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IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Source Type: journals

Postoperative Management of Crohn DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 impo...
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Su Min Cho, Sung W. Cho, Miguel Regueiro Source Type: journals

Novel Diagnostic and Prognostic Modalities in Inflammatory Bowel DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 valuab...
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Timothy L. Zisman, David T. Rubin Source Type: journals

Clostridium Difficile and Inflammatory Bowel DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarizes the available literature on the impact of C difficile infection on IBD and discusses the various diagnostic testing and treatment options available. Also reviewed are clinical situations specific to patients with IBD that are important for the treating physician to recognize. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Ashwin N. Ananthakrishnan, Mazen Issa, David G. Binion Source Type: journals

Safety Profile of IBD Therapeutics: Infectious RisksEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Over the last decade, the medical treatment of inflammatory bowel disease (IBD) has been revolutionized, with increasing use of both immunomodulatory and biologic medications. Corticosteroids have increasingly been associated with an elevated risk of serious and opportunistic infections, both independently and in combination with immunomodulator and biologic agents. There are limited data on the infectious risk of immunomodulators. It is unclear if anti-tumor necrosis factor agents increase overall infectious risk in patients with IBD, but the available literature has demonstrated an increased risk of opportunistic infecti...
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Waqqas Afif, Edward V. Loftus Source Type: journals

Safety Profile of IBD: Lymphoma RisksEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the cancer risks of commonly used inflammatory bowel disease (IBD) medications, with an emphasis on hematologic malignancy risks. The increasing use of immunosuppressant therapies in the treatment of IBD has raised this question to an even greater importance. Studies evaluating these medications are complicated due to varying disease severity and concomitant use of other immunosuppressant medication. The potential risks of all therapies must be weighed against the benefits these therapies can offer these patients. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Meenakshi Bewtra, James D. Lewis Source Type: journals

Pouchitis and Pouch DysfunctionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Restorative proctocolectomy with ileal pouch-anal anastomosis has become the surgical treatment of choice for most patients with ulcerative colitis who require surgery. Although the surgical procedure offers a cure in some patients, postoperative inflammatory and noninflammatory complications are common. Pouchitis is the most common long-term complication of the procedure. Pouchitis represents a spectrum of disease processes with heterogeneous risk factors, clinical phenotypes, natural history, and prognosis. Accurate diagnosis and classification are important for proper treatment and prognosis. (Source: Gastroenterology C...
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Hao Wu, Bo Shen Source Type: journals

Pregnancy and Inflammatory Bowel DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This review covers important questions that arise for physicians caring for women with inflammatory bowel disease. Fertility, pregnancy outcomes and the safety of medications in pregnancy and lactation are discussed. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Uma Mahadevan Source Type: journals

Pediatric Inflammatory Bowel Disease: Highlighting Pediatric Differences in IBDEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses clinically relevant epidemiology and treatment aspects of pediatric IBD, with special focus on similarities and differences in pediatric and adult IBD. Evidence-based treatment algorithms, with special focus on pediatric studies and care for children, are also highlighted. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Cary G. Sauer, Subra Kugathasan Source Type: journals

Treatment of Fistulizing Inflammatory Bowel DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Fistulas manifest frequently in Crohn disease and can result in significant morbidity and often lead to the need for surgical intervention. Historically, it has been more difficult to obtain complete fistula closure in patients with perianal Crohn disease. Anti-tumor necrosis factor-alpha agents and the use of more accurate imaging modalities such as magnetic resonance imaging and rectal endoscopic ultrasound have enhanced the ability to manage fistulizing Crohn disease. A combined medical and surgical approach usually presents the best option for most patients. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: David A. Schwartz, Brad E. Maltz Source Type: journals

Evolving Inflammatory Bowel Disease Treatment Paradigms: Top-Down Versus Step-UpEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides an overview of the current approaches to therapy for CD and UC and focuses on the evidence supporting the rationale for changing paradigms in the management of IBD, including mucosal healing as an end point and earlier use of immunosuppressive and biologic agents, particularly in CD (so-called top-down therapy). (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Shane M. Devlin, Remo Panaccione Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We are honored to serve as the editors for this issue of Gastroenterology Clinics of North America titled “Challenges in Inflammatory Bowel Disease.” The authors comprise a distinguished group of physician scientists and clinicians who are leaders in the field of inflammatory bowel disease (IBD). In this issue, they share their insights and expertise into how they manage challenging IBD presentations. We believe this issue provides an invaluable consulting reference for all health care providers. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Authors: Miguel Regueiro, Arthur M. Barrie Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - November 13, 2009 Category: Gastroenterology Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Source Type: journals

