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Coeliac plexus neurolysisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the technique of EUS-CPN, the evidence supporting its use and recent advances in this procedure.
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Ian D. Penman Source Type: journals

Contrast-enhanced endoscopic ultrasound and elastosonoendoscopyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Until recently, there was no contrast harmonic imaging technique available for EUS examination. Second-generation US contrast agents produce harmonic signals at lower acoustic powers and, therefore, are suitable for EUS imaging at low acoustic powers. CE-EUS could provide a contribution to the differential diagnosis between a primary pancreatic carcinoma, chronic pancreatitis and a pancreatic metastasis, and therefore can have a decisive influence on the selection of appropriate therapeutic strategies (follow-up, chemotherapy or surgery, for example). However, histology remains the standard in the differential diagnosis of...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Marc Giovannini Source Type: journals

Role of endosonography in drainage of fluid collections and other NOTES proceduresEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Endosonography (EUS) has become the accepted procedure for drainage of pancreatic fluid collections in the past decade. EUS was shown to be safe and effective and it has been the first-line therapy for uncomplicated pseudocysts. Where walled-off pancreatic necrosis was originally thought to be a contraindication for endoscopic treatment, multiple case series have now shown that these fluid collections also can be treated endoscopically with low morbidity and mortality. Analogous to the treatment of pancreatic fluid collections, others, such as abscesses in the lower and upper abdomen, have also been treated successfully, a...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Domenico Galasso, Rogier P. Voermans, Paul Fockens Source Type: journals

Aims & Scope/ Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Why an issue on endosonography? For several reasons! Endosonography has matured, is here to stay and should be an integral part of the training schedule for new gastroenterologists.
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: G.N.J. Tytgat Source Type: journals

Choice of endosonographic equipment and normal endosonographic anatomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Endosonography may be considered as a very special area in endoscopy. It really revolutionised endoscopy in allowing seeing behind the digestive lumen, in accessing the mediastinum and the pancreas, and in performing the first “NOTES” procedures. Endoscopists have usually mixed feelings towards endosonography: most of them consider EUS as the “Holy Grail” since it is one of the most complex diagnostic and therapeutic endoscopic procedures, but many users are still uncomfortable with some anatomical landmarks and with the choice of equipment. Echoendoscopes are indeed known to be costly and fragile, and quite versat...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Pierre H. Deprez Source Type: journals

Endosonography of high-grade intra-epithelial neoplasia/early cancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Endosonography (EUS) is frequently used for staging of early malignant gastrointestinal lesions. High-grade intra-epithelial neoplasia (HGIN) and mucosal cancer have a very low risk for lymphatic metastasis and therefore are suitable for endoscopic therapy. In HGIN and early oesophageal and gastric cancer, high-frequency miniprobes can provide detailed imaging of the different layers. However, diagnostic accuracy differentiating between mucosal and submucosal disease is not sufficient, and therefore (diagnostic) endoscopic resection should be performed in all localisable lesions to detect submucosal cancer at risk for lymp...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Oliver Pech, Erwin Günter, Christian Ell Source Type: journals

Endosonographic staging of upper intestinal malignancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Numerous studies conducted over the last 25 years provide evidence on the high diagnostic accuracy and important role of endoscopic ultrasonography (EUS) in staging oesophageal and gastric carcinoma. This extensive research was recently subjected to metaanalyses, condensing our knowledge on EUS performance and facilitating its comparison with competing methods. It is, however, important to realise that the management of oesophageal and gastric carcinoma is evolving and so are staging algorithms, setting new challenges for EUS and re-defining its position. Restaging after neoadjuvant treatment and precise assessment of earl...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: M. Polkowski Source Type: journals

Endosonographic staging of lower intestinal malignancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The use of EUS in the assessment of rectal pathology is well established. The accurate staging of lower intestinal tumours predicts prognosis and guides the planning of individual patient treatment. Increased experience and the development of high resolution three-dimensional EUS has lead to the greater accuracy of rectal staging with EUS of rectal tumours now considered the gold standard showing T stage accuracy that ranges from 75% to 95%, with N stage accuracy ranging from 65% to 80%. The use of EUS in the staging of colonic pathology, however, is not so well established though advances in miniprobe EUS has improved the...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Alexis M.P. Schizas, Andrew B. Williams, John Meenan Source Type: journals

