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Common anorectal disorders: Diagnosis and treatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides an update on the evaluation and treatment of common anorectal disorders. Content Type Journal ArticleDOI 10.1007/s11894-009-0062-yAuthors Brian E. Lacy, Dartmouth-Hitchcock Medical Center Division of Gastroenterology and Hepatology Area 4C, 1 Medical Center Drive Lebanon NH 03756 USAKirsten Weiser Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Inflammatory bowel diseases and management considerations: Fertility and pregnancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Young women with inflammatory bowel disease (IBD) pose a unique set of challenges. These women and their treating physicians must make difficult choices in matters regarding conception, pregnancy, and breastfeeding. This review highlights recent evidence and management issues that arise when taking care of women with IBD in terms of fertility, outcomes, and medication safety in pregnancy and breastfeeding. Ultimately, treatment must be individualized for each patient based on the available evidence and the woman’s preferences. Content Type Journal ArticleDOI 10.1007/s11894-009-0059-6Authors M...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Evolving concepts in Clostridium difficile colitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Clostridium difficile infection (CDI) is the most important cause of nosocomial diarrhea. The emergence of a hypervirulent strain and other factors including antibiotic overuse contribute to the increasing incidence and severity of this potentially lethal infection. CDI has been reported in persons previously considered as low risk, such as young healthy persons without exposure to health care settings or antibiotics, peripartum women, and children. In patients with inflammatory bowel disease, the risk of C. difficile infection is even greater, with higher rates of hospitalization, bowel surgery, a...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Serotonin and the GI tractEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Serotonin (5-hydroxytryptamine, 5-HT) participates in several functions of the gastrointestinal tract. Receptors in seven families (5-HT1-5-HT7) were identified, many of which are present on enterocytes, intrinsic and extrinsic neurons, interstitial cells, and gut myocytes. Most 5-HT is released from enterochromaffin cells in response to physiologic and pathologic stimuli. Roles of 5-HT in health include control of normal gut motor activity, secretion, and sensation, and regulation of food intake and cell growth. Abnormalities of serotonergic function contribute to symptom genesis in functional bowe...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

NSAIDs and the gastrointestinal tractEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract NSAIDs incur significant gastrointestinal (GI) side effects. The complication risk increases with history of peptic ulcer or older age. Helicobacter pylori infection and cardioprotective aspirin have independent and additive risks in the presence of NSAID use. NSAID enteropathy is increasingly recognized. Cardiovascular and GI risk stratification and H. pylori infection testing should be done before initiating NSAIDs. An NSAID combined with a proton pump inhibitor (PPI) is comparable to cyclooxygenase (COX)-2 inhibitors for gastroprotection, but for high-risk patients, COX-2 plus PPI should be consid...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Clinical significance of inflammatory markersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Inflammatory markers play a key role in the evaluation of patients with gastrointestinal symptoms. For patients presenting with nonspecific symptoms of abdominal pain and diarrhea, distinguishing inflammatory bowel disease from other disorders can be difficult, and invasive diagnostic procedures may be required. Inflammatory markers can be useful to differentiate patients who may require further workup from those who do not. Several serum, fecal, and other markers are reviewed for their use in clinical practice. Although no single ideal marker exists, a few show promise in diagnosing inflammatory di...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Bile acids in regulation of intestinal physiologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract In addition to their roles in facilitating lipid digestion and absorption, bile acids are recognized as important regulators of intestinal function. Exposure to bile acids can dramatically influence intestinal transport and barrier properties; in recent years, they have also become appreciated as important factors in regulating cell growth and survival. Indeed, few cells reside within the intestinal mucosa that are not altered to some degree by exposure to bile acids. The past decade saw great advances in the knowledge of how bile acids exert their actions at the cellular and molecular levels. In th...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Diabetic diarrheaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focuses on the etiologies of diarrhea that are seen with higher incidence in diabetic patients. Content Type Journal ArticleDOI 10.1007/s11894-009-0054-yAuthors Milena GouldJoseph H. Sellin, Baylor College of Medicine Section of Gastroenterology 1709 Dryden Road, Suite 8.36 Houston TX 77030 USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Serrated adenomasEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Serrated adenomas are categorized as sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs). SSAs are more prevalent in the proximal colon and lack classic dysplasia, whereas TSAs are more prevalent in the rectosigmoid and have cytologic dysplasia. Serrated adenomas may progress to colorectal adenocarcinoma through diverse molecular alterations. Colonoscopy is the only test for the early detection of serrated adenomas that allows inspection of the entire colon and same-session biopsy sampling or polypectomy, if necessary. If an endoscopic biopsy at the right colon reveals SSA with...