group of patients having asymptomatic gallstones except in those undergoing major upper abdominal surgery for other pathologies (grade B). Laparoscopic cholecystectomy is the preferred treatment for all patient groups with symptomatic gallstones (grade B). Patients with gallstones along with common bile duct stones treated by endoscopic sphincterotomy should undergo cholecystectomy (grade A). Laparoscopic cholecystectomy with laparoscopic common bile duct exploration or with intraoperative endoscopic sphincterotomy is the preferred treatment for obstructive jaundice caused by common bile duct stones, when the expertise and infrastructure a... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571237 Tue, 18 May 2010 13:16:36 +0100 3571237 http://www.medworm.com/index.php?rid=3571236&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000221%2Fabstract%3Frss%3Dyes Bile duct stone management has greatly changed in the past 2 decades. Open surgical techniques have mostly been replaced by transoral endoscopic techniques. Routine common bile duct stones can be managed by standard biliary endoscopic sphincterotomy and extraction. Various advanced transoral techniques can also manage most difficult ductal stones. In skilled centers, laparoscopic ductal stone management has assumed a back-up role. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571236 Tue, 18 May 2010 13:16:36 +0100 3571236 http://www.medworm.com/index.php?rid=3571235&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000021X%2Fabstract%3Frss%3Dyes Epidemiologic investigations, clinical observations, and family and twin studies in humans, as well as gallstone prevalence investigations in inbred mouse models, support the concept that cholesterol cholelithiasis could result from a complex interaction of environmental factors and the effects of multiple undetermined genes. Quantitative trait locus (QTL) analysis is a powerful genetic method for identifying primary rate-limiting genetic defects and discriminating them from secondary downstream lithogenic effects caused by mutations of the primary genes, and the subsequent positional cloning of such genes responsible for QTLs, followed by the use of manufactured mouse strains with “knockout” or “knockin” of the genes, could lead to the discovery of lithogenic actions of gallstone ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571235 Tue, 18 May 2010 13:16:35 +0100 3571235 http://www.medworm.com/index.php?rid=3571234&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000245%2Fabstract%3Frss%3Dyes Cholesterol gallstone formation is a complex process and involves phase separation of cholesterol crystals from supersaturated bile. In most cases, cholesterol hypersecretion is considered the primary event in gallstone formation. The sterol is transported through the hepatocytic canalicular membrane by ABCG5-G8. Expression of this transport protein is regulated by transcription factor Liver X Receptor-α, which may be responsible for biliary hypersecretion. Hydrophobic bile salt pool, bile concentration, excess pronucleating mucin, and impaired gallbladder and intestinal motility are secondary phenomena in most cases but nevertheless may contribute to gallstone formation. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571234 Tue, 18 May 2010 13:16:35 +0100 3571234 http://www.medworm.com/index.php?rid=3571233&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000178%2Fabstract%3Frss%3Dyes Gallstones are common with prevalences as high as 60% to 70% in American Indians and 10% to 15% in white adults of developed countries. Ethnic differences abound with a reduced frequency in black Americans and those from East Asia, while being rare in sub-Saharan Africa. Certain risk factors for gallstones are immutable: female gender, increasing age, and ethnicity/family (genetic traits). Others are modifiable: obesity, the metabolic syndrome, rapid weight loss, certain diseases (cirrhosis and Crohn disease), gallbladder stasis (from spinal cord injury or drugs, such as somatostatin), and lifestyle. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571233 Tue, 18 May 2010 13:16:35 +0100 3571233 http://www.medworm.com/index.php?rid=3571232&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000270%2Fabstract%3Frss%3Dyes Gallbladder diseases, particularly gallstone-related syndromes, are common clinical problems facing practicing gastroenterologists and surgeons. Our understanding of the pathogenesis of gallbladder disease, including gallstones, acalculous cholecystitis, gallbladder dysmotility, and gallbladder cancer, continues to advance at a rapid pace. Furthermore, our ability to diagnose and treat gallbladder diseases is rapidly evolving. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571232 Tue, 18 May 2010 13:16:35 +0100 3571232 http://www.medworm.com/index.php?rid=3571231&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985531000035X%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571231 Tue, 18 May 2010 13:16:35 +0100 3571231 http://www.medworm.com/index.php?rid=3571230&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000348%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571230 Tue, 18 May 2010 13:16:35 +0100 3571230 http://www.medworm.com/index.php?rid=3571229&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000336%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3571229 Tue, 18 May 2010 13:16:35 +0100 3571229 http://www.medworm.com/index.php?rid=3328652&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000105%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328652 Mon, 01 Mar 2010 00:00:00 +0100 3328652 http://www.medworm.com/index.php?rid=3328651&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001253%2Fabstract%3Frss%3Dyes Follow-up of the large numbers of patients undergoing bariatric surgery poses problems for surgical programs and for internists who care for morbidly obese patients. Early surgical follow up is concentrated on the perioperative period to ensure healing and care for any surgical complications. It is especially important to treat persistent vomiting to avoid thiamine deficiency. Subsequently, monitoring weight loss and resolution of comorbidities assumes more importance. Identification and management of nutritional deficiencies and other unwanted consequences of surgery may become the responsibility of internists if the patient no longer attends the office of the operating surgeon. The long-term goal is to avoid weight regain and deficiencies, especially of protein, iron and vitamin B12, and... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328651 Mon, 01 Mar 2010 00:00:00 +0100 3328651 http://www.medworm.com/index.php?rid=3328650&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001241%2Fabstract%3Frss%3Dyes The disease of obesity has continued to increase in the United States. Obesity is defined as a body mass index (BMI) greater than 30 kg/m2. In 1991, the National Institute of Health Consensus Panel on Gastric Surgery for Severe Obesity defined the population who would most likely benefit from bariatric surgery. These same criteria continue to be used today to determine which patients should undergo metabolic and weight loss surgery. These recommendations include patients who have a BMI greater than 35 kg/m2 with significant comorbid conditions such as diabetes, hypertension, or obstructive sleep apnea; and patients who have a BMI greater than 40 kg/m2 with or without any significant comorbid conditions because they have a significant increased risk for developing these conditions. (Source:... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328650 Mon, 01 Mar 2010 00:00:00 +0100 3328650 http://www.medworm.com/index.php?rid=3328649&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001174%2Fabstract%3Frss%3Dyes Bariatric surgery has become an increasingly important method for management of medically complicated obesity. In patients who have undergone bariatric surgery, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively. Bariatric surgery can reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergone bariatric surgery require indefinite, regular follow-up care by physicians who need to follow laboratory parameters of macronutrient as well as micronutrient malnutrition. Physicians who care for patients after bariatric surgery need to be familiar with common postoperative syndromes that result from specific nutrient deficiencies. (Source: Gastroenterology Clinics ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328649 Mon, 01 Mar 2010 00:00:00 +0100 3328649 http://www.medworm.com/index.php?rid=3328648&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001228%2Fabstract%3Frss%3Dyes This article discusses the different options available for endoscopists who are faced with the need to perform endoscopic retrograde cholangiopancreatography in patients after Roux-en-Y reconstruction, with special emphasis on those after RYGB. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328648 Mon, 01 Mar 2010 00:00:00 +0100 3328648 http://www.medworm.com/index.php?rid=3328647&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985530900123X%2Fabstract%3Frss%3Dyes This article reviews the special risks that obese patients face while undergoing endoscopy, endoscopic management of patients postbariatric surgery, and future role of endoscopy in the management of obese patients. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328647 Mon, 01 Mar 2010 00:00:00 +0100 3328647 http://www.medworm.com/index.php?rid=3328646&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001265%2Fabstract%3Frss%3Dyes This article discusses the factors that a gastroenterologist should assess before the surgery. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328646 Mon, 01 Mar 2010 00:00:00 +0100 3328646 http://www.medworm.com/index.php?rid=3328645&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000026%2Fabstract%3Frss%3Dyes This article examines the transitions in pharmacological therapy for obesity. It reviews the current options approved by the Food and Drug Administration and several drugs approved for other indications that can be used to treat obesity as well. Because weight regulation is complex and redundant systems protect against perceived starvation, optimal treatment of obesity in individual patients will likely require different combinations of behavioral, nutritional, pharmacologic, endoscopic, and surgical therapies. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328645 Mon, 01 Mar 2010 00:00:00 +0100 3328645 http://www.medworm.com/index.php?rid=3328644&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001150%2Fabstract%3Frss%3Dyes This article reviews mechanisms that mediate the pathogenesis of obesity-related liver disease, summarizes clinical evidence that demonstrates obesity-related liver disease can be life-threatening, and discusses whether or not treatments for obesity or related comorbidities impact liver disease outcomes. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328644 Mon, 01 Mar 2010 00:00:00 +0100 3328644 http://www.medworm.com/index.php?rid=3328643&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001198%2Fabstract%3Frss%3Dyes Obesity is a risk factor for colorectal cancer and adenomatous polyps. The increased prevalence of neoplasia coupled with the observation that obesity may be associated with a suboptimal bowel preparation may diminish the adequate detection of adenomas for obese who undergo colonoscopy. The colonic complications of obesity are reviewed in this article. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328643 Mon, 01 Mar 2010 00:00:00 +0100 3328643 http://www.medworm.com/index.php?rid=3328642&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001162%2Fabstract%3Frss%3Dyes Gastroesophageal reflux disease (GERD) is a common condition, with multifactorial pathogenesis, affecting up to 40% of the population. Obesity is also common. Obesity and GERD are clearly related, both from a prevalence and causality association. GERD symptoms increase in severity when people gain weight. Obese patients tend to have more severe erosive esophagitis and obesity is a risk factor for the development of Barrett's esophagus and adenocarcinoma of the esophagus. Patients report improvement in GERD when they lose weight and there are several reports suggesting a decrease in GERD symptoms after bariatric surgery. At present, there is little evidence that obesity has any effect on the efficacy of antisecretory therapy, with conflicting data on surgical outcomes. This review attempts ... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328642 Mon, 01 Mar 2010 00:00:00 +0100 3328642 http://www.medworm.com/index.php?rid=3328641&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001204%2Fabstract%3Frss%3Dyes Obesity is a leading cause of illness and death worldwide. It is a risk factor for many common gastrointestinal symptoms and digestive disorders, including many cancers. Disruption of mechanisms that regulate appetite and satiety are fundamental to the development of obesity. Knowledge of these issues that are discussed in this article will provide the basis to develop health strategies to prevent obesity-related diseases. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328641 Mon, 01 Mar 2010 00:00:00 +0100 3328641 http://www.medworm.com/index.php?rid=3328640&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001216%2Fabstract%3Frss%3Dyes Until recently, the epidemiology of gastrointestinal (GI) symptoms had not been adequately studied in relation to increasing body mass index. To date there are only a few studies in the literature, and thus the relationship between obesity and specific GI symptoms is poorly understood. Future studies that incorporate different ethnicities from varied geographic locations are urgently required. A greater understanding of how GI symptoms are related to obesity and the physiology will be important in the clinical management of these patients. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328640 Mon, 01 Mar 2010 00:00:00 +0100 3328640 http://www.medworm.com/index.php?rid=3328639&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001289%2Fabstract%3Frss%3Dyes This article describes some of the epidemiologic features of obesity, including global prevalence, secular trends, risk factors, and burden of illness related to obesity with special emphasis on obesity trends in the United States. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328639 Mon, 01 Mar 2010 00:00:00 +0100 3328639 http://www.medworm.com/index.php?rid=3328638&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309001277%2Fabstract%3Frss%3Dyes Obesity has emerged as a major global health problem with disease prevalence reaching epidemic proportions. In the United States alone, obesity is responsible for more than 300,000 deaths per year. Additionally, the direct and indirect related costs for care of obesity-related disease exceed $100 billion per year. Obesity has a particular relevance to gastroenterologists given the wide spectrum of causally related disease implications specific to this specialty. It is increasingly apparent that obesity has significant implications for gastrointestinal diseases and increased risks of serious consequences, including cancer. Gastroenterologists are increasingly involved in the care of obese and overweight patients. This involvement includes assessing for appropriate screening for neoplasia, a... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328638 Mon, 01 Mar 2010 00:00:00 +0100 3328638 http://www.medworm.com/index.php?rid=3328637&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000099%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328637 Mon, 01 Mar 2010 00:00:00 +0100 3328637 http://www.medworm.com/index.php?rid=3328636&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000087%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328636 Mon, 01 Mar 2010 00:00:00 +0100 3328636 http://www.medworm.com/index.php?rid=3328635&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855310000075%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3328635 Mon, 01 Mar 2010 00:00:00 +0100 3328635 http://www.medworm.com/index.php?rid=2986666&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS088985530900106X%2Fabstract%3Frss%3Dyes (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2986666 Fri, 13 Nov 2009 14:14:17 +0100 2986666 http://www.medworm.com/index.php?rid=2986665&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309000752%2Fabstract%3Frss%3Dyes Crohn disease often recurs after surgical resection. Despite extensive research in the prevention of postoperative Crohn disease, optimal management strategies have yet to be defined. Risk of disease recurrence needs to be carefully balanced against potential risks associated with treatment. Patients with low risk of postoperative recurrence may not require medication, whereas those at moderate risk may benefit from antibiotics or immunomodulators. Those at highest risk of recurrence may benefit from biologic therapy for maintenance of surgical remission. Postoperative colonoscopy within 1 year of resective surgery is important for identification of disease recurrence and modification of medications. (Source: Gastroenterology Clinics of North America) Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2986665 Fri, 13 Nov 2009 14:14:17 +0100 2986665 http://www.medworm.com/index.php?rid=2986664&cid=s_33225_17_f&fid=33225&url=http%3A%2F%2Fwww.gastro.theclinics.com%2Farticle%2FPIIS0889855309000892%2Fabstract%3Frss%3Dyes Inflammatory bowel disease remains a complex disease with variable clinical presentations and often nonspecific symptoms. Physicians must rely on diagnostic tools for clarification of disease diagnosis and for guiding management of patients with established disease. Advances in radiologic imaging modalities facilitate early and accurate detection of luminal disease and extraluminal complications. The introduction and dissemination of small bowel capsule endoscopy and double-balloon enteroscopy permit detailed visualization and sampling of the mucosa throughout the entire bowel. Serologic biomarkers are evolving as a valuable tool to clarify diagnosis and stratify patients by disease phenotypes and patterns of behavior. Neutrophil-derived fecal biomarkers are emerging as useful surrogate ma... Gastroenterology Clinics of North America journals http://www.medworm.com/rss/comments.php?id=2986664 Fri, 13 Nov 2009 14:14:16 +0100 2986664