The impact of EUS in primary gastric lymphomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastric lymphoma is the most frequent site of gastrointestinal lymphoma and is accessible for endosonographic evaluation. Most primary gastric lymphomas are classified as mucosa-associated lymphoid tissue (MALT)-type lymphomas that develop in the course of chronic Helicobacter pylori infection. Endoscopic ultrasonography (EUS) is regarded to be the most accurate method for the local staging of gastric lymphoma, although scientific evidence is limited. In stage uEI1 low-grade lymphoma, EUS is able to predict a high chance for cure by H. pylori eradication. The significance of EUS elastography or EUS-guided fine-needle aspir...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Jan Janssen Source Type: journals

The role of endosonography in submucosal tumoursEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Submucosal tumours (SMTs) are relatively common findings in patients undergoing endoscopy, especially in upper gastrointestinal (GI) tract. This term includes various non-neoplastic and neoplastic conditions. Endoscopic ultrasonography (EUS) is the best imaging procedure to characterise SMT and to determine the need for further explorations. In this review, the following issues will be addressed: the endosonographic features of SMT; the diagnostic accuracy of EUS; the ability of EUS to distinguish benign and malignant SMTs; the value of EUS-guided fine-needle aspiration (FNA); and the influence of EUS on clinical management.
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Bruno Landi, Laurent Palazzo Source Type: journals

Endosonography in the management of biliopancreatic disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Over the past two decades, endoscopic endosonography (EUS) has evolved into an indispensible diagnostic and therapeutic utility in the diagnosis and treatment of patients with pancreatobiliary disease. In this article, we summarise its current potential and provide an update of the latest literature.
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: F. Harinck, M.J. Bruno Source Type: journals

Endosonography in bronchopulmonary diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The diagnostic approach to diseases of the mediastinum is divided into two phases: (1) imaging techniques and (2) procedures for obtaining tissue samples for cytologic and histologic examination. The latter has for many years represented a considerable challenge to the clinician. Often invasive procedures in general anaesthesia as mediastinoscopy or thoracoscopy have been necessary. However, the sampling of tissue from the mediastinum has been revolutionized by EBUS and EUS, since they give access to the middle and the posterior compartment via the trachea and the oesophagus, respectively. Both EUS FNA and EBUS-TBNA of med...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Peter Vilmann, Jouke Annema, Paul Clementsen Source Type: journals

Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Intraductal ultrasonography (IDUS) is an imaging modality having unique characteristics and suitable for imaging of a narrow ductal cavity, its wall and the neighbouring structures. As IDUS uses high-frequency ultrasound (12–30MHz), its image quality is very high within approximately 2-cm range of radius. The bile duct and the pancreatic duct, therefore, are good targets for the assessment by IDUS. Biliopancreatic IDUS is mainly performed through the papilla of Vater in the same session as endoscopic retrograde cholangiopancreatography (ERCP). Biliary IDUS is possible through the percutaneous transhepatic route as well. ...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Naotaka Fujita, Yutaka Noda, Go Kobayashi, Kei Ito, Jun Horaguchi, Shinsuke Koshita, Yoshihide Kanno Source Type: journals

Endoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology – An overviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Endoscopic ultrasound (EUS)-guided biopsies are reliable, safe and effective techniques in obtaining samples for cytological or histological examinations either as a primary procedure or in cases where other biopsy techniques have failed. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA), as well as endoscopic ultrasound-guided trucut biopsy (EUS-TCB), has proven to be of significant value in the diagnostic evaluation of benign and malignant diseases, as well as in staging of the malignant tumours of the gastrointestinal tract and of adjacent organs. The diagnostic yield of EUS-guided biopsies depends on...
Source: Best Practice & Research. Clinical Gastroenterology - September 9, 2009 Category: Gastroenterology Authors: Christian Jenssen, Christoph F. Dietrich Source Type: journals