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Fructose-sorbitol malabsorptionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Important dietary carbohydrates such as fructose and sorbitol are incompletely absorbed in the normal small intestine. This malabsorption is sometimes associated with abdominal complaints and diarrhea development, symptoms indistinguishable from those of functional bowel disease. Recently, polymerized forms of fructose (fructans) also were implicated in symptom production in patients with irritable bowel syndrome (IBS). Evidence from uncontrolled and controlled challenge studies suggests that malabsorbed sugars (fructose, sorbitol, lactose) and fructans may act as dietary triggers for clinical sympt...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Intravenous esomeprazole for prevention of recurrent peptic ulcer bleedingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0065-8Authors Alan B. R. Thomson, University of Alberta Division of General Internal Medicine, Department of Medicine Edmonton Canada Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Advances in colorectal cancer screeningEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides a focused assessment of effectiveness, limitations, and alternative available screening methods. New modalities endorsed in the updated guidelines (eg, fecal immunochemical tests, fecal DNA, and CT colonography) are reviewed. In addition, advances and updates in existing tests (eg, guaiac-based fecal occult blood tests and colonoscopy) are evaluated. Content Type Journal ArticleDOI 10.1007/s11894-009-0061-zAuthors Hongha T. VuCarol A. Burke, Cleveland Clinic Foundation Digestive Disease Institute, Department of Gastroenterology and Hepatology 9500 Euclid Avenue, A-30 Cleveland OH 44195 USA ...
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Food for thoughtEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0064-9Authors Joseph H. Sellin, Baylor College of Medicine Division of Gastroenterology Houston USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 5 / October, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - September 20, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

A role for corticotropin-releasing factor in functional gastrointestinal disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Functional gastrointestinal disorders (FGIDs), which include irritable bowel syndrome (IBS), encompass a heterogeneous group of diseases identified by chronic or recurrent symptom-based diagnostic criteria. Psychosocial factors are key components in the outcome of clinical manifestations of IBS symptoms. Anxiogenic and endocrine responses to stress are mediated by the corticotropin-releasing factor (CRF)-CRF1 receptor pathway. Preclinical studies show that activation of the CRF1 receptor by exogenous CRF or stress recapitulates many functional symptoms of IBS diarrhea-predominant patients as related ...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Is rosacea another disorder of gut microbes?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0049-8Authors Walter J. Coyle, Division of Gastroenterology and Hepatology LaJolla USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Controversial results with use of probiotics in critical illness: Confirmation of early positive resultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0051-1Authors Jeremy R. Stapleton, University of Louisville School of Medicine Division of Gastroenterology/Hepatology Louisville USAStephen A. McClave, University of Louisville School of Medicine Louisville USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Controversial results with use of probiotics in critical illness: Contradictory findings from large multicenter trialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0052-0Authors Jeremy R. Stapleton, University of Louisville School of Medicine Division of Gastroenterology/Hepatology Louisville USAStephen A. McClave, University of Louisville School of Medicine Louisville USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Controversial results with use of probiotics in critical illness: Early single-center positive resultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0050-2Authors Jeremy R. Stapleton, University of Louisville School of Medicine Division of Gastroenterology/Hepatology Louisville USAStephen A. McClave, University of Louisville School of Medicine Louisville USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / August, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Acute kidney injury (AKI) is a frequently observed complication in critically ill patients. Its presentation may range from the early risk of renal dysfunction to complete renal failure. Morbidity and mortality in the AKI patient increase with the decline of renal function. Appropriate nutrition therapy is essential in the medical management of the AKI patient. Assessment of nutritional requirements should take into account the patient’s underlying complication, comorbid medical conditions, and severity of the renal dysfunction. Various stages of AKI determine the direction of nutrition therapy. A...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