Pharmacologic Consideration of Commonly Used Gastrointestinal Drugs in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the alterations in pharmacokinetic disposition of medications that occur with aging and highlights the pharmacology of commonly used GI drugs. Selected GI conditions that are drug induced and preventable are identified, and recommendations for GI drugs to be avoided in older adults are provided. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Barbara J. Zarowitz Source Type: journals

Solitary Rectal Ulcer Syndrome and Stercoral UlcersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focuses on two of the less commonly diagnosed diseases: solitary rectal ulcer syndrome and stercoral ulceration, both related to local tissue ischemia and often seen in the elderly population. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Yair Edden, Shirley S. Shih, Steven D. Wexner Source Type: journals

Intestinal Ischemia in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the clinical spectrum of mesenteric ischemia in the elderly with particular emphasis on the varied presentations, evaluation, and management of ischemic disorders of the intestines. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: John R. Cangemi, Michael F. Picco Source Type: journals

Diverticulosis and Acute DiverticulitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Colonic diverticulosis is a common, usually asymptomatic, entity of Western countries, with an incidence that increases with age. When these diverticula become infected and inflamed, patients can present with a wide variety of clinical manifestations. Management of acute, uncomplicated diverticulitis can often be treated successfully with antibiotics alone and the decision to proceed with more aggressive measures such as surgical intervention is made on a case-by-case basis. The treatment algorithm for diverticular disease continues to evolve as the pathophysiology, etiology, and natural history of the disease becomes bet...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: John G. Touzios, Eric J. Dozois Source Type: journals

Fecal Incontinence in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Fecal incontinence affects up to 20% of community-dwelling adults and more than 50% of nursing home residents, and is one of the major risk factors for elderly persons in the nursing home. Institutionalization itself is a risk factor (eg, immobility due to physical restraints). Management should focus on identifying and treating underlying causes, such as diet- or medication induced diarrhea, constipation, and fecal impaction. Use of absorbent pads and special undergarments is useful. Anorectal physiologic testing of nursing home residents has revealed an association between constipation, stool retention, and fecal inconti...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Felix W. Leung, Satish S.C. Rao Source Type: journals

Diarrhea and Malabsorption in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the impact of diarrhea in the elderly, many of whom are less fit physiologically to withstand the effect of diarrhea on fluid balance and nutritional balance. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Lawrence R. Schiller Source Type: journals

Chronic Constipation in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Chronic constipation is a common problem in the elderly, with a variety of causes, including pelvic floor dysfunction, medication effects, and numerous age-specific conditions. A stepwise diagnostic and therapeutic approach to patients with chronic constipation based on historical and physical examination features is recommended. Prudent use of fiber supplements and laxative agents may be helpful for many patients. Based on their capabilities, patients with pelvic floor dysfunction should be considered for pelvic floor rehabilitation (biofeedback), although efficacy in the elderly is uncertain. Clinical awareness and focus...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Ernest P. Bouras, Eric G. Tangalos Source Type: journals

Inflammatory Bowel Disease in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the epidemiology, clinical manifestations, diagnosis, prognosis, and treatment of inflammatory bowel disease (IBD), which will grow in prevalence as the population ages. Prognosis of late-onset ulcerative colitis (UC) is generally similar to that of early-onset UC, whereas in Crohn disease it is probably better because of a tendency for colonic involvement. Disease complications are related more to the duration of the inflammatory bowel disease than the subject's current age. The diagnosis in elderly patients can be challenging due to the large number of conditions that mimic IBD on radiologic, endosco...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Michael F. Picco, John R. Cangemi Source Type: journals

Celiac Disease in the ElderlyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It has become apparent recently that celiac disease, once believed to be primarily a childhood disease, can affect people of any age. Epidemiologic studies have suggested that a substantial portion of patients are diagnosed after the age of 50. Indeed, in one study, the median age at the diagnosis was just under the age of 50 with one-third of new patients diagnosed being older than 65 years. The purpose of this review is to address the prevalence, clinical features, diagnosis, and consequences of celiac disease in the elderly. The authors also review management strategies for celiac disease and adjust these with emphasis ...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Shadi Rashtak, Joseph A. Murray Source Type: journals