Aims & Scope/ Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We thank the editorial board for inviting us to put together this special issue devoted to common proctology scenarios that the gastroenterologist is likely to encounter. These are often difficult to treat, not least as they are often not in the curriculum of training, being considered the preserve of surgeons in many countries.
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Anton Emmanuel, Dave Chatoor Source Type: journals

Anorectal and pelvic floor anatomyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The anorectum and pelvic floor are crucial in maintaining continence, facilitating evacuation, providing pelvic organ support while in females the pelvic floor is part of the birth canal. The anal sphincter is a multilayered cylindrical structure, including the smooth muscle internal sphincter and the outer striated muscle layer. The latter comprises the external sphincter as lower outer half and puborectalis as upper outer half of the sphincter. The external sphincter is continuous with the rectum at the anorectal junction.The pelvic floor constitutes four principal layers: endopelvic fascia, the muscular pelvic diaphragm...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Jaap Stoker Source Type: journals

The physiology of continence and evacuationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Continence is maintained by the coordinated function of the pelvic floor, rectum and anal sphincters. Evacuation occurs through a relaxed pelvic floor. The rectum acts to either store or expel stool both of which require cortical sensory awareness acting in conjunction with intramural and spinal reflexes that ensure timely defecation. The anal sphincters act individually and in unison in response to rectal distension and the sensation of rectal filling. Reflex relaxation of the internal anal sphincter has an additional sensory function in allowing sampling of rectal contents in the upper anal canal. Voluntary control of th...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Adeel Bajwa, Research.Fellow, Anton Emmanuel Source Type: journals

Imaging pelvic floor dysfunctionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Pelvic floor function and structure are complex, and imaging (integrated with an understanding of physiology) is central to guiding the clinician in managing patients with incontinence, constipation, difficult rectal evacuation and pelvic organ prolapse. Multimodal imaging techniques such as static and dynamic imaging techniques (sometimes combined in a single sitting) have revolutionised our understanding of functional anatomy. The advent of endo-luminal imaging has increased our spatial resolution by its closer proximity to the area of interest. Dynamic imaging gives us a near physiological data set which helps us to sim...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Stuart A. Taylor Source Type: journals

Anal incontinenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
is a life restricting condition that is sometimes challenging to treat. There is an equal gender prevalence, however women are more likely to present particularly early in life, as a result of obstetric injury. This is still one of the leading causes of anal incontinence and sphincter tears can be missed at the time of delivery. As a result, there is a heightened awareness for sphincter injury based on risk assessment, digital rectal examination and an endo-anal ultrasound. Surgical repair is still invaluable in the presence of disruption and salvage procedures for severe refractory incontinence such as the dynamic gracil...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: David C.C. Bartolo, Hugh M. Paterson Source Type: journals

Constipation and evacuation disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Constipation and evacuation difficulty symptoms are common in the general populace. The ROME III criteria define the latter as a subset of the former. Constipation and defaecatory symptoms rarely occur in isolation and can often form part of a global pelvic floor problem, involving bladder voiding difficulties, sexual dysfunction and pain syndromes. While there is often a functional cause for symptoms, there are a number of organic causes particularly in the elderly that should not be missed. Novel physiological and imaging insights are improving our understanding, and potentially treatment, of these symptoms. Conservative...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Dave Chatoor, Anton Emmnauel Source Type: journals

Neurogenic colorectal and pelvic floor dysfunctionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Constipation and faecal incontinence are common symptoms among patients with spinal cord injury (SCI), myelomeningocoele (MMC), multiple sclerosis (MS), Parkinson's disease (PD) and stroke. Faecal incontinence in SCI, MMC and MS is mainly due to abnormal rectosigmoid compliance and rectoanal reflexes, loss of rectoanal sensibility and loss of voluntary control of the external anal sphincter. Constipation in SCI, MMC and MS is probably due to immobilisation, abnormal colonic contractility, tone and rectoanal reflexes or side effects from medication. In PD, dystonia of the external anal sphincter causes difficult rectal evac...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Klaus Krogh, Peter Christensen Source Type: journals