The microbiome and obesity: Is obesity linked to our gut flora?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract The human gut is a lush microbial ecosystem containing about 100 trillion microorganisms, whose collective genome, the microbiome, contains 100-fold more genes than the entire human genome. The symbiosis of our extended genome plays a role in host homeostasis and energy extraction from diet. In this article, we summarize some of the studies that have advanced the understanding of the microbiome and its effects on metabolism, obesity, and health. Metagenomic studies demonstrated that certain mixes of gut microbiota may protect or predispose the host to obesity. Furthermore, microbiota transplantation...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Treating pelvic floor disorders of defecation: Management or cure?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Pelvic floor disorders that affect defecation consist of structural disorders (eg, rectocele) and functional disorders (eg, dyssynergic defecation). Evaluation includes a thorough history and physical examination, a careful digital rectal examination, and physiologic tests such as anorectal manometry, colonic transit study, and balloon expulsion test. Defecography and dynamic MRI may facilitate detection of structural defects. Management consists of education and counseling regarding bowel function, diet, laxatives, and behavioral therapies. Recently, several randomized, clinical trials have shown t...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Managing dyspepsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract The prevalence of dyspepsia in the general population is as high as 40%, and its management represents a considerable financial burden to the health care system. Causes of dyspepsia amenable to medical therapy include peptic ulcer and functional dyspepsia, and testing for Helicobacter pylori and treating positive individuals is beneficial in both conditions. Individuals presenting for the first time with uninvestigated dyspepsia, age greater than 50 years, or alarm features require upper gastrointestinal (GI) endoscopy to exclude gastroesophageal malignancy. Upper GI endoscopy for younger individual...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Escherichia coli O157: What every internist and gastroenterologist should knowEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Infections with Escherichia coli O157:H7 have gained media attention in recent years because of cases associated with unusual sources (eg, produce and swimming pools). Although most adults recover without sequelae, children and the elderly are more likely to develop complications (eg, hemolytic uremic syndrome and death). The diagnosis typically has been made by culture; however, newer handheld immunoassays and polymerase chain reaction technology have led to more rapid detection of this important pathogen in stools, food, and water. Treatment is largely supportive; nonetheless, new methods to neutr...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

The burden of IBS: Looking at metricsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Irritable bowel syndrome (IBS) is a prevalent and expensive condition that significantly impairs health-related quality of life (HRQOL) and reduces work productivity. Based on strict criteria, 7% to 10% of people have IBS worldwide. Community-based data indicate that IBS-diarrhea and IBS-mixed subtypes are more prevalent than IBS-constipation, and that patients may switch among subtype groups. IBS is 1.5 times more common in women than in men, more common in lower socioeconomic groups, and more commonly diagnosed in patients younger than 50 years of age. Patients with IBS visit the doctor more frequ...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Prophylaxis for travelers’ diarrheaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Travelers’ diarrhea affects more than 10 million people per year and is usually contracted through the ingestion of microbially contaminated food or water. Although most cases resolve in 3 to 5 days, chronic conditions are associated with acute infections. Prevention encompasses avoidance of ingesting contaminated products and, in certain situations, taking prophylactic medications. The available prophylactic antibiotics are very effective in prevention, but are recommended only for specific at-risk individuals and are contraindicated for most travelers. Content Type Journal ArticleDOI 10.1007/...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Hepatotoxic herbs: Will injury mechanisms guide treatment strategies?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Harmful and fatal outcomes related to specific herbal therapies are reported with increasing regularity. However, US physicians remain inadequately informed about potential toxicities. The purpose of this focused review is to highlight past and more recently recognized herbal therapies or complementary and alternative medicine (CAM) that are shown to cause hepatotoxicity. Where available, the proposed mechanisms for toxicity are discussed. An aggressive approach for more stringent regulation of CAM is needed, in addition to a systematic and scientific study of causality and underlying toxic mechanis...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Should the principle of “pay for performance” be applied to nutrition support?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Americans spent 2.4 trillion dollars on health care in 2008. The massive size of this expenditure has led to perpetual efforts to improve health care quality while attempting to reduce overall cost. A recent development in reimbursement strategies is the “pay-for-performance” model. Retrospective reports showed variable success for this model for the treatment of acute myocardial infarction, pneumonia, and congestive heart failure. As the model gains popularity, there is pressure to apply pay for performance to an increasing number of diseases and treatment settings. In this article, we evaluate...