Oropharyngeal DysphagiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although the aging process per se can produce measurable changes in the normal oropharyngeal swallow, these changes alone are rarely sufficient to cause clinically apparent dysphagia. The causes of oropharyngeal dysphagia in the elderly are predominantly neuromyogenic, with the most common cause being stroke. The evaluation of oropharyngeal dysphagia in the elderly involves early exclusion of structural abnormalities, detection of aspiration by videofluoroscopy which might dictate early introduction of nonoral feeding, and exclusion of underlying systemic and neuromyogenic causes that have specific therapies in their own r...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Ian J. Cook Source Type: journals

Undernutrition and Anorexia in the Older PersonEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article provides a brief overview of the prevalence and consequences of undernutrition, age-related changes to appetite, food intake, and body composition, the factors contributing to the development of anorexia and undernutrition, and recommended management strategies. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Renuka Visvanathan, Ian McPhee Chapman Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This issue of the Gastroenterology Clinics of North America devoted to gastroenterology in the elderly is timely and important, because the evidence is overwhelming: the demographics of the population in the United States and worldwide are rapidly changing, with a growing proportion of older people. With this change will come an accentuation of many clinical disease states. Baby boomers have just started to retire; by the year 2030, there will be 27 million people aged 65 years and older in the United States. Their maladies, along with their desire to stay young and healthy, create a tension that only intensifies with each...
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Authors: Nicholas J. Talley, Eric G. Tangalos Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - August 22, 2009 Category: Gastroenterology Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Source Type: journals

Differences in Peptic Ulcer Between the East and the WestEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Despite improved understanding of peptic ulcer disease (PUD) pathogenesis, advances in diagnostic modalities, and the availability of modern pharmalogical, endoscopic and surgical treatments, gastroduodenal ulcer remains a major cause of morbidity and mortality worldwide. The predominant risk factors of this disorder remain Helicobacter pylori and ulcerogenic drugs. However, the proportion of idiopathic PUD is increasing worldwide often coinciding with the declining prevalence of H pylori infection. PUD heterogeneity worldwide is due to host genetic, bacterial and environmental factors. Variable ages in the acquisition of ...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Rupert W. Leong Source Type: journals

Helicobacter pylori-Negative Nonsteroidal Anti-Inflammatory Drug-Negative UlcerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A vast majority of ulcers of the stomach and duodenum are due to H pylori infection or nonsteroidal anti-inflammatory drug (NSAID) usage. In patients with apparent H pylori negative NSAID negative ulcers, it is essential to ensure that the H pylori tests are not falsely negative and that the patient is not taking mucosal damaging drugs unknowingly. There are a variety of rare causes of true H pylori negative NSAID negative ulcers which need to be considered, including underlying cancer/lymphoma, Crohn's disease, rare infections and the Zollinger Ellison syndrome. Patients with idiopathic ulcers should be maintained on prot...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Kenneth E.L. McColl Source Type: journals

Nonsteroidal Anti-Inflammatory Drugs and Lower Gastrointestinal ComplicationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Nonsteroidal anti-inflammatory drug (NSAID)-associated intestinal damage to the small and/or large bowel is frequent and may be present in up to 60% to 70% of patients taking these drugs long term. Intestinal damage is subclinical in most cases (eg, increased mucosal permeability, inflammation, erosions, ulceration), but more serious clinical outcomes, such as anemia and overall bleeding, perforation, obstruction, diverticulitis, and deaths, have also been described. Recent data suggest that serious lower gastrointestinal (GI) clinical events linked to NSAID use may be as frequent and severe as upper GI complications. Trea...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Angel Lanas, Federico Sopeña Source Type: journals

Prevention of Nonsteroidal Anti-Inflammatory Drug-Induced Ulcer: Looking to the FutureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for treatment of pain and inflammation, despite their association with gastrointestinal complications, including bleeding and perforation. Inhibition of cyclooxygenases (COXs), is the main mechanism of action of aspirin and NSAIDs. Inhibition of COX-1 derived prostanoids in the stomach represent the underlying mechanism involved in development of gastric and duodenal ulcers in patients taking NSAIDs. Selective COX-2 inhibitors (coxibs) spare the gastrointestinal tract, but their use increases the risk of heart attack and stroke. In addition to prostanoids,...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Stefano Fiorucci Source Type: journals