Neuromodulation for functional bowel disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In patients with functional bowel disorders not responding to maximal medical treatment, bowel lavage or biofeedback therapy, can nowadays be treated by sacral nerve neuromodulation (SNM). SNM therapy has evolved as a treatment for faecal incontinence and constipation. The exact working mechanism remains unknown. It is known that SNM therapy causes direct stimulation of the anal sphincter and causes changes in rectal sensation and several central nervous system areas. The advantage of SNM therapy is the ability to do a minimally invasive temporary screening phase to assess permanent stimulation outcome. Ideal candidates fo...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: B. Govaert, W.G. van Gemert, C.G.M.I. Baeten Source Type: journals

Complex pelvic floor failure and associated problemsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The pelvic floor is a highly complex structure made up of skeletal and striated muscles, support and suspensory ligaments, fascial coverings and an intricate neural network. Its dual role is to provide support for the pelvic viscera (bladder, bowel and uterus) and maintain functional integrity of these organs. In order to maintain good pelvic floor function, this elaborate system must work in a highly integrated manner. When this system if damaged, pelvic floor failure ensues. The aetiology is inevitably multi-factorial, and seldom as a consequence of a single aetiological factor. It can affect one or all the three compart...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Sohier Elneil Source Type: journals

Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Anorectal disorders like haemorrhoids, rectal prolapse, anal fissures, peri-anal fistulae and sexually transmitted diseases are bothersome benign conditions that warrant special attention. They, however, can all be diagnosed by inspection or proctoscopy (sexually transmitted proctitis). Constipation can play an underlying role in haemorrhoids, rectal prolapse and anal fissures, and it is important to treat these conditions in order to avoid recurrences. Haemorrhoids and anal fissures are generally treated conservatively and surgery is seldom required. Rectal prolapse and cryptoglandular peri-anal fistulae are treated surgi...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Richelle J.F. Felt-Bersma, Joep F. Bartelsman Source Type: journals

Chronic pelvic painEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
affects both men and women; there are probably common mechanisms that involve the central nervous system. In many cases, the symptoms may be localised to a single end organ. However, the involvement of the central nervous system may result in a complex regional pain syndrome affecting the whole pelvis and as a consequence, multiple-organ symptomatology. The initial trigger may be relatively benign but a predisposed individual may develop a range of significant sensory and efferent functional abnormalities. Stimuli not normally reaching threshold may be perceived and normal sensations may be magnified to become dysphoric o...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Andrew Paul Baranowski Source Type: journals

Organising a clinical service for patients with pelvic floor disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The evolution of the multidisciplinary approach to the management of chronic conditions is a reflection of how medicine has evolved from a singular to a plural effort recognising the complex causations and consequences of such disorders. This thinking should not be confined to tertiary centres alone and should be adapted where local expertise is available. Such an approach is especially important in pelvic floor disorders, where the correlation between structure and function is not always straightforward. There is a need to avoid over-investigation by accurate clinical assessment allied to tailored investigation, leading t...
Source: Best Practice & Research. Clinical Gastroenterology - August 1, 2009 Category: Gastroenterology Authors: Dave Chatoor, Marco Soligo, Anton Emmanuel Source Type: journals

Aims & scope/editorial boardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The past decade has witnessed an impressive increase in our understanding of many aspects of gastrointestinal functions and their disorders. At the same time, a variety of new techniques have been introduced and used to assess specific functions, and several of them were established as advanced diagnostic test procedures.
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: P. Layer Source Type: journals

Gastrointestinal motility testingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastrointestinal motility and the effects on luminal contents that are brought about by it can be studied in several ways. In clinical practice, manometry remains one of the most important investigational techniques, in particular for oesophageal and anorectal disorders. Radiographic examination of bolus transit through the gastrointestinal tract also continues to be a valuable tool. Scintigraphy still is the gold standard for assessment of gastric emptying, but 13C breath tests are an alternative. Many other techniques are used mainly in the context of scientific research but some of these may become incorporated in the d...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: André J.P.M. Smout, Marco W. Mundt Tags: A. Methods and Functions Source Type: journals