Source: Current Gastroenterology Reports - July 22, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Outcomes in pediatric autoimmune hepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Autoimmune hepatitis (AIH) is a common cause of acute and chronic hepatitis in childhood. Once the diagnosis is established, treatment with corticosteroid or corticosteroid and azathioprine is indicated. Most children with AIH respond to such therapy and experience remission from active disease. Eliminating drug therapy while maintaining remission is the ultimate goal of therapy. The optimal duration of therapy before drug elimination is unclear. Relapse rate is inversely related to therapy duration before drug withdrawal; thus, discontinuing immunosuppressive treatment is considered only after at l...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Evaluation of esophageal motor disorders in the era of high-resolution manometry and intraluminal impedanceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides an update on these technologies in clinical practice and how they may be helpful in the future. Content Type Journal ArticleDOI 10.1007/s11894-009-0029-zAuthors John E. Pandolfino, Northwestern University, Feinberg School of Medicine Division of Gastroenterology, Department of Medicine 676 North St. Clair Street, Suite 1400 Chicago IL 60611 USAWilliam J. Bulsiewicz Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Dilated intercellular spaces as a marker of GERDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Gastroesophageal reflux disease (GERD) is typically heralded by the substernal burning pain of heartburn. On endoscopic examination, about one third of GERD subjects with heartburn have erosive disease, and the remainder have nonerosive reflux disease (NERD). Unlike patients with erosive disease, those with NERD (∼ 50%) often do not respond to therapy with proton pump inhibitors (PPIs), raising the question of whether they have NERD and, if they do, whether the cause of their symptoms is similar to those who respond to PPIs. Recently, biopsies established that subjects with heartburn and PPI-respo...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Eosinophilic esophagitis: Concepts, controversies, and evidenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Eosinophilic esophagitis has become a prominent chronic esophageal disorder in clinical pediatric and adult gastroenterology. Its manifestations are protean in childhood, but dysphagia predominates the clinical presentation in adults. Adverse immune responsiveness to dietary antigens underlies most cases, as is reflected in clinical and histologic remission with appropriate diet management in the majority, although an understanding of the mechanisms underlying the inflammatory process remains incomplete. Intense investigations to explain the underpinnings of the disorder and to discover effective th...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Esophageal, gastric, and duodenal manifestations of IBD and the role of upper endoscopy in IBD diagnosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Upper gastrointestinal (GI) tract inflammation in inflammatory bowel disease has become increasingly recognized, even in the absence of specific localizing symptoms, as patients more frequently undergo upper endoscopy. Although the recent Montreal classification system allowed classification of upper GI involvement in Crohn’s disease (CD), independent of other locations, a consensus regarding the definition of what qualifies as significant “involvement” is still lacking. Reported incidence data vary considerably depending on the definitions used and the selected target population. Pediatric da...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Pediatric juvenile polyposis syndromes: An updateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Colon polyps are a common finding in pediatrics and can present with rectal bleeding, abdominal pain, or polyp prolapse from the rectum. Histologically classified as hamartomas, these isolated pediatric polyps lack epithelial dysplasia and have no cancer risk. However, when polyps are present in greater numbers, or are associated with a family history of polyps or colon or other cancers, a polyposis or hereditary colorectal cancer syndrome should be considered. Using a casebased format, this article reviews the clinical features and provides updates on the three most common hamartomatous polyp syndr...