Balancing Risks and Benefits of Cyclooxygenase-2 Selective Nonsteroidal Anti-Inflammatory DrugsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The recognition that nonsteroidal anti-inflammatory drugs (NSAIDs) increase not only gastrointestinal (GI) but cardiovascular (CV) adverse events as well has created a dilemma for practicing physicians. Clinicians selecting appropriate NSAID therapy must estimate each patient's baseline risk for both (GI) and (CV) adverse events, and then estimate the impact of each medication (and its dose) for the individual patient. To synthesize a rational current treatment approach, we have developed a 2×2 table to guide NSAID medication choice, considering the use of concomitant aspirin as well as gastroprotective therapy. COX-2 inh...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: James M. Scheiman Source Type: journals

Management of Patients with High Gastrointestinal Risk on Antiplatelet TherapyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Increasing use of antiplatelet therapies is associated with increasing GI complications, such as ulceration and GI bleeding. Identification of high-risk patients and, in such patients, incorporation of strategies to reduce their GI risk would be clinically prudent. After assessment and treatment of H pylori in patients with prior ulcer or GI bleeding histories, further reduction in GI risk in other high-risk patients who require antiplatelet agents is primarily accomplished by prescribing drugs that when coadministered with antiplatelet agents protect against mucosal ulceration, primarily proton pump inhibitors (PPIs). How...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Byron Cryer Source Type: journals

Refractory Peptic Ulcer DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Refractory peptic ulcer disease (PUD) manifests as either hemorrhagic complications (persistent or recurrent bleeding) or gastrointestinal (GI) complications (perforation, stricture, obstruction). Treatment strategies for hemorrhagic complications include Endoscopic therapy, surgery, and transcatheter angiographic embolization. Treatment strategies for GI complications include endoscopic dilation for stricture and surgery for perforation and obstruction. Potential etiologies of persistent or worsening PUD must be considered in these cases and include the following: patient risk factors and noncompliance, persistent Helicob...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Lena Napolitano Source Type: journals

Stress-Induced Ulcer Bleeding in Critically Ill PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the epidemiology, pathogenesis, risk factors, and management of stressrelated bleeding. The various prophylactic agents should be used judiciously to prevent unwanted drug side effects. Standard algorithms for critically ill patients are needed to identify those at high risk and to delineate criteria for the use of prophylactic therapeutic options in these patients. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Tauseef Ali, Richard F. Harty Source Type: journals

Management of Massive Peptic Ulcer BleedingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Managing massive bleeding from a peptic ulcer remains a challenge, and it should involve a multidisciplinary team. Endoscopy is the first-line treatment. Even with larger ulcers, endoscopic hemostasis can be achieved in the majority of cases. Surgery is clearly indicated in patients in whom arterial bleeding cannot be controlled at endoscopy. Angiographic embolization is an alternate option, particularly in those unfit for surgery. In selected patients judged to belong to the high-risk group, a more aggressive postendoscopy management is warranted. The role of early elective surgery or angiographic embolization in selected...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Frances K.Y. Cheung, James Y.W. Lau Source Type: journals

Predicting Poor Outcome from Acute Upper Gastrointestinal HemorrhageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Acute upper gastrointestinal (GI) hemorrhage is one of the commonest causes for hospitalization worldwide. Endoscopic therapy is effective in achieving primary hemostasis. The shift of management from the operating theater to the endoscopy suite has not changed the rate of mortality over the past 20 years. Several hypotheses are discussed that may account for the lack of improvement in the mortality resulting from bleeding peptic ulcer. One potential way to improve management is to identify those at risk for adverse outcomes, which may improve the initial triage, timing of primary endoscopic hemostasis, and postendoscopic ...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Philip W.Y. Chiu, Enders K.W. Ng Source Type: journals