Reflux monitoring: pH-metry, Bilitec and Oesophageal impedance measurementsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastro-oesophageal reflux disease (GERD) is a highly prevalent condition in Western countries leading to millions of outpatient visits per year. GERD symptoms including heartburn, regurgitation and chest pain are caused by reflux of gastric content in the oesophagus even in the absence of endoscopically visible mucosal lesions. Several procedures are used to identify gastro-oesophageal reflux, the clinically widely used are: conventional (catheter-based) pH monitoring, wireless oesophageal pH monitoring (Bravo), bilirubin monitoring (Bilitec), and combined multichannel intraluminal impedance–pH monitoring (MII–pH). Eac...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Daniel Pohl, Radu Tutuian Tags: A. Methods and Functions Source Type: journals

Visceral sensitivity testingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Visceral hypersensitivity is regarded as an important factor in the pathogenesis of functional gastrointestinal disorders. Assessment of visceral sensitivity has several important aims: increasing the understanding of normal and abnormal visceral sensory mechanisms and participating sensory pathways, serving as diagnostic tool to detect patients with abnormal visceral sensitivity, and evaluating therapeutic interventions directed towards modification of visceral sensitivity. Current stimulation modes in sensitivity tests include mechanical distension by barostat or tensostat, nutrient drink or water load, chemical stimulat...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Viola Andresen Tags: A. Methods and Functions Source Type: journals

Secretion and absorption (methods and functions)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
With the development and wide availability of endoscopic procedures, the importance of secretion and absorption tests for the diagnosis of gastrointestinal diseases has decreased. Still, only in about half of the patients with abdominal complaints an organic cause can be established by imaging techniques and/or conventional laboratory tests. In the other patients diagnosis may partly be clarified by gastrointestinal function tests. This chapter focuses on indications, practical performance and interpretation of tests of gastrointestinal secretion and absorption (for breath tests compare chapter 5). Some tests of gastrointe...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Paul Georg Lankisch Tags: A. Methods and Functions Source Type: journals

Methods and functions: Breath testsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Breath tests provide a valuable non-invasive diagnostic strategy to in vivo assess a variety of enzyme activities, organ functions or transport processes. Both the hydrogen breath tests and the 13C-breath tests using the stable isotope 13C as tracer are non-radioactive and safe, also in children and pregnancy.Hydrogen breath tests are widely used in clinical practice to explore gastrointestinal disorders. They are applied for diagnosing carbohydrate malassimilation, small intestinal bacterial overgrowth and for measuring the orocecal transit time.13C-breath tests non-invasively monitor the metabolisation of a 13C-labelled ...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Barbara Braden Tags: A. Methods and Functions Source Type: journals

Sonographic assessments of gastrointestinal and biliary functionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ultrasound has been established as a routine work-up imaging method in abdominal diseases. It assesses the morphology of intra-abdominal organs and depicts the normal and pathological anatomy of the gastrointestinal tract as well as of the biliopancreatic system. Ultrasound is the method of choice for visualisation of motion sequences since it is, in contrast to other imaging methods, a real-time method. The non-invasiveness and the repeatability of the method are important advantages when performing investigations of functional processes. Therefore, ultrasound is most suited for functional studies. Up to now, functional u...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Christoph F. Dietrich, Barbara Braden Tags: A. Methods and Functions Source Type: journals

Utility of non-endoscopic investigations in the practical management of oesophageal disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current available methods for diagnosis of GORD are symptom questionnaires, catheter and wireless pH-metry, impedance-pH monitoring and Bilitec@. Osophageal pH monitoring allows both quantitative analysis of acid reflux and assessment of reflux-symptom association. Impedance-pH monitoring detects all types of reflux (acid and non-acid) and allows assessment of proximal extent of reflux, a relevant parameter for understanding symptoms perception and extraoesophageal symptoms. Bilitec provides a quantitative assessment of duodeno-gastro-oesophageal reflux. Oesophageal motor abnormalities have been associated with GORD sy...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Daniel Sifrim, Kathleen Blondeau, Lidia Mantillla Tags: B. Diseases Source Type: journals