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Probiotics in pediatric inflammatory bowel diseasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article examines the currently available published trials studying probiotics for the treatment of IBD, with particular emphasis on their role in pediatric IBD patients. Content Type Journal ArticleDOI 10.1007/s11894-009-0037-zAuthors Ajay S. Gulati, University of North Carolina at Chapel Hill Department of Pediatrics, Division of Pediatric Gastroenterology 130 Mason Farm Road, 5143 Bioinformatics, CB-7229 Chapel Hill NC 27599 USAMarla C. Dubinsky Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 20...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Eosinophilic esophagitis: Pathophysiology and optimal managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Eosinophilic esophagitis (EoE) is an increasingly recognized disease characterized by esophageal symptoms accompanied by increased esophageal mucosal eosinophilia. The reasons for the increasing prevalence and understanding of the pathogenesis of EoE are areas of active investigation. Food and environmental allergy, host immunologic predisposition, and interactions with gastroesophageal reflux disease have emerged as important aspects of the disease. The optimal management of EoE is controversial and evolving. Therapeutic options include medical therapy with acid suppression, corticosteroids, and bi...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Current perspectives on pediatric intestinal transplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Irreversible intestinal failure in children is predominantly caused by surgical conditions such as volvulus, necrotizing enterocolitis, and gastroschisis. Functional intestinal failure from motility disorders such as intestinal pseudo-obstruction or enterocyte dysfunction with microvillus inclusion disease also may require intestine replacement. Approved indications for intestinal transplantation include liver dysfunction, loss of major venous access, frequent central line-related sepsis, and recurrent episodes of severe dehydration despite intravenous fluid management. Surgical options include tran...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Screening and surveillance of Barrett’s esophagusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Esophageal adenocarcinoma (EAC) is the most rapidly increasing cancer in the Western world and Barrett’s esophagus (BE) is the only known precursor lesion for this lethal cancer. Long-term survival may be improved if EAC is diagnosed early, providing an opportunity for early intervention. Screening for BE in patients with gastroesophageal reflux disease is not routinely recommended; however, if diagnosed, enrollment into a surveillance program may be beneficial. Surveillance of all patients with known BE is probably not costeffective and factors predictive of BE progression to dysplasia/EAC are po...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Second-line therapy for severe pediatric ulcerative colitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0026-2Authors Susan R. Orenstein Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

The clinical usefulness of high-resolution manometry for the management of achalasiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0027-1Authors Marcelo F. Vela Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

The relationship between gastroesophageal reflux disease and sleepEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Recent studies demonstrate a bidirectional relationship between gastroesophageal reflux disease (GERD) and sleep in which nighttime reflux leads to sleep deprivation and sleep deprivation can exacerbate GERD by enhancing perception of intraesophageal stimuli. Current treatment primarily focuses on reducing nighttime reflux, thus improving sleep quality. Future studies are needed to further explore the relationship between GERD and sleep and the potential of novel therapeutic options to interrupt the vicious cycle between them. Content Type Journal ArticleDOI 10.1007/s11894-009-0032-4Authors Ron...