The Role of Proton Pump Inhibitors in the Management of Upper Gastrointestinal BleedingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarizes and appraises the evidence from randomized controlled trials (RCT) and meta-analyses of RCTs on the role of proton pump inhibitors (PPIs) in non-variceal upper gastrointestinal bleeding, with a specific emphasis on peptic ulcer bleeding. PPIs have an established role in the management of endoscopically documented peptic ulcer bleeding. PPIs, compared with H2-receptor antagonists or placebo, consistently reduce re-bleeding rates. All-cause mortality is reduced in patients with high risk endoscopic signs and in Asian populations. The optimal dose and route of PPI administration in peptic ulcer bleedin...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Grigorios I. Leontiadis, Colin W. Howden Source Type: journals

Preface: Peptic Ulcer DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This issue provides an extensive overview of recently published literature on peptic ulcer disease that differ in many respects from the previous issue of the Gastroenterology Clinics of North America. A collection of authorities in the field has been assembled to provide focused overviews of new scientific information in key areas. The series begins with an overview of the role of proton-pump inhibitor in the management of upper gastrointestinal bleeding. Controversial issues like pre-endoscopic administration of proton-pump inhibitor and the impact of proton-pump inhibitor therapy on mortality are discussed. Recurrent bl...
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Authors: Francis K.L. Chan Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - May 19, 2009 Category: Gastroenterology Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - March 1, 2009 Category: Gastroenterology Source Type: journals

Future Developments in Esophageal Cancer ResearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The progress that has been made against esophageal carcinoma is limited. Many relevant issues remain. Herein the author discusses his outlook for the treatment of this disease, which has a steadily rising incidence. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - March 1, 2009 Category: Gastroenterology Authors: Jaffer A. Ajani Source Type: journals

Esophagectomy for the Treatment of Esophageal CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Esophageal cancer is an aggressive disease with an overall poor prognosis. Esophagectomy remains a key therapeutic option in treating patients who have this disease. Tailoring the surgical approach to the patient and the nature of his or her malignancy is essential. Over time, advances in staging, preoperative assessment, operative techniques, and postoperative care have resulted in decreased operative mortality and better long-term outcomes. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - March 1, 2009 Category: Gastroenterology Authors: Sandra Tomaszek, Stephen D. Cassivi Source Type: journals

Traditional Chinese Medicinal Herbs in the Treatment of Patients with Esophageal Cancer: A Systematic ReviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Traditional Chinese medicines are sometimes used as an adjunct to radiotherapy or chemotherapy for esophageal cancer. These medicines may have a benefit on the survival and quality of life of patients who have advanced esophageal cancer. Evidence from current studies appears weak due to methodological limitations. Due to conflicting reports, it is difficult to argue for or against the use of traditional Chinese medicines as a treatment for esophageal cancer. (Source: Gastroenterology Clinics of North America)
Source: Gastroenterology Clinics of North America - March 1, 2009 Category: Gastroenterology Authors: Taixiang Wu, Xunzhe Yang, Xiaoxi Zeng, Guy D. Eslick Source Type: journals

Preoperative Therapy for Esophageal CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article examines the role of combined-modality therapy for treating locally advanced esophageal cancer. Although surgery remains a cornerstone of treatment, recent studies have demonstrated that pre- or perioperative chemotherapy is associated with improved survival for patients who have adenocarcinoma histology. Primary chemoradiotherapy is the accepted standard of care for medically inoperable patients. Recent studies also suggest that definitive chemoradiotherapy is acceptable for patients who have squamous histology, while subsequent surgery improves local control without conferring a clear survival benefit. Neoad...
Source: Gastroenterology Clinics of North America - March 1, 2009 Category: Gastroenterology Authors: Geoffrey Y. Ku, David H. Ilson Source Type: journals

New Treatments, New Challenges: Pathology's Perspective on Esophageal CarcinomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
While frank esophageal carcinoma rarely presents a diagnostic challenge, early lesions are often tricky to assess. This difficulty stems in part from drawbacks in the classification systems designed to stratify early lesions as a guide for deciding treatment. These systems are complex and wrought with specific pathologic challenges brought on by new treatment modalities. Such interventions as endoscopic mucosal resection, photodynamic therapy, and chemotherapy/radiation combinations present the pathologist with new histologic challenges that have a direct impact on patient care. In this article, we discuss staging issues p...
Source: Gastroenterology Clinics of North America - March 1, 2009 Category: Gastroenterology Authors: Jennifer R. Scudiere, Elizabeth A. Montgomery Source Type: journals