Mandatory and optional function tests in gastroduodenal disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A number of patients have symptoms suggestive of a disturbance of gastroduodenal function. Current gastric function tests allow us to study gastric emptying, motor activity, gastroduodenal sensitivity to distention and accommodation to a meal. The best application of these tests seems to be in the explanation of symptoms. However, most of the available tests have a low diagnostic specificity, and their results usually have no major impact on the choice of therapy. In rare or refractory cases, small bowel manometry may lead to specific diagnoses and gastric emptying testing may prompt the decision to consider more invasive ...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: J. Tack Tags: B. Diseases Source Type: journals

Disorders of intestinal secretion and absorptionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The gastrointestinal tract possesses a huge epithelial surface area and performs many different tasks. Amongst them are the digestive and absorptive functions. Disorders of intestinal absorption and secretion comprise a variety of different diseases, e.g. coeliac disease, lactase deficiency or Whipple’s disease. In principle, impaired small intestinal function can occur with or without morphological alterations of the intestinal mucosa. Therefore, in the work up of a malabsorptive syndrome an early small intestinal biopsy is encouraged in conjunction with breath tests and stool analysis to guide further management. In ad...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Jörg-Dieter Schulzke, Hanno Tröger, Maren Amasheh Tags: B. Diseases Source Type: journals

Intestinal and anorectal motility and functional disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Motility and functional disorders of the small intestine, the colon and the anorectum can induce or contribute to symptoms such as diarrhoea, constipation and abdominal pain and may impair nutrient absorption in severe cases. Acute affections of intestinal functions e.g. during gastrointestinal infections usually need no functional diagnostics but resolve spontaneously or with adequate therapy of the underlying disease. By contrast, chronic disturbances of small intestinal, colonic and anorectal motility and/or sensitivity are subject to gastrointestinal function tests. The role of these tests for diagnosis and therapeutic...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Jutta Keller, Peter Layer Tags: B. Diseases Source Type: journals

Tests of pancreatic exocrine function – Clinical significance in pancreatic and non-pancreatic disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The pancreas functions as the main factory for digestive enzymes and therefore enables food utilisation. Pancreatic exocrine insufficiency, partial or complete loss of digestive enzyme synthesis, occurs primarily in disorders directly affecting pancreatic tissue integrity. However, other disorders of the gastrointestinal tract, such as coeliac disease, inflammatory bowel disease, Zollinger-Ellison syndrome or gastric resection can either mimic or cause pancreatic exocrine insufficiency. The overt clinical symptoms of pancreatic exocrine insufficiency are steatorrhoea and maldigestion, which frequently become apparent in ad...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Jutta Keller, Ali Alexander Aghdassi, Markus M. Lerch, Julia V. Mayerle, Peter Layer Tags: B. Diseases Source Type: journals

Mandatory and optional function tests for biliary disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Function tests in gastroenterology and hepatology aim to provide criteria for diagnosis of specific disorders and for prediction of patient responses to therapy. This review focuses on the utility of function tests in the management of gallstone disease and functional biliary disorders. In gallstone disease, function tests may be considered in the selection of candidates for nonsurgical therapy of gallbladder stones only. In cases of suspected functional biliary disorders, experts have advocated the use of classical noninvasive tests such as hepatobiliary scintigraphy. However, unequivocal evidence for their utility in dia...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Marc Dauer, Frank Lammert Tags: B. Diseases Source Type: journals

Non-invasive diagnosis and monitoring of liver fibrosis and cirrhosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The accurate staging of liver fibrosis in chronic liver diseases, especially the early diagnosis of liver cirrhosis, is crucial for prognostic assessment of the course of the disease. The histological evaluation of a liver biopsy cylinder is still the gold standard in assessing the stage of liver fibrosis. However, liver biopsy is an invasive procedure and carries the risk of complications. This has to be balanced against the information benefit of liver histology. To overcome this, non-invasive tests were developed assessing liver fibrosis based on combinations of laboratory markers or techniques measuring liver elasticit...
Source: Best Practice & Research. Clinical Gastroenterology - June 1, 2009 Category: Gastroenterology Authors: Ulrike W. Denzer, Stefan Lüth Tags: B. Diseases Source Type: journals