Source: Current Gastroenterology Reports - May 21, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Laparoscopic pancreatic surgery: What now and what next?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract In recent years, improved laparoscopic skill sets have expanded surgical management of pancreatic disease to encompass pancreatic resection, tumor enucleation, débridement, and drainage. With the aid of radio-logically guided drainage catheters, necrosectomy for acute pancreatitis can be delayed and accomplished laparoscopically in a select patient population. Pancreatic pseudocysts from chronic pancreatitis can now be approached via minimally invasive strategies, including emerging combined laparoendoscopic procedures and natural orifice transluminal endoscopic surgery. It is clear that laparoscop...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Neuroendocrine tumors of the pancreasEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Pancreatic endocrine tumors are rare neoplasms accounting for less than 5% of pancreatic malignancies. They are broadly classified into either functioning tumors (insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas) or nonfunctioning tumors. The diagnosis of these tumors is difficult and requires a careful history and examination combined with laboratory tests and radiologic imaging. Signs and symptoms are usually related to hormone hypersecretion in the case of functioning tumors and to tumor size or metastases with nonfunctioning tumors. Surgical resection remains the treatment o...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Prevention, detection, and management of infected necrosis in severe acute pancreatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract The management of infected peripancreatic or pancreatic necrosis in patients with severe pancreatitis has changed considerably in recent years. This review discusses the recent literature on prevention, detection, and management of infected necrosis. Though antibiotics, probiotics, and enteral nutrition have been tried to prevent infected necrosis, only enteral nutrition has consistently proven to be effective. Antibiotics and probiotics have not shown a consistent beneficial effect on outcome. Enteral nutrition reduced infectious complications and mortality in severe pancreatitis, compared with par...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

The changing character of acute pancreatitis: Epidemiology, etiology, and prognosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Acute pancreatitis continues to be a diagnostic and therapeutic challenge for physicians and surgeons. It ranks third in the list of hospital discharges for gastro intestinal diseases. In most patients the cause is either gallstones or alcoholism. The overall mortality is less than 5%, but severe acute pancreatitis leads to prolonged hospitalization and much higher mortality. There are important differences in disease susceptibility and case fatality rates: the incidence is higher in blacks than in whites, and mortality is higher in older patients than in younger patients. Reports from various count...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Endoscopic therapy for chronic pancreatitis: Technical success, clinical outcomes, and complicationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Chronic pancreatitis (CP) can cause failure of both the exocrine and endocrine portions of the gland. Pain is the most recalcitrant clinical complaint in CP. Generally, conservative measures are first attempted to manage pain. These include cessation of alcohol use and smoking, enzyme replacement therapy, and finally, opioid analgesia. Endoscopy can be employed to treat the pain and complications due to CP. The results of the only two prospective randomized controlled trials suggest that surgery has a more durable effect than endoscopic therapy in controlling pain. Both trials suffer from severe lim...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Antioxidants for chronic pancreatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0014-6Authors Christopher E. Forsmark, University of Florida Division of Gastroenterology, Hepatology, and Nutrition Florida USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Spare the steroids, miss the diagnosis?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Content Type Journal ArticleCategory Clinical Trials ReportDOI 10.1007/s11894-009-0015-5Authors John Baillie, Wake Forest University Health Sciences Section on Gastroenterology Winston-Salem USA Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Minimizing complications in pancreaticobiliary endoscopyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are invaluable tools in the diagnostic and therapeutic evaluation and management of a variety of pancreatobiliary disorders. Along with a significant refinement in the equipment and techniques used has come a recent trend toward aggressive therapeutic interventions. Because of the technical nature of these procedures and the characteristics of the patients, postprocedural complications may occur, ranging from minor (requiring brief hospitalization) to severe (causing permanent disability or death). This review summarizes...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

The investigation of unexplained biliary dilatationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract The investigation of biliary dilatation forms a routine part of gastroenterology practice. In developed countries, biliary dilatation is usually the result of obstruction of bile flow by either stones or mitotic lesions of the pancreas or biliary tree, and standard radiologic and endoscopic techniques are used to identify and relieve the obstruction. In the absence of an obvious cause, however, the investigation and management of biliary dilatation can prove challenging, particularly while trying to minimize invasive studies. This review examines factors thought to influence bile duct size in the ab...
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals

Preoperative biliary drainage in malignant obstruction: Indications, techniques, and the debate over riskEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article examines the arguments for and against preoperative biliary drainage, the conflicting data on the subject, and the techniques used. Content Type Journal ArticleDOI 10.1007/s11894-009-0022-6Authors Alan Coss, University of British Columbia Division of Gastroenterology 5135-2775 Laurel Street Vancouver BC V5Z 1M9 CanadaMichael F. Byrne Journal Current Gastroenterology ReportsOnline ISSN 1534-312XPrint ISSN 1522-8037 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Gastroenterology Reports)
Source: Current Gastroenterology Reports - March 17, 2009 Category: Gastroenterology Tags: Current Gastroenterology Reports Source Type: journals