Aims & Scope/Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In the 1990s the underlying gene defects for most of the hereditary colorectal cancer (CRC) syndromes and several benign conditions of the gastrointestinal (GI) tract were identified. In the last decade the genome has been further unraveled and this has led to the identification of DNA-variants that are associated with various GI-diseases. These new developments have had important clinical implications. In hereditary GI-cancer syndromes predictive tests have become available for use in clinical practice. With the use of these tests we are now able to discriminate between carriers of a gene defect and those without a gene d...
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Authors: Hans F.A. Vasen Source Type: journals

Introduction to molecular and clinical genetics of colorectal cancer syndromesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The understanding of molecular genetics in the field of gastroenterology has rapidly grown over the last two decades. In recent years many genes involved in the disorders of the gastrointestinal (GI) tract such as colorectal cancer (CRC) and inflammatory bowel disease have been identified. The elucidation of the molecular genetics of these diseases made it possible to study the high-penetrance susceptibility genes for disease-causing mutations with direct implications for relatives of affected individuals. The most immediate application of these advances is the opportunity of pre-symptomatic diagnosis in relatives of affec...
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Authors: Carli M.J. Tops, Juul Th. Wijnen, Frederik J. Hes Source Type: journals

Hereditary gastric cancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastric cancer is a heterogeneous and highly prevalent disease, being the fourth most common cancer and the second leading cause of cancer associated death worldwide. Most cases are sporadic and familial clustering is observed in about 10% of the cases. Hereditary gastric cancer accounts for a very low percentage of cases (1–3%) and a single hereditary syndrome – Hereditary Diffuse Gastric Cancer (HDGC) – has been characterised. Among families that fulfil the clinical criteria for HDGC, about 40% carry CDH1 germline mutations, the genetic cause of the others being unknown. The management options for CDH1 asymptomatic...
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Authors: Carla Oliveira, Raquel Seruca, Fátima Carneiro Source Type: journals

Hereditary pancreatic cancer: A clinical perspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes research to date on hereditary pancreatic cancer, addresses how best clinicians should recognise hereditary forms of pancreatic cancer and explains the emotional burden of discovering a potentially lethal mutation. Many controversies and unanswered questions in hereditary pancreatic cancer remain.
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Authors: Julia B. Greer, Henry T. Lynch, Randall E. Brand Source Type: journals

Hereditary haemochromatosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Haemochromatosis should currently refer to hereditary iron overload disorders presenting with a definite and common phenotype characterised by normal erythropoiesis, increased transferrin saturation and ferritin and primarily parenchymal iron deposition related to innate low (but normally regulated) production of the hepatic peptide hormone hepcidin. Since the discovery of the haemochromatosis gene (HFE) in 1996, several novel gene defects have been detected, explaining the mechanism and diversity of iron overload diseases. Overall, at least four main types of hereditary haemochromatosis (HH) have been identified.This revi...
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Authors: M.C.H. Janssen, D.W. Swinkels Source Type: journals

Genetic testing in gastroenterology: Lynch syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Lynch syndrome/Hereditary non-polyposis colorectal cancer is caused by inherited germline mutations in mismatch repair (MMR) genes, and accounts for 2–5% of colorectal cancers (CRC) . It is characterized by young onset CRC and an increased risk for gynaecologic, urinary tract and gastrointestinal cancers. Family history evaluation is crucial in the early identification of individuals at risk for Lynch syndrome. Individuals whose family history includes multiple relatives with cancer, two or more primary cancers, or component tumours diagnosed at a young age, should undergo genetic evaluation for Lynch syndrome. Guideline...
Source: Best Practice & Research. Clinical Gastroenterology - April 1, 2009 Category: Gastroenterology Authors: Shilpa Grover, Sapna Syngal Source Type: